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I’m so sorry. I’m going to give you some tough love.
You are applying to what has become one of that most competitive specialties in the US.
As an international graduate, programs are looking for you to have superior scores to your American medical school graduate peers. Your 2 consecutive low scores on the USMLE will make program directors worried that you will not pass your ABA board exams, which will hurt their programs’ standing (they are judged in part by their boards pass rate).
The fact that these lower USMLE’s are not offset by an above average GPA is strike 2.

After not matching x2, PD’s worry more that previous PD’s are onto something.

I would seriously consider whether you can be happy in another specialty and at least dusl apply in the next round.

I’m sorry this hurts but I also want you to be able to get your life started and enjoy some career success. This is radical candor. I wish you well.
 
If you’re in the lowest quartile of your class, an IMG, and have step scores 30+ points below the average, anesthesiology is not going to work for you. Two match cycles have told you exactly what you need to know. It is past time to move on. No letters of rec or research papers will fix the underlying issue.
The three issues I mentioned are the source of your problem and are not fixable.
An advisor should have told you this long ago.
Not trying to be mean, but I didn’t get to be a dermatologist or orthopedic surgeon for the exact same reasons. You have to have insight to know what specialties you are competitive for. With those scores and now this NRMP history, you need to seriously consider if you can get a spot in anything so that your years of medical school don’t become a waste, with a bunch of med school debt and no way to pay it back.
 
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Do another specialty. You may actually like it. Or at least gives u an opportunity to switch over to anesthesia

Have you even done a pgy-1 year? That’s the biggest obstacle to it.
 
anesthesiadoc said:
I’m so sorry. I’m going to give you some tough love.
You are applying to what has become one of that most competitive specialties in the US.
As an international graduate, programs are looking for you to have superior scores to your American medical school graduate peers. Your 2 consecutive low scores on the USMLE will make program directors worried that you will not pass your ABA board exams, which will hurt their programs’ standing (they are judged in part by their boards pass rate).
The fact that these lower USMLE’s are not offset by an above average GPA is strike 2.

After not matching x2, PD’s worry more that previous PD’s are onto something.

I would seriously consider whether you can be happy in another specialty and at least dusl apply in the next round.

I’m sorry this hurts but I also want you to be able to get your life started and enjoy some career success. This is radical candor. I wish you well.
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No need to apologize for the tough love, that’s why I asked! Thanks 🙂
 
aneftp said:
Do another specialty. You may actually like it. Or at least gives u an opportunity to switch over to anesthesia

Have you even done a pgy-1 year? That’s the biggest obstacle to it.
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Not yet. I’ve been less successful with getting into internal medicine. Trying to focus on postings on residentswap for the time being
 
I would do an EM residency and then consider a pain fellowship, both of which have steadily decreased in level of competition but have good lifestyle potential in the future
 
I think it will be an uphill battle for various reasons. Of note, you have plenty of ways to become a crit care doc if you want. You can do IM to pulm/crit, EM to crit care and if you like kids, peds to peds icu and neuro to neuro crit care are some of the options you have. Obviously you won’t be working in the OR but other aspects may be somewhat similar (depends on who you ask). I do believe that hard work pays off and I think it’s about how much you are committed into this.

I agree with above statements that no matter how many papers you publish and present at the conference, your board scores are subpar for the specialty. Also, most PDs know how to read between lines on reference letters, so you may think you have a stellar letter when it’s just an average letter (not saying it is but it could be). If the PD can write a such a good letter, perhaps he/she may be able to reach out to other PDs personally and vouch for you.
 
MouseAnesthesiologist said:
With current updates of additional publications and becoming a board member of a non-profit, would this increase chances for anesthesia or is it time to really consider other specialities?
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The publications will help some if you're a first author if it's in a journal people have heard of, the board member of a non-profit is not going to make a big difference but gives you something to talk about during an interview.

