From unmatched to matched: Tips for Non-US IMGs
Written by Antoine Younes, MD
“We are sorry, you did not match to any position”.
I never knew words could hurt this much. On March 14, 2022, I received this awful news. I still remember the feeling of shock, mixed with a sense of devastation and failure. I had excellent USMLE Step scores, I was doing research, and I had great feedback from my interviewers. I could not understand how this was happening to me, all my friends matched, and I didn’t. I just felt so alone and disappointed in myself. But, you are not alone. And here are my tips to reapply as a non-US-IMG:
Go easy on yourself, you are not the only person who did not match.
You are not alone in this. And although, at this moment, you may feel like this is happening to you and only you, however, it is not. This year, per NRMP, the match rate for non-US-IMGs was 59.4%. Finding support from people who went unmatched can help a lot. So go easy on yourself; you are graduating (or graduated), you may have gone through many obstacles, and have juggled so many aspects of your life, and here you are still standing. How impressive! Nevertheless, it is not only okay to feel sad, but it is also necessary, which brings me to my next point:
2. Take time to grieve.
You just took a hit… and a big one. Many people will deal with this differently. Some may continue as if nothing happened, and some may feel like giving up. Grieve, and find love within your family and friends. Although it may feel like they cannot possibly understand what you are going through, and let's be fair, how could they? But believe me, they are heartbroken for you. Also, take some time to stay away from social media. The celebrations will hurt, and you are already in so much pain. It is okay to feel vulnerable at this moment, and it is okay to take a moment to breathe and be sad because what is coming next is going to be brutal:
3. Decision time, to SOAP or not to SOAP.
Everything happens so fast, and now it is time to decide if you are going to SOAP or choose a different route. I decided not to SOAP, as I was not ready to give up on neurology, and only a few spots were left unfilled. I urge you to reach out to someone who has gone through the SOAP process. You will find a community ready to help, especially on Twitter. If you decide not to SOAP, you need to come up with another plan, and the best way to do that is to:
4. Analyze what you can improve.
Consider whether you have any “red flags” (year of graduation, STEPs attempt, low scores...)? Did you apply broadly enough? No matter the reason, I would start by asking myself: did I receive a good number of interviews? If the answer is no (let’s say five or less), there is a good chance that either your application did not overcome the harsh ERAS filters or your application was not competitive enough. For example, in my case, I did not have any U.S. clinical experience since my elective opportunity got canceled due to COVID (the gift that keeps on giving, right?). And although I was working on research, our papers were not published in time. Those were the first issues I wanted to tackle before reapplying. Now, If you had a high number of interviews (let’s say seven or more) and still did not match, I would focus more on interviewing skills.
For your application, in your personal statement, you can describe how you did not match and describe how you are overcoming this adversity. Doing this will express to the PD your resilience, a very appealing quality for an applicant. And don't be ashamed of what happened. Show the program how much you have grown from this experience and what you learned from it. Use what everyone thinks is a weakness as your strength. Now that you got your interviews, are you ready for interview season?
5. Try obtaining a research position in the U.S.
I know you may have read this everywhere, a million times. And as you know, it is hard to find a research position in the U.S., but it is not impossible. Start emailing everyone within your field of interest, and check big academic hospitals since they usually have spots opening after match day. If you cannot find a research position, try doing some observerships. Now I am not saying this only because it will improve your CV (It will), but most importantly, it will help you make the connections you need.
6. Connections, connections, connections!
When I applied the first time, I had no idea how important this part was, and I wish someone had told me this earlier. Now put yourself in the program’s shoes. They get around 1000 applications from incredibly well-qualified neurology aspirants for only 5-10 open spots. Choosing who to interview can be mind-wrecking. And this is where an email to the PD from a resident at the program you applied to, or a phone call from an attending with ties to the program can go a long way.
Now, connections may not guarantee a match, but they may help you surpass some ERAS filters and reassure the PD that you would fit in the program, especially if you have a strong CV backing up this recommendation.
So how can connect with residents and attendings?
Send an email to residents that graduated from your medical school and even residents from the same nationality. If you are applying to neurology, contact board-certified attendings you worked with during medical school.
Try and attend neurology conferences and meet people there.
Attend the virtual open houses as well and connect with the residents.
Use social media! It is a great way to introduce yourself and meet many people in your field of interest. Neurology is a close community; people know each other, and everyone is usually helpful.
Own the fact that you did not match.
7. Be genuine during the interview and practice beforehand!
Be genuine and be yourself. I promise you; programs have been doing this for a long time and have gotten quite good at detecting ingenuity. You don’t need to oversell yourself and overly complement everything a program director does. Be the person you are among your friends, family, and colleagues. In one of my interviews, some applicants even got called out for it! The goal is to find the program that will fit you best. However, being genuine does not mean you don’t have to practice for the interview! You are still competing with the best for very few spots, so practice with your friends, get feedback, and improve this crucial skill. Do not memorize answers but be ready for anything they may throw at you.
8. Thank you notes, a letter of intent, and second looks.
It is unlikely that thank you notes will change your place in the rank list. So, if that is your purpose for sending one, don’t. If you genuinely want to thank the program coordinator or director, proceed as you see fit.
As for letters of intent, I cannot stress this enough but only send one to your top program! Neurology is a small community, and there is a chance that programs may find out you lied, but programs will know you lied on Match Day. PDs will know if they went lower than you on their rank list. Believe me... losing your integrity is not worth it.
Finally, try to attend as many second looks (virtual or in-person) as possible. This can show how interested you are in joining a program and learning more about them.
9. Making a Rank list.
This one will be quick. Rank the programs in the order you want! Do not rank programs where you feel you have a better chance of matching, higher on your list. The NRMP algorithm is applicant proposing, and you get a shot to get into your dream program.
… and hopefully, in March of the following year, you will receive a different message in your inbox: “Congratulations, you have matched!”
Congratulations! You did all the work, and you finally matched. It was a grueling year, but you came out of it stronger. You are just where you need to be, so celebrate with your loved ones, and don’t forget to help the next generation in any way you can!
