Sunday, April 18, 2021

Didn’t Match into Residency...What are Some of my Options?

Over the past couple of years, I have received numerous messages asking me about options for those who didn’t match into a residency position. I don’t consider myself an expert on the topic, but as someone who went through the process of not matching, to securing an internship, not matching again, and then starting work as an urgent care physician before my recent match into plastic surgery, I will share as much advice and insight as I can. Not matching can feel like the end of the world, especially when you’ve invested a massive amount of money, time, energy, and years to become a physician, but there is a hope (and I’m living proof of that).

What if I fail to match into any position?

Every year, thousands of medical school graduates go unmatched. Despite what many people would like to believe, there isn’t a physician shortage, but a shortage of residency positions due to various reasons that I won’t get into with this post. If you’re a 4th year medical student who is unmatched at this point, my advice is the following:

Focus on securing a one year preliminary or transitional year position! Even if you had your heart set on a particular specialty, at this point, making sure you graduate with a JOB should be of utmost importance. Having at least a year of training under your belt will open so many doors, and I’ll get more into that below. You should be stalking sites daily that list open positions. A few that I found useful were Resident Swap, SDN, UnmatchedMD, and for those interested in surgery, APDS. I’m sure there are more specialty-specific sites, but these are a good start.

If you have had no luck finding a preliminary or transitional year position, a possible option would be to extend your graduation date by a year. Not all schools will allow this, but by extending your graduation date, the major advantage is you will still be eligible for student loans to help with living expenses. Also, when you do re-apply for a residency position, you will be considered a graduating medical student senior which is useful for those residency programs that automatically screen out graduates. After extending your graduation date, the year can be utilized as a research year that can help you enhance your application and build further connections. 

In the event you are unsuccessful at extending your graduation date or securing an internship position, options for practicing medicine tend to become severely limited. There are a few states like Missouri, that will allow you to practice as an “Assistant Physician” with a collaborating physician to supervise your work. This would require relocating and I am not aware of how much it pays. There is also the option of electronic health record (EHR) training and support work where you would travel to various hospitals/clinics around the country and train individuals on how to use EMR systems. 

Outside of this, I am not aware of any other options for graduating physicians without having completed any type of internship/residency training, but if you’re reading this and know of a few options, please let me know in the comments below.

What are my options if I completed an intern year and/or never finished residency?

Most people think that completion of a residency program and having board certification is an absolute requirement to practice medicine. While having these things can make life a bit easier and provide you with more practice options, they are not an absolute necessity. In most states, the only major requirement for full licensure and the ability to practice independently is completion of twelve months of postgraduate medical training and passing all three required medical board exams. These requirements tend to vary for International Medical Graduates (IMGs), and there are a few states such as California that require more than 1 year of training, but you can find a full list of requirements HERE.  

After failing to match a second time, I knew this would be my initial route. I made sure to take my final medical board licensing exam in December of my intern year so my results would be available in enough time to receive my license. I also checked my state’s requirements and had everything ready for submission. By the final day of my intern year, the only thing I needed was a certificate from my program director stating I finished the 12 months of required training. I mailed everything in immediately after and had my license 3 weeks later.

I heavily explored my options and decided urgent care would be the best fit for me. Having not completed a residency program, my options were limited in hospital settings and other facilities run by insurance companies that require board certification, but I was lucky enough to find a physician owned and operated facility to work at. Urgent care work definitely isn’t for everyone though. You have to be comfortable managing everything from lacerations, fractures, genital issues, etc in all age ranges and completely on your own. The umbrella of protection that residency provides is no longer available, and you have to be able to make quick decisions on your feet and balance a large number of patients in a given shift. Luckily, my surgical intern year prepared me well for this, but I would suspect it would be a steep learning curve for anyone coming from less intense specialties.

Another option would be to start your own practice. Now this is something I don’t highly recommend, but only because I still value the learning experience. In the urgent care setting, even though I work alone, I know I can always call on my colleagues for advice. Plus, I am constantly learning new things and staying up to date on clinical guidelines. It would probably be harder to find the support if on your own, but after you obtain your license, you could theoretically start your own practice as a General Practitioner (GP). Thirty or so years ago, this was not abnormal, but it has since heavily fallen out of favor. 

As a GP, it is possible to bypass the headache of dealing with insurance companies by running a cash-only practice or having a Direct Primary Care practice where patients pay via a subscription-type service for visits. It would also be possible to go into concierge medicine and focus on VIP patients. Working as an urgent care physician in Atlanta, it’s not unusual to have celebrity patients every once in a while, but the thought hadn’t crossed my mind until I was asked if I provided the service by one of my patient’s assistants. I definitely considered it, but realized I don’t want to be available to anyone 24/7 and I don’t give into patient demands which can sometimes come with people used to getting what they want. 

Another option for a licensed physician without board certification includes Medicare wellness assessments where you would perform quick history & physical (H&P) exams and have patients answer health questions. This typically involves having to travel to patient’s homes, and there is some dissatisfaction from PCPs with these as insurance companies tend to use it as a way to not pay them full price. The benefit to working for these companies though is that they tend to pay per person for these assessments and provide free rental cars, hotel rooms, and gas reimbursement. The drawback is having to travel all around a city and you may have to enter homes that may be unsanitary or in unsafe areas.

