I had a similar problem (matched advanced position but not for PGY1). There is usually some way you can find a first year. While there may not be many "official" TYs or prelim IM years out there, you should be able to find a spot of some sort. What will happen: at a certain time on scramble day, a list is released with unfilled programs. You call around to find a spot. You will need access to the internet, long distance phone line, and fax (to send and receive contracts). Start with the official programs, but also look for IM, surgery, or FP (if your advanced position allows FP first year, which many will grudgingly do) programs that are unfilled. Some of these will agree to a one year contract just to have a warm body in the intern class. You should be able to secure something. Best of luck - I know how stressful this is (and yes, I did get a PGY1 spot, and am happily into my residency - it can be done).