MouseAnesthesiologist said:
2025 received 2 interviews in anesthesia (from not home institution)
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That seems like a surprisingly low number of interviews. It seems like you're being auto sorted out due either board scores or grades or something else? Have you asked the PD and Chair letter writers for candid feedback on what you can work on (if anything)? Why is your home institution not interviewing you? I've interviewed for residency and fellowship programs and if you had a compelling interview and package otherwise I would think you should have a decent shot at something.

Are you not considering Aus/NZ?
 
Agast said:
I would do an EM residency and then consider a pain fellowship, both of which have steadily decreased in level of competition but have good lifestyle potential in the future
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PAC2DO said:
I think it will be an uphill battle for various reasons. Of note, you have plenty of ways to become a crit care doc if you want. You can do IM to pulm/crit, EM to crit care and if you like kids, peds to peds icu and neuro to neuro crit care are some of the options you have. Obviously you won’t be working in the OR but other aspects may be somewhat similar (depends on who you ask). I do believe that hard work pays off and I think it’s about how much you are committed into this.

I agree with above statements that no matter how many papers you publish and present at the conference, your board scores are subpar for the specialty. Also, most PDs know how to read between lines on reference letters, so you may think you have a stellar letter when it’s just an average letter (not saying it is but it could be). If the PD can write a such a good letter, perhaps he/she may be able to reach out to other PDs personally and vouch for you.
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I totally agree with you, I was weary too. I’ve actually gotten the chance to read them
kidthor said:
The publications will help some if you're a first author if it's in a journal people have heard of, the board member of a non-profit is not going to make a big difference but gives you something to talk about during an interview.


That seems like a surprisingly low number of interviews. It seems like you're being auto sorted out due either board scores or grades or something else? Have you asked the PD and Chair letter writers for candid feedback on what you can work on (if anything)? Why is your home institution not interviewing you? I've interviewed for residency and fellowship programs and if you had a compelling interview and package otherwise I would think you should have a decent shot at something.

Are you not considering Aus/NZ?
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the journals would be both British journal of anesthesia and journal of biomolecules.

Funny enough, I directly used the phrase “candid feedback” when I chatted with my letter writers again. And they said that ultimately it was that I previously didn’t match that was the biggest issue with my app. But also suggested a prelim year. But I’m worried that my app leans way too heavy into anesthesia for other programs to really want me.

Not sure why home institute didn’t interview me. I found it surprising too - the PD that wrote my letter wasn’t from anesthesia but rather from a combined anesthesia program. Considering the letters I had, I thought that I’d get an interview. The interviews I did get were from Oschner and Yale

I’ve considered Aus/nz. But decided against it due to distance from family.
 
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PAC2DO said:
I think it will be an uphill battle for various reasons. Of note, you have plenty of ways to become a crit care doc if you want. You can do IM to pulm/crit, EM to crit care and if you like kids, peds to peds icu and neuro to neuro crit care are some of the options you have. Obviously you won’t be working in the OR but other aspects may be somewhat similar (depends on who you ask). I do believe that hard work pays off and I think it’s about how much you are committed into this.

I agree with above statements that no matter how many papers you publish and present at the conference, your board scores are subpar for the specialty. Also, most PDs know how to read between lines on reference letters, so you may think you have a stellar letter when it’s just an average letter (not saying it is but it could be). If the PD can write a such a good letter, perhaps he/she may be able to reach out to other PDs personally and vouch for you.
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Thank you for the really thoughtful advice! I actually became interested in anesthesia due to crit care.

As for the letters, I was pretty skeptical too if they were good or not. I got the opportunity to read them though because of applying to outside of Match residency options and felt like it was a legit strong letter. Spoke mainly to dedication curiosity and personality
 
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MouseAnesthesiologist said:
I totally agree with you, I was weary too. I’ve actually gotten the chance to read them

the journals would be both British journal of anesthesia and journal of biomolecules.

Funny enough, I directly used the phrase “candid feedback” when I chatted with my letter writers again. And they said that ultimately it was that I previously didn’t match that was the biggest issue with my app. But also suggested a prelim year. But I’m worried that my app leans way too heavy into anesthesia for other programs to really want me.

