Unmatched — What to do Now
Written by Justin Doroshenko, DO, M.Ed.
In the minds of many medical students, the residency match is the true culmination of medical education. Matching into residency means being on the pathway to board certification, physician income, and realizing a dream of working as a physician. But for thousands of residency applicants every year,1 going unmatched is an unfortunate reality. After all the time and money spent on applications and interviews, even after navigating the existential wormhole that is the Supplemental Offer and Acceptance Process (SOAP), these applicants are left wondering what to do next. But it’s important to pause, take a few breaths, and think broadly (and perhaps unconventionally) about what to do next.
Take time to feel everything. There are likely to be a lot of emotions around going unmatched, and it’s important to allow yourself to feel them. Denying any of those feelings just might make things more difficult moving forward. Be angry. Be embarrassed. Be upset. Be confused. Talk to friends and loved ones and say what you’re feeling. It’s certainly important to start planning the logistics, but plan for your health and safety, too.
Find mentors and advisors who have experience in this space. Some applicants have great advising resources for navigating life after not matching at their school program, but everyone should look beyond those immediate resources to individuals or organizations that are invested in helping unmatched applicants. There are dozens of individuals on Twitter who offer expert mentorship and advice. Talk to people who have experienced this side of the match process before you. And leverage the experience and willingness from organizations like Inside The Match.
Talk to the program directors that interviewed you. This is a crucial step to identify where any problem areas in the application and interview process. Politely email them and ask if they would be willing to chat with you for a few minutes. Ask them if they are willing to share why you weren’t ranked higher, what they think might have happened, and what their advice is.
What are your options? The common advice usually revolves around a few approaches: finding a still unfilled preliminary or transitional position, research fellowship, pursuing an MPH or similar degree, or deferring medical school graduation. These are all approaches taken by many applicants in the past, and all have value. But there are more options than you think. There’s no requirement for what unmatched applicants must do for the next year, and many applicants have found great success with creative approaches to their year.
What do YOU want to do with your year? This is the big question, and it’s important to think broadly. Is it all about clinical medicine for you? Did you have experience or a career before school that you can leverage? Did you develop any skills in school that you want to pursue? Are there parallel interests in medicine that you can pursue? Certainly, one consideration is that of income and personal expenses, but consider starting with broad thoughts of what you want for yourself and ways to feel fulfilled.
Be on the lookout for open PGY-1 positions. Openings after the match do occur regularly, and you should be ready for them. Keep that CV and camera-ready face handy, as things can move very quickly.
Know you’re not alone. It can be a lonely place as an unmatched applicant. It’s not easy to watch classmates celebrate their match knowing that you may not be sharing in their joy. But there are many others in positions like yours, and there are even more who have experienced it before you. Find those people. Lean on those people.
Remember that failure is an option, and we need to be okay with it. It may not be easy to be open about going unmatched but try to do it if you can. We must begin to destigmatize the conversation around not matching. You probably didn’t intend it this way, but this is a part of your story now. In many ways, medical education has created a system where failure is viewed as an endpoint rather than a tipping point—a time where great change and growth can occur.
*Justin graduated from medical school after going unmatched during the 2021 cycle. His views and opinions do not represent those of his employers or affiliations. Engage with him on Twitter at @dorojustin or via email at justin.doro@gmail.com
1. Mock J. Unmatched Doctors: How Big Is the Problem, and What Can Be Done? Medscape. Published June 24, 2021. Accessed March 5, 2022. https://www.medscape.com/viewarticle/953675
