Went unmatched in family med. Any advice for next time?

[WantToBeFamMed]

I am sharing my situation in search for any advice anyone here may offer me for my situation, that they feel may I should know in order to help me match this year. I am open to hearing and considering any and all ideas, feedback, strategies, etc, that people may feel could be useful for me. Is there anything else I am missing or should be doing, or an experience I should be participating in now that I am not? Anything I can add to my application that would be especially beneficial for someone in my specific situation?

I am a U.S. citizen, attended a U.S. allopathic medical school. I have multiple red flags on my application, so applied to 20 programs in Family Medicine last year, 17 in my home state and its bordering states, was offered 7 interviews at mostly highly-to-moderately competitive programs, of which I took all and ranked all. I took the often heard advice of rank your favorite programs at the top, which for me happened to be the most competitive programs. In hindsight I think I should have weighed more heavily my individual situation of my low competitiveness, and personally believe I likely would have matched if I had ranked the less competitive programs at the top. Participated in SOAP with no luck. Naturally I am a quiet and reserved person, humble, friendly and easy-going. I felt my interviews generally seemed to go well, for the most part going smoothly, comfortably, and relaxed.

The negatives on my application, and my corresponding explanations for them:
-DUI 7 years ago, occurred 1 month after getting accepted to medical school and approximately 9 months prior to beginning my courses. I was 22 years old at the time and made poor decisions with irresponsible drinking habits typical of an undergraduate kid, learned from mistake, and am now 28 and a much different, more mature person without irresponsible drinking habits.
-poor grades in first two basic science years, failed two consecutive courses during 2nd year and was forced by the school to take a one year leave of absence to reflect on my struggles before returning to complete 2nd year. I take responsibility for this, as I entered medical school without developed study habits, due to largely succeeding in high school and college only due to natural mental aptitude. Was admitted to medical school with only a 3.4 undergraduate GPA thanks largely to a 36 MCAT. Initially I had also not yet developed the maturity and responsibility necessary for a commitment such as medical school. As a result of all this I struggled to transition to the demands.
-Step 1: 172, 187, 206. Due to poor performance during basic science years.
-Step 2 CK: 201.
-CS: Pass.
-One clerkship fail in my first core required clerkship, Internal Medicine, due to lack of group participation and tentativeness to ask questions and offer answers with team (I was suffering from lack of confidence as this was immediately following my 172 Step 1 score report). Later successfully remediated. No other clerkship struggles.

Positives:
-I have long shown strong commitment and interest to rural broad-spectrum Family Medicine.
-My academic performance in courses and clerkships immediately improved dramatically since returning from my leave of absence in 2nd year to present. My 3rd & 4th year clerkship performance, including grades, clerkship test performance, and evaluations have largely been consistently positive.

Since not matching, I have actively sought out and received a lot of feedback and advising. From April-June I have worked part-time on a research project with my school's family medicine clinical research dept, and will be getting a LoR from the physician leading the study that I helped work on. My medical school, in an effort to help its unmatched students, has offered the opportunity to extend my enrollment, with my official graduation date now pushed back to December. This is to allow me to continue to keep up my clinical skills and maintain recent direct clinical patient care experience as a medical student. Through this opportunity I will be enrolled in additional clerkships from July-October, and will plan to obtain more LoR's. Working around that, I will be TA'ing 1st year medical students this fall in the Anatomy cadaver lab and their course for physical exam skills. I will be attending the National Family Med conference in Kansas City at the end of the month to get to know programs. I have been advised to apply to somewhere along the lines of 50-100 programs this year instead of 20. Knowing who the unmatched programs were last year, I plan to focus my applications towards those programs as well as rural track programs.

Thank you for any help!

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[Winged Scapula]

I took the often heard advice of rank your favorite programs at the top, which for me happened to be the most competitive programs. In hindsight I think I should have weighed more heavily my individual situation of my low competitiveness, and personally believe I likely would have matched if I had ranked the less competitive programs at the top.

It sounds as if you don't understand how the match works.