Not sure why home institute didn’t interview me. I found it surprising too - the PD that wrote my letter wasn’t from anesthesia but rather from a combined anesthesia program. Considering the letters I had, I thought that I’d get an interview. The interviews I did get were from Oschner and Yale

I’ve considered Aus/nz. But decided against it due to distance from family.
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The fact that your home program didn’t interview you, despite doing a research year with the faculty there, is a huge red flag.

Even if your app isn’t competitive; they should have at least given you a courtesy interview.

There’s something glaring in your app that your advisors haven’t told you. Maybe one of your letters has a “read-between-the-lines” disapproval. If I were you, I would reach out to several of the external programs that you applied to.. and ask for a candid feedback about your app. The PD at one of these programs may be able to tell you what your letter writers are too afraid to..
 
I'm just blown away by the fact that we're turning people away these days. When I wanted an anesthesia residency, I just kicked in the program director's door and asked when do I start. Nowadays you have to develop another inhalation agent and that may not be enough.
 
MouseAnesthesiologist said:
Hi all!

I was hoping for some advice because I’m a bit stuck….I didn’t match this cycle - this being my second time applying to anesthesia. I’m having some issues on figuring out how to proceed from here because my application has been heavily anesthesia focused which I fear may be a turn off for other areas of medicine. But anesthesia has been (and still is) my ultimate goal.

About me:
  • US IMG - Graduated from University of Queensland In Dec 2022
    • GPA on lower quartile but with strong narrative evaluations
    • Received an academic award 3rd year of medical school
  • Now T32 NIH Fellow under Chair of Anesthesia at major academic hospital
    • In progress of being first author on 3 papers and 4th on different paper (not on previous app)
      • 2 in Anesthesia
      • 1 review for viral myocarditis
    • Gave 2 poster presentations within anesthesia (basic science)
    • I’ve been able to shadow 2 attendings within anesthesia during this time to remain in a clinical environment.
  • USMLE Score: 1 pass, 2 221, 3 215 - I know these are on the low side.
  • Letters of Recommendation
    • 1 from Program Director in Anesthesia
    • 1 from Chair of Anesthesia
    • I know that these letters are very strong.
  • Applied to both 2023 and 2025 match
    • 2025 received 2 interviews in anesthesia (from not home institution)
  • Other notable background
    • 12 spots away for qualifying to Olympic team in 2010
    • Just became a board member for non-profit focused on US development of athletic talent in specific sport where other board members are former olympians (not on previous app)

Questions:

  1. I’ve been told that my time away from giving clinical care is becoming an increasingly bigger red flag, aside from a transition year, do you know of any other ways to get some clinical experience?
  2. Do vacancies within anesthesia typically open up post match or is it such a coveted position that residents tend to hold on to the position?
  3. With current updates of additional publications and becoming a board member of a non-profit, would this increase chances for anesthesia or is it time to really consider other specialities?
  4. My current plan has been to email all programs in US to give them my application in case any openings pop up, while also applying to any openings so that perhaps I can transfer to an advanced spot. Does this sound reasonable or wishful?
  5. Any other general advice or specific resources/people to point me to?
  6. Any advice on navigating post match hunting?

Thank you so much!!!!
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I would have applied to every program in the country this time around

I would have had a backup like IM already loaded into the system in case I did not match into anesthesia

A bit of bad timing for you with the surge in competitiveness now, in years past you would have likely gotten into some lower tier programs at least

Lots of IMGs out there with >90% board scores and they even struggle to get in sometimes.

That's just the way the system is set up here.

If your an IMG and you DONT have >90% board scores, in this competitive environment forget it.


I would try to get into a categorical IM program at a major university, ASAP.

Prove yourself in that program and open up doors for matching into a great IM fellowship, like Crit Care or Cards.

How long can you butt heads with the anesthesia thing? Going to waste another year on it? I would let it go, bad timing, don't let it further delay your otherwise great potential in another specialty
 
Agast said:
I would do an EM residency and then consider a pain fellowship, both of which have steadily decreased in level of competition but have good lifestyle potential in the future
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I’ll counter this and say only do EM if you have an interest in it. The social issues stuff can be horribly frustrating. Most places don’t do the big traumas so you professional life might be much more urgent care type stuff.

