You didn’t match into your first-choice specialty…now what?
Written by Krishna V. Suresh
Each year, it is an undisputed fact that numerous 4th year medical students unfortunately go unmatched in their specialty of choice. In ultra-competitive specialties, such as plastic surgery, dermatology, neurosurgery, orthopaedic surgery, and ENT, these unmatched rates are higher, given the baseline level of high achievement that characterizes the prototypic applicant for these specialties. The NRMP match process, as equitable as it claims to be, is flawed, with medical students submitting a greater number of applications each year (at an immense financial cost that not all students may be able to pay) to increase their likelihood of securing interviews. And as this most recent year has shown, this price paid does not guarantee a match for students, especially in ultra-competitive specialties, leaving thousands of applicants to search for any open position in the frantic SOAP process.
You didn’t match into the specialty you wanted. Now what? Should you SOAP into another specialty? Should you still pursue that fervent dream of becoming an orthopaedic surgeon? Here’s my take, plain and simple.
The specialty you choose does not entirely define who you are, and ultimately, is a career. If you are not dead set on your primary choice of specialty, please consider the SOAP process. It is simply not worth the anxiety, uncertainty, financial costs of re-application, and the opportunity cost for you to risk your mental health for another shot at a competitive specialty. Especially when considering that the odds of you matching into these ultra-competitive specialties are significantly decreased as a re-applicant. This is my piece of advice for all re-applicants, but particularly those who are re-applying a second time. Your happiness and sanity are never worth a career. Never.
That being said, let’s assume you are first-time reapplicant dead set on your specialty of choice. What should you do? Should you pursue a preliminary position or consider a research year? If you are in this position, I advise you to strongly consider a research year, and here’s why. It will help you cement strong connections with faculty IN YOUR SPECIALITY OF CHOICE at the program you do your research year at. I also highly recommend that you dual apply the second time. This way, you can ensure that you give yourself a chance at your primary specialty of choice, while having an insurance policy in the chance it does not pan out.
When choosing where to do a research year, try to optimize your search to institutions that have a track record of taking their research fellows for residency. The biggest misconception about completing a research year is this: I need to publish X number of articles to be successful. In fact, the purpose of a research year is rather to 1) work closely with a faculty mentor and demonstrate your work ethic, team skills, and critical thinking ability and 2) publish papers. Notice the order of these goals.
This isn’t to say that if you choose a preliminary year, it won’t be possible to match into your specialty of choice. Conversely, I am not suggesting that if you do a research year, you are guaranteed a match the subsequent year. This is the inherent risk involved in applying to an ultra-competitive specialty—even if you do it “perfectly”, you may still not match. I am not trying to dissuade anyone from following their dreams, but rather being practical and realistic. You need to establish a time-limit for yourself after which, you accept that you can still be happy doing another specialty. Because ultimately, any single specialty cannot encompass who you are as person and what you want outside the narrow focus of a career.