Ranking more competitive programs at the top (because you preferred them) did NOT affect your chances of matching. If you don't match at the first program on your list, the iteration goes on to the next and so on, until you match (or don't).

Unfortunately, none of the programs on your list ranked you highly enough to match and that wouldn't have changed because of the order you ranked them.

Given your application, I'm surprised you weren't advised to apply to more programs. There are a lot of red flags; 17 programs is only slightly more than the average applicant applies to. This time you need to substantially increase the number of programs applied to.

 

[NotAProgDirector]

I am sharing my situation in search for any advice anyone here may offer me for my situation, that they feel may I should know in order to help me match this year. I am open to hearing and considering any and all ideas, feedback, strategies, etc, that people may feel could be useful for me. Is there anything else I am missing or should be doing, or an experience I should be participating in now that I am not? Anything I can add to my application that would be especially beneficial for someone in my specific situation?

I am a U.S. citizen, attended a U.S. allopathic medical school. I have multiple red flags on my application, so applied to 20 programs in Family Medicine last year, 17 in my home state and its bordering states, was offered 7 interviews at mostly highly-to-moderately competitive programs, of which I took all and ranked all. I took the often heard advice of rank your favorite programs at the top, which for me happened to be the most competitive programs. In hindsight I think I should have weighed more heavily my individual situation of my low competitiveness, and personally believe I likely would have matched if I had ranked the less competitive programs at the top. Participated in SOAP with no luck. Naturally I am a quiet and reserved person, humble, friendly and easy-going. I felt my interviews generally seemed to go well, for the most part going smoothly, comfortably, and relaxed.

I'll second what WS said above. The "good" news here is that you're completely wrong about the match. No matter what order you put your rank list in, you would not have matched. Although that's not good news, at least you shouldn't worry that you somehow messed this up with your rank list.

The negatives on my application, and my corresponding explanations for them:
-DUI 7 years ago, occurred 1 month after getting accepted to medical school and approximately 9 months prior to beginning my courses. I was 22 years old at the time and made poor decisions with irresponsible drinking habits typical of an undergraduate kid, learned from mistake, and am now 28 and a much different, more mature person without irresponsible drinking habits.

Nobody cares about this. It's in the past.

-poor grades in first two basic science years, failed two consecutive courses during 2nd year and was forced by the school to take a one year leave of absence to reflect on my struggles before returning to complete 2nd year. I take responsibility for this, as I entered medical school without developed study habits, due to largely succeeding in high school and college only due to natural mental aptitude. Was admitted to medical school with only a 3.4 undergraduate GPA thanks largely to a 36 MCAT. Initially I had also not yet developed the maturity and responsibility necessary for a commitment such as medical school. As a result of all this I struggled to transition to the demands.
-Step 1: 172, 187, 206. Due to poor performance during basic science years.
-Step 2 CK: 201.
-CS: Pass.

This is a big problem. You did very poorly in the first two years of medical school. One would think that failing multiple courses and being forced to take an LOA would have helped you understand how serious this was, but then you return and your performance remains poor with multiple Step 1 failures. You have a chance to prove you've improved on Step 2, and get an acceptable but unimpressive score -- it's better but well below the mean.

-One clerkship fail in my first core required clerkship, Internal Medicine, due to lack of group participation and tentativeness to ask questions and offer answers with team (I was suffering from lack of confidence as this was immediately following my 172 Step 1 score report). Later successfully remediated. No other clerkship struggles.

This is a HUGE red flag. You seem to classify this just like failing a course first year. Failing a clerkship is a really big deal.

Positives:
-I have long shown strong commitment and interest to rural broad-spectrum Family Medicine.

Not sure what this means, or how you would prove it, but sounds OK.

-My academic performance in courses and clerkships immediately improved dramatically since returning from my leave of absence in 2nd year to present. My 3rd & 4th year clerkship performance, including grades, clerkship test performance, and evaluations have largely been consistently positive.

Not really. If you believe this, that's part of the problem. You failed a clerkship. You failed Step 1 twice. All of that happened after you came back from your leave.

