What happens if you don't match in your preferred specialty?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

GH253

Membership Revoked
Removed
Account on Hold
10+ Year Member
Joined
Mar 19, 2009
Messages
885
Reaction score
148
Suppose you're dead set on a certain residency, but you don't match when it comes time. Do you have any recourse then? Such as staying in med school for another year, then reapplying the following year? Or do you have to start another residency and then hope to switch at a later date?

Members don't see this ad.
 
Then you're screwed. You'll probably have to scramble into a specialty like medicine or family practice which usually don't fill all of their spots, and you won't get a prime location.

Or you can apply for two specialties, one competitive and one non-competitive.
 
Can you get a research job or something and apply again the next cycle or will you have an even lower shot next time through?
 
Members don't see this ad :)
Getting in a year of research might make you more attractive to some programs. You can reapply the next year through the NRMP. But if you didn't match due to low board scores, an unenthusiastic dean's letter, or a poor showing in the clinical years, you are in a difficult place as these components of your application can't be done over, so enhancing your ECs is really the only thing you might do to make yourself more competitive, along with, maybe, better LORs.
 
Can someone explain how the preliminary year thing works? This is my understanding: let's say I'm interested in anesthesia. I apply for categorical anesthesia programs in the match. If I don't get into any of these, I can do a medicine or surgery preliminary year somewhere then reapply for an anesthesia program the next year. Is this actually how it works?
 
From this old article on matching into derm: http://www.studentdoctor.net/2009/10/the-successful-match-getting-into-dermatology/

"In 2007, out of 407 U.S. seniors applying to dermatology, 158 failed to match (39% of U.S. senior applicants).7 Applicants who fail to match often wish to reapply the following year. What can these applicants do to strengthen their application?
There are certainly a number of dermatology fellowships out there. It's been documented that applicants who complete these fellowships have a higher match rate the second time around. I think that's probably because you get to know the director well, and since they know how you work and how you produce results, they can write you a better letter of recommendation. I've also seen some individuals plan to do degree-producing programs, such as a Masters of Public Health, or a program with a focus in biostatistics or epidemiology.
There are certain objective measures that can't be changed. You can't change the Dean's letter, you can't change your board scores, and you can't be AOA the second time around. However, you can publish and get new letters of recommendation. These are ways to strengthen your application.


Some applicants who fail to match pursue a pre-residency dermatology fellowship. In a recent survey of fellowship directors, it was learned that 92% of past fellows (176/190) were able to match successfully following completion of the fellowship.8 How can applicants make the most of these fellowships?

Most of these fellowships are directed by individuals that are fairly well-known in their specialty. A letter of recommendation from a faculty member that spent months, or sometimes a year, with an applicant is a very valuable resource. That's going to be more information than the prior application, and the letter writer is able to be very rich in their detail about what supports the positive things that they say about the applicant. We look very closely at that.
Many fellowships are directed by some very productive members of our specialty. If the director is known for publishing, putting abstracts in meetings, and making headway in addressing different questions, then it's expected that the applicant will have participated in those results.
There may be interview questions such as "why do you think you didn't match?" There are certainly applicants who don't match who have fantastic records, and for some reason they just didn't make it. There may be cases where you cannot say that's the reason I didn't get in. But if there were an item or items that weren't so good, then you have to plan to address those. You can't change those items, but another way to address prior performance is to demonstrate in a more current job that you can do the work, and you can do it well."

Also from this article on getting into ophtho: http://www.studentdoctor.net/2009/0...w-with-dr-andrew-lee-ophthalmology/#more-2018

"Applicants who fail to match often wonder how they should spend the year before they reapply. What recommendations can you offer to these applicants?
The best chance for a match in ophthalmology is as a first time US senior medical student. The match rate drops off precipitously after this first application. The second application needs to be better than the first application if the second time applicant is to be successful. This means demonstrating perseverance, passion, and persistence through a research year in ophthalmology (e.g., a clinical or bench project), a pre-residency fellowship (e.g., ocular pathology), or an observational fellowship combined with the above. The "brick walls" in the process are meant to keep the other people out (i.e., those who don't want it as badly or who fail to make a significant improvement in their application)."
 
Last edited:
Can someone explain how the preliminary year thing works? This is my understanding: let's say I'm interested in anesthesia. I apply for categorical anesthesia programs in the match. If I don't get into any of these, I can do a medicine or surgery preliminary year somewhere then reapply for an anesthesia program the next year. Is this actually how it works?

I believe you have to do a preliminary or transitional year prior to your anesthesiology residency. As far as I know, you apply for both spots at the same time. But don't quote me.
 
I believe you have to do a preliminary or transitional year prior to your anesthesiology residency. As far as I know, you apply for both spots at the same time. But don't quote me.

Right. There are two kinds of residency paths: categorical and advanced. Categorical means the internship is built in, and you start your specialty right out of med school. The fields that are "advanced" include anesthesia, derm, rads, PM&R, neuro, rad onc, nuclear medicine, optho, and maybe a few others I'm forgetting. What that means is that for those fields, you have to already have had your internship year by the time you start. (The notion in these fields is that you ought to be a generalist first, and a specialist later, a holdover from the olden days when everyone did a medicine internship right out of med school). So you must apply both for those advanced programs as well as a preliminary or transitional (internship) year when you apply for the match. A prelim year is most frequently a year of medicine or surgery, and is basically the rough internship year you always read about. Transitional years can be cushy, where you basically rotate through different specialties for a month at a time, but because they are so cushy, they often get snapped up by the best of the ROAD crowd, and can be among the most competitive slots in the match. So when you are applying for anesthesia, you will typically be applying for both a prelim/transitional year for year 1, and an advanced anesthesia residency for years 2-4. (There are a handful of categorical anesthesia programs, but advanced is more common).