Consider IM from the sheer possibility of potential career paths - ICU to cardiology to allergy. Lots of diversity in potential careers. Add in there are LOTS of IM programs (aka spots) and your chance of matching is higher.

You don’t have a shot at matching to Anesthesiology right now because of the desirability of the speciality among medical students. But, I have known a bunch of people who have finished IM and then gone into Anesthesia, including current residents. So there is a chance (small but it does exist). I personally have never met someone who went EM->Anes.
 
CopaceticOne said:
I’ll counter this and say only do EM if you have an interest in it. The social issues stuff can be horribly frustrating. Most places don’t do the big traumas so you professional life might be much more urgent care type stuff.

Consider IM from the sheer possibility of potential career paths - ICU to cardiology to allergy. Lots of diversity in potential careers. Add in there are LOTS of IM programs (aka spots) and your chance of matching is higher.

You don’t have a shot at matching to Anesthesiology right now because of the desirability of the speciality among medical students. But, I have known a bunch of people who have finished IM and then gone into Anesthesia, including current residents. So there is a chance (small but it does exist). I personally have never met someone who went EM->Anes.
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OP needs to get anything they can get at this point.

Just to get a full unrestricted medical license in most states requires 1 year of medical residency training
 
aneftp said:
OP needs to get anything they can get at this point.

Just to get a full unrestricted medical license in most states requires 1 year of medical residency training
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I agree with needing to get a spot. But the dread from a job you hate cannot be underestimated. That is why I suggested IM, lots of spots and programs that are dependent on non-USMGs.
 
Hoya11 said:
I would have applied to every program in the country this time around

I would have had a backup like IM already loaded into the system in case I did not match into anesthesia

A bit of bad timing for you with the surge in competitiveness now, in years past you would have likely gotten into some lower tier programs at least

Lots of IMGs out there with >90% board scores and they even struggle to get in sometimes.

That's just the way the system is set up here.

If your an IMG and you DONT have >90% board scores, in this competitive environment forget it.


I would try to get into a categorical IM program at a major university, ASAP.

Prove yourself in that program and open up doors for matching into a great IM fellowship, like Crit Care or Cards.

How long can you butt heads with the anesthesia thing? Going to waste another year on it? I would let it go, bad timing, don't let it further delay your otherwise great potential in another speci
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Would you have any advice for doing that at this point in the cycle? Would emailing PD asking for any open spots be the way to go or wait until next cycle? Thanks!!
 
NicholasPavona said:
I'm just blown away by the fact that we're turning people away these days. When I wanted an anesthesia residency, I just kicked in the program director's door and asked when do I start. Nowadays you have to develop another inhalation agent and that may not be enough.
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I know of a program that historically only filled with DOs and IMGs that now has a class full of USMDs from good schools.
 
CopaceticOne said:
I agree with needing to get a spot. But the dread from a job you hate cannot be underestimated. That is why I suggested IM, lots of spots and programs that are dependent on non-USMGs.
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This is so true. Both inside and outside of medicine people often pick a career based on the wrong things. Showing up to work everyday for a career/place you hate is just never worth it.

IM is absolutely a good fallback option. I enjoyed living the quasi hospitalist life by the end of intern year and could picture it being fun. I felt a little sad to leave it once I went onto anesthesia rotations. Plus, as you said, a ton of a fellowship options (anywhere from critical care to clinical informatics).

Don't rule out PM&R either. It incorporates the joy of not really having to take proper call...
 
MouseAnesthesiologist said:
1. Hold a candlelight vigil for the end of the anesthesia dream
2. Contact PD and outside PD for candid feedback
3. See wherever has openings in any area and see what shakes out.

Thanks everybody for the advice!
-B
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Please don't delete your posts after you get an answer. The point of a forum is so that other people with similar issues can also learn from your experience and the forum's responses.
 
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