Since not matching, I have actively sought out and received a lot of feedback and advising. From April-June I have worked part-time on a research project with my school's family medicine clinical research dept, and will be getting a LoR from the physician leading the study that I helped work on. My medical school, in an effort to help its unmatched students, has offered the opportunity to extend my enrollment, with my official graduation date now pushed back to December. This is to allow me to continue to keep up my clinical skills and maintain recent direct clinical patient care experience as a medical student. Through this opportunity I will be enrolled in additional clerkships from July-October, and will plan to obtain more LoR's. Working around that, I will be TA'ing 1st year medical students this fall in the Anatomy cadaver lab and their course for physical exam skills. I will be attending the National Family Med conference in Kansas City at the end of the month to get to know programs. I have been advised to apply to somewhere along the lines of 50-100 programs this year instead of 20. Knowing who the unmatched programs were last year, I plan to focus my applications towards those programs as well as rural track programs.

Thank you for any help!

This sounds like a reasonable plan. The good news in your story is that despite all of your problems, you still got 7/20 interviews. As mentioned by WS, you need to go on many, many more interviews. Focusing on programs that didn't fill last year is a good idea. Focusing on geographically less desireable locations is a good idea. You really want to match this time, so plan on a much busier (and likely more expensive) interview season. You can also look for off cycle spots while interviewing -- if a program has an open spot and interviews you for the match, nothing stops them from starting you in January.

 

[WantToBeFamMed]

Thank you for the feedback, it certainly gives me some viewpoints to consider. Clearly the two of you are correct that I should have applied to many more programs. I feel I was unknowledgeable of just exactly how uncompetitive I was as a Family Medicine applicant. Though I considered it a very real possibility that I would not match based on my academic history, going into match week I had felt confident and optimistic that I had taken adequate steps necessary to match.

The two of you are probably right that I don't fully understand how the match works, and I assume you are correct. I read this last year and had thought it worked this way: http://www.nrmp.org/res_match/about_res/algorithms.html
This example led me to believe that the programs' rank list only played a factor among applicants who ranked the program in an equal position on their own respective ROLs (and of course whether programs ranked an applicant at all). That page seemed to suggest that if a program were to fill its final positions with applicants who ranked the program #3, that I (or anyone for that matter no matter how high up the program's rank list) would miss an opportunity to match there if I ranked it #4, but would have matched there before them if I had just ranked it #1 or #2 even if I were much farther down the program's rank list (assuming as long as the program had ranked me on their list at all). I was saying because that of my low competitiveness I should have ranked the way applicant Hassan did in that example rather than the way applicant Ford had. Regardless, it sounds that you two are saying the example on that page is misleading and I have been misinformed, and I take your word on that.

