The programs in scramble try to fill their unfilled spots as soon as they can. The programs receive hundreds of applications in the first few minutes and want to close this door fast. They dont know if you applied for pathology or IM and they dont care. If the program finds the suitable candidate he will offer him the position immediately and update the ERAS that the position already filled. One of the problems are the LORs which usually recommend to one direction or another for example, if the letters point out that you will be good in laboratory medicine will not work for prelim and so on unless you have many LORs which cover many fields. Because of that the ERAS recommend the LORs to be general, from my opinion, this is not working. The faculty who recommend you will be from one specialty and the program have no time in scramble to read all the LORs, they will look for who write this to screen the applicants. In scramble the unmatched candidate has 30 free programs to apply, he should pick any ones he is qualified to with the required criteria and LORs.
All what I wrote is my personal feeling and speculation to the process but for sure every program deals with it differently.
Friend of mine did not match and in the same medical school we are in, there were 5 unfilled position in very uncompetitive filed. I went with him physically, in the first 30 minutes of scramble, to meet the PD who we know him well. You cant imagine, we found tens of candidates and/or their representative came personally with their papers to meet the PD asking for a position. After about 30 minutes or so waiting, the coordinator meets us and took the papers and thanks us for coming and no position offered.