If you don't get the specialty, or the prelim, you can scramble for whatever part you are missing. Typically if you don't match into the specialty you desire, as mentioned, you can spend some time doing research and apply again (which may bolster your CV if that was the issue), you can snag a prelim program and apply again as a resident (which is tough in terms of getting the time to interview but at least you can show you are capable of working as a resident). Or you can scramble and take whatever other field you can get into, and give that a shot. I would honestly say that your odds do drop off for each match you go through toward a particular target. It's probably best to not be married to a particular specialty until you get further along and can objectively assess your competitiveness.

Don't go to med school to be a particular specialty. It may not happen for you, and most folks change their minds at least once. Go to med school to be a clinician. After that you can further specialize based on the opportunities/options. You can take your stab, but if you have the attitude that you only want to be, say, an anesthesiologist and otherwise don't want to be a doctor, I wouldn't bother with med school.
 
Most people I know who didn't match or scramble into their preferred specialty did an intern year (prelim or transitional). Some of them were able to match in the field they wanted as an intern, some stayed in internal medicine. Some ended up in an entirely different field.

It's true that if your interest is in something really competitive, you should be flexible. If you have your heart set on something like derm, you have to start early being at the top of your class, doing research, and you also need to be very geographically flexible.
 
... If you have your heart set on something like derm, you have to start early being at the top of your class, doing research, and you also need to be very geographically flexible.

I would go further and say if you already have your heart set on the most competitive field as a premed, you probably need to rethink whether med school makes any sense, because most people won't get derm. Most of the top quarter of the class won't get derm. It's not just a study hard and you can do it kind of thing -- your Step 1 scores and your innate abilities and skills are going to make some roads possible, and others impossible. So the question has to be, if I end up having to do a different specialty, would I still want to be a doctor? Unless the answer is an unequivocal yes, then maybe there is a better career choice.
 
Can you get a research job or something and apply again the next cycle or will you have an even lower shot next time through?

You won't know until March that you didn't match, which gives you maybe six months to do research. That's really not enough to do anything meaningful.
 
Members don't see this ad :)
You won't know until March that you didn't match, which gives you maybe six months to do research. That's really not enough to do anything meaningful.

are you The Prowler from OT? :hello:
 
You won't know until March that you didn't match, which gives you maybe six months to do research. That's really not enough to do anything meaningful.

Agreed. You need to invest an entire year to realistically make a notable improvement to a CV. Just like premed it is foolhardy to try to rush things.
 
It's also possible (although less common now) to complete an entire IM residency and apply to advanced programs. One of the attendings I work with did IM then rads, you can also do gen surg and plastics fellowship. Some surgical specialties don't have fellowships anymore (urology, I think neuro and ortho too now)
 
It's also possible (although less common now) to complete an entire IM residency and apply to advanced programs. One of the attendings I work with did IM then rads, you can also do gen surg and plastics fellowship. Some surgical specialties don't have fellowships anymore (urology, I think neuro and ortho too now)

http://www.aamc.org/students/cim/specialties.htm

I think all of them have subspecialization options but they are not as abundant as they are in non-surgical specialties.
 
I'm fairly sure a lot of ortho folks go on to do fellowships.

I meant a fellowship to practice ortho after a gen surg residency. Combined and integrated plastics are pretty new residencies. There are fellowships for subspecialization in most of the surgical specialties.
 
I meant a fellowship to practice ortho after a gen surg residency. Combined and integrated plastics are pretty new residencies. There are fellowships for subspecialization in most of the surgical specialties.
There are no fellowships for a general surgeon to become an ENT, urologist, ortho, or neurosurgeon. Possibly gyn-onc...
 
There are no fellowships for a general surgeon to become an ENT, urologist, ortho, or neurosurgeon. Possibly gyn-onc...

Yeah that's what I said before. There's only gyn-onc after ob, vascular, colorectal, transplant, plastics, surgical oncology, endocrine, bariatric, and a few others some others after general.

For neuro, I think this change was in the last 20 years, because that ns that operated on Ted Kennedy did a ns fellowship in the late 80s early 90s IIRC.
 
Yeah that's what I said before. There's only gyn-onc after ob, vascular, colorectal, transplant, plastics, surgical oncology, endocrine, bariatric, and a few others some others after general.

For neuro, I think this change was in the last 20 years, because that ns that operated on Ted Kennedy did a ns fellowship in the late 80s early 90s IIRC.

I had no idea! What if someone doesn't know if they want plastics, ortho, ENT or urology? It's not like we have clerkships in any of those to decide if it's what we want to do. I don't think that's fair at all. I can understand how some people are 100% sure about what they want, which is why combined programs are a good option for them. But the small people like me end up getting screwed in this. I'm supposed to know what I wanna spend the rest of my life doing by the beginning of 4th year even though I haven't really had some decent time to explore (post clerkship) 🙁

PS: I tried google to see if there's a list of gen sur fellowships, but nothing comes out. Is gyn-onc the only one?
 
The ones I listed are all fellowships from gen surg except gyn onc is after ob/gyn. Usually your school will have you do half your surg clerkship in gen surg and half in various surgical specialties. You should also try to shadow as much as possible in fields you're interested in. Most surgeons esp at community hospitals would be happy to have a med student around to give their day a little variety and will let you scrub and probably retract haha
 
Top