aPD, thank you for your honest opinions on my situation.
-1. I mention the DUI because I was asked directly about it probably 2-3 times during my interviews.
-2. Whether you see my academic performance as having not improved following my LoA, there has been a well-noted substantial change by faculty and administration in my motivation, commitment, work ethic, and study habits. I went from consistently scoring 65-75% (passing being 70%) on exams during my first 1.5 years prior to my leave, just passing my courses with final grades of 70-72% until my failures resulting in my leave. On my return I passed every exam of the remainder of 2nd year, including scoring the top and 2nd best scores in my class on a few individual exams. I believe I did so miserably with Step 1 because due to my early performance, I came out of 2nd year FAR behind my peers, and because of my recent improvement and success with the new material, I was ignorant and unappreciative of just how far behind them I was in my knowledge and mastering of the early material. I believe that where most of them probably a needed a few weeks of vigorous review to do well, in hindsight I feel I was in need of months and months of such studying to be on the same page. I passed SHELF exams in all of my 3rd and 4th year core clerkships on the 1st attempt, including in the initial Internal Medicine failure. I would have liked to have done better on Step 2, and probably could and should have. In an effort to secure a passing score for my application I took it what I felt was relatively early in relation to my classmates, in August heading into 4th year, without yet having gotten to my core OB/Gyn, Emergency Med, or 4th yr Internal Med Sub-I clerkships in my schedule. But perhaps you are correct and after all of my early struggles the improvements I made needed to be more substantial.
-3. I realize that the clerkship fail early in 3rd year is a large negative on my transcript, but given my Step 1 difficulty, my 2nd year leave of absence, and the DUI, I assumed it was far from the biggest red flag on my application. I was told that clerkship, 3rd yr Internal Med, has the highest failure rate of all our core rotations, with me getting the impression it was probably somewhere along the lines of 5+ % or so. I've also known of classmates with clerkships failures who've matched, including hearing that one classmate required 4 attempts at OB/Gyn after 3 failures (and matched). I understand that, their situations may be different, and along with the rest of my application it becomes even more meaningful as it can be interpreted as a repeating pattern.
-4. I'm glad to hear the steps I'm taking now seem to be appropriate.
-5. From my experience last interview season, it seems that approximately half of interviewers will not even bring up the topic of the negative areas of my application. I do not know if this is in order to make the applicant feel more relaxed, or I suppose more likely is to see how/if the applicant addresses the issues? During the first half of my interview season, I figured try to focus and draw attention to your positives and not your negatives, so I was perfectly content concluding those interviews without having discussed them. However about halfway through I felt this just didn't seem right, and if my struggles weren't brought up it may be better if I took my opportunity to explain them myself, and what I've learned from them. Any thoughts on this?
-6. If I interviewed with competitive programs last year, ranked them in positions such as #1, 2, or 3, and did not match, should I bother reapplying again? I can't rank them any better. If I applied to moderately-less competitive programs last year that did not offer me interviews, do I try applying again?

Thank you again, advice is very appreciated by me during this process.

 

[johhnybgood]

APd and winged scapula gave you some fantastic advice. It was astonishing that you got seven interviews with your history. However, even with all the previous shortcomings you should likely match this year. I would apply to 100 programs. Go on 20 interviews if needed. Rank them how do you like them, this is how the matching algorithm works. It favors the applicant. Good luck with the match and keep working hard.

 

[NotAProgDirector]

The two of you are probably right that I don't fully understand how the match works, and I assume you are correct. I read this last year and had thought it worked this way: http://www.nrmp.org/res_match/about_res/algorithms.html
This example led me to believe that the programs' rank list only played a factor among applicants who ranked the program in an equal position on their own respective ROLs (and of course whether programs ranked an applicant at all). That page seemed to suggest that if a program were to fill its final positions with applicants who ranked the program #3, that I (or anyone for that matter no matter how high up the program's rank list) would miss an opportunity to match there if I ranked it #4, but would have matched there before them if I had just ranked it #1 or #2 even if I were much farther down the program's rank list (assuming as long as the program had ranked me on their list at all). I was saying because that of my low competitiveness I should have ranked the way applicant Hassan did in that example rather than the way applicant Ford had. Regardless, it sounds that you two are saying the example on that page is misleading and I have been misinformed, and I take your word on that.

Let's not beat a dead horse. Your ranking had nothing to do with not matching. In the example on the NRMP site you reference, they point out that Hassan did a POOR job ranking programs, as he could have gotten into a better program had he ranked correctly. Don't do what Hassan did.

Another way of looking at it: Where you rank a program on your rank list has NOTHING to do with whether you will match or not. The only thing that matters is where they rank you on their list. (Note that your rank list has EVERYTHING to do with where you will match if you do match).

-1. I mention the DUI because I was asked directly about it probably 2-3 times during my interviews.

I wouldn't have expected that. But your experience suggests it may play a role.

-2. Whether you see my academic performance as having not improved following my LoA, there has been a well-noted substantial change by faculty and administration in my motivation, commitment, work ethic, and study habits. I went from consistently scoring 65-75% (passing being 70%) on exams during my first 1.5 years prior to my leave, just passing my courses with final grades of 70-72% until my failures resulting in my leave. On my return I passed every exam of the remainder of 2nd year, including scoring the top and 2nd best scores in my class on a few individual exams. I believe I did so miserably with Step 1 because due to my early performance, I came out of 2nd year FAR behind my peers, and because of my recent improvement and success with the new material, I was ignorant and unappreciative of just how far behind them I was in my knowledge and mastering of the early material. I believe that where most of them probably a needed a few weeks of vigorous review to do well, in hindsight I feel I was in need of months and months of such studying to be on the same page. I passed SHELF exams in all of my 3rd and 4th year core clerkships on the 1st attempt, including in the initial Internal Medicine failure. I would have liked to have done better on Step 2, and probably could and should have. In an effort to secure a passing score for my application I took it what I felt was relatively early in relation to my classmates, in August heading into 4th year, without yet having gotten to my core OB/Gyn, Emergency Med, or 4th yr Internal Med Sub-I clerkships in my schedule. But perhaps you are correct and after all of my early struggles the improvements I made needed to be more substantial.

If it's clear on your transcript that you did better in your 2nd year -- lots of "H"'s or whatever your school gives out for good performance, then you should make sure you talk about that.

My point is simply that, in situations like this, you'd like to prove that your problems are in the past and done with. Your record makes that difficult to state.

-3. I realize that the clerkship fail early in 3rd year is a large negative on my transcript, but given my Step 1 difficulty, my 2nd year leave of absence, and the DUI, I assumed it was far from the biggest red flag on my application. I was told that clerkship, 3rd yr Internal Med, has the highest failure rate of all our core rotations, with me getting the impression it was probably somewhere along the lines of 5+ % or so. I've also known of classmates with clerkships failures who've matched, including hearing that one classmate required 4 attempts at OB/Gyn after 3 failures (and matched). I understand that, their situations may be different, and along with the rest of my application it becomes even more meaningful as it can be interpreted as a repeating pattern.

As above, it unfortunately demonstrates a pattern of continued poor performance.

-5. From my experience last interview season, it seems that approximately half of interviewers will not even bring up the topic of the negative areas of my application. I do not know if this is in order to make the applicant feel more relaxed, or I suppose more likely is to see how/if the applicant addresses the issues? During the first half of my interview season, I figured try to focus and draw attention to your positives and not your negatives, so I was perfectly content concluding those interviews without having discussed them. However about halfway through I felt this just didn't seem right, and if my struggles weren't brought up it may be better if I took my opportunity to explain them myself, and what I've learned from them. Any thoughts on this?

There isn't a right or wrong answer here. My suggestion would be to bring it up. No one is going to miss this in your application. If your interviewers don't bring it up, it's because 1) they want to but are uncomfortable and don't know how to start; 2) they don't care about it; or 3) they want to see if you have insight into your issues, and one way to assess that is to see if you bring it up for discussion. So, yes, I would bring it up.

-6. If I interviewed with competitive programs last year, ranked them in positions such as #1, 2, or 3, and did not match, should I bother reapplying again? I can't rank them any better. If I applied to moderately-less competitive programs last year that did not offer me interviews, do I try applying again?

Also no easy answer. Again, the position of these programs on your rank list is meaningless for this discussion. The question is, if you interview with them again, can you try to get ranked higher than you were last year? Can you demonstrate further iprovement, etc. There's always the chance that you were just after the "last kid picked", and in that case being in the same position on the ROL and a bit of luck will get you matched. Programs that didn't interview you last year are unlikely to interview you this year, unless you've improved in some way. All that said, applying to programs is relatively inexpensive and you might just want to apply.

As mentioned above, the goal is 20-25 interviews. And you rank all of them.

And, again on that dead horse thing, you rank them IN THE ORDER THAT YOU LIKED THEM. Even if some program has "promised" you a spot, if it's your least fav program rank it #25. If you fail to match at your top 24, you will match at your #25 if they have ranked you high enough to match. You cannot lose a spot at a "sure thing" by ranking it lower on your rank list (except if you match somewhere higher on your rank list, but I don't consider that "losing" anything)

 

[rokshana]

well the fact that you got 7 interviews out of the 20 programs you applied to seems to say that some programs overlooked the red flags on your application. Since the order of which you ranked these programs most likely didn't effect your changes of matching, it seems that the programs either didn't rank you at all or ranked you really low...and IMHO, your interview may have been a contributing factor.

you may want to consider asking someone in the family program at your med school to do a mock interview with you and then give you feedback on what you are doing right and what you may be doing wrong...

also you may want to make an appointment with the PD (or one of the associate PDs) to see if they can go over your application and give you some advice about the programs that you should send your applications.

 

[Silent Cool]

I am sharing my situation in search for any advice anyone here may offer me for my situation, that they feel may I should know in order to help me match this year. I am open to hearing and considering any and all ideas, feedback, strategies, etc, that people may feel could be useful for me. Is there anything else I am missing or should be doing, or an experience I should be participating in now that I am not? Anything I can add to my application that would be especially beneficial for someone in my specific situation?

I am a U.S. citizen, attended a U.S. allopathic medical school. I have multiple red flags on my application, so applied to 20 programs in Family Medicine last year, 17 in my home state and its bordering states, was offered 7 interviews at mostly highly-to-moderately competitive programs, of which I took all and ranked all. I took the often heard advice of rank your favorite programs at the top, which for me happened to be the most competitive programs. In hindsight I think I should have weighed more heavily my individual situation of my low competitiveness, and personally believe I likely would have matched if I had ranked the less competitive programs at the top. Participated in SOAP with no luck. Naturally I am a quiet and reserved person, humble, friendly and easy-going. I felt my interviews generally seemed to go well, for the most part going smoothly, comfortably, and relaxed.

The negatives on my application, and my corresponding explanations for them:
-DUI 7 years ago, occurred 1 month after getting accepted to medical school and approximately 9 months prior to beginning my courses. I was 22 years old at the time and made poor decisions with irresponsible drinking habits typical of an undergraduate kid, learned from mistake, and am now 28 and a much different, more mature person without irresponsible drinking habits.
-poor grades in first two basic science years, failed two consecutive courses during 2nd year and was forced by the school to take a one year leave of absence to reflect on my struggles before returning to complete 2nd year. I take responsibility for this, as I entered medical school without developed study habits, due to largely succeeding in high school and college only due to natural mental aptitude. Was admitted to medical school with only a 3.4 undergraduate GPA thanks largely to a 36 MCAT. Initially I had also not yet developed the maturity and responsibility necessary for a commitment such as medical school. As a result of all this I struggled to transition to the demands.
-Step 1: 172, 187, 206. Due to poor performance during basic science years.
-Step 2 CK: 201.
-CS: Pass.
-One clerkship fail in my first core required clerkship, Internal Medicine, due to lack of group participation and tentativeness to ask questions and offer answers with team (I was suffering from lack of confidence as this was immediately following my 172 Step 1 score report). Later successfully remediated. No other clerkship struggles.

Positives:
-I have long shown strong commitment and interest to rural broad-spectrum Family Medicine.
-My academic performance in courses and clerkships immediately improved dramatically since returning from my leave of absence in 2nd year to present. My 3rd & 4th year clerkship performance, including grades, clerkship test performance, and evaluations have largely been consistently positive.

Since not matching, I have actively sought out and received a lot of feedback and advising. From April-June I have worked part-time on a research project with my school's family medicine clinical research dept, and will be getting a LoR from the physician leading the study that I helped work on. My medical school, in an effort to help its unmatched students, has offered the opportunity to extend my enrollment, with my official graduation date now pushed back to December. This is to allow me to continue to keep up my clinical skills and maintain recent direct clinical patient care experience as a medical student. Through this opportunity I will be enrolled in additional clerkships from July-October, and will plan to obtain more LoR's. Working around that, I will be TA'ing 1st year medical students this fall in the Anatomy cadaver lab and their course for physical exam skills. I will be attending the National Family Med conference in Kansas City at the end of the month to get to know programs. I have been advised to apply to somewhere along the lines of 50-100 programs this year instead of 20. Knowing who the unmatched programs were last year, I plan to focus my applications towards those programs as well as rural track programs.

Thank you for any help!

Problem: your academic record is terrible and is making it difficult for you to move forward.

Solution: apply to every ACGME family medicine program in the country. Rank all of them.
Apply to Psych as well. Attend every interview invite you get.

Problem solved.