The final options I can think of for those who can obtain a medical license are doing consulting work (companies value the physician credentials, but I have no information on how to get involved with this), performing disability exams on veterans, and traveling to various hospitals and clinics to provide Electronic Health Record (EHR) training. 

This post isn’t exhaustive of all the options available, but it pretty much sums up all the ones I can think of at the moment. If you know of any other good options for unmatched physicians and those who didn’t complete residency, please drop your knowledge in the comments below!

Saturday, April 17, 2021

2020 - 2021 Residency Season (Diary Posts)

So happy to be done with the process!

Happy Saturday! As promised, I am releasing the posts I previously wrote during this past residency application season. I originally planned to write weekly, but life remained busy as usual, so I only wrote two posts, one from 10/22/2020 and another from 10/23/2020. There's not much, so I'll just include both posts here. Not sure if it will help anyone, and I made sure to retract program names, so just posting on the blog for my memories. 


I’m a little late with my first ERAS post, but things have been super busy this week. Right now, I am at work and just got a break. I am 11 hours into my shift and between physical and telemedicine visits, I have seen a total of 46 patients today AND finished all my notes! Hopefully, this last hour will be a smooth one.

Anyway, back to ERAS. I officially submitted my surgery applications on Sunday night, and it was an interesting experience. My application has been done for a while, but I figured submitting on October 18th would give me enough time to find any flaws (due to the pandemic this year, programs weren’t able to review applications until 9am on 10/21/2020). I didn’t get off work until 11:15pm, so by the time I got home and took a shower it was technically Monday when I was able to sit down and submit. I grabbed my laptop, had my boyfriend sit next to me for moral support, typed in my info, and after a little hesitation, forcefully hit the submit button. I was about to breathe a sigh of relief but quickly saw the words “card declined”. Now I have more than enough money in my bank account, so I initially thought I entered my address wrong. I carefully re-entered all my information and clicked submit again only to get declined. I was super confused! It was then that I realized my bank was probably blocking the charge because I had literally never spent so much money at one time in my entire life. It took me a few hours, but I figured out how to temporarily increase my daily spend limit, and I was finally able to successfully submit around 1:30am. The total charge for my application to 289 general surgery programs and 80 Plastic Surgery programs came out to be $9032. (Yep, you’re reading that correctly) To put that amount into context, the very first car I bought was around $7000 and took me a few years to pay off. Even the lavish birthday trip to Paris that I treated my daughter to last year cost me less than a third of the cost I spent on ERAS applications this year. Let that sink in.

To be honest, as tough as it was seeing the money leave my account, applying to so many programs is probably the biggest change from my previous applications. When I first applied in the 2018 cycle, the total I spent was $1910 ($1686 in the actual match and the rest during SOAP...reviewing my payment history now). For the 2019 cycle, I spent a total of $372, and the total spent on the 2020 cycle was $353 (and I forgot to register for SOAP, so did not participate this year). You’re probably thinking “What the hell! Why didn’t she apply to more programs the first time around?!?!” Well, the answer is simple...I couldn’t afford it. 

What most people don’t realize is the whole process of becoming a physician is super expensive. I couldn’t just use credit cards to pay for my applications, because I was already maxed out from previous years (having a ton of student loan debt and trying to stay afloat as a single parent will do that to you). I also knew I couldn’t afford to travel to interviews all over the country. Yep, that’s another thing they don’t tell you: you not only pay just to APPLY to residency programs, but then you’re responsible for the cost of flight, hotel, car rental, and any incidental expenses. It all adds up. By the time most medical students get ready to apply for residency, they have already spent thousands of dollars just taking board exams alone, not to mention the other costs associated with being a medical student. And on top of all this, you’re still expected to have extra money for the few months between graduation and the start of residency when you’re likely moving to a new state and having to put down security deposits on new places to live. I guess the one good thing about being in a pandemic this year is I will save a lot of money by not having to travel everywhere. Yay for virtual interviews! 

So yes, the main reason why I didn’t apply to all the programs I would have liked to in previous years was because I couldn’t afford it. I also couldn’t afford to apply as an intern with a resident’s salary (even though they are physicians, when you average out the hours worked with the pay, the majority of resident physicians make less than minimum wage **and don’t even get me started on how expensive it was living in Philadelphia**), and I couldn’t afford to apply last cycle because I had just moved back to Georgia and was jobless for my first month back. None of that applies this year, because not only have I been blessed with the opportunity to save up for residency applications, but I’ll also be able to relocate and start residency without being on a struggle bus. Turns out going unmatched and having to start working as a physician has been a huge blessing! Shout out to God for always having my back even when I can’t see it!

To wrap this up and get back on track, submitting my residency applications this year feels like a huge relief and I’m actually hopeful of what’s to come. I’m a little scared that being 2 years out of medical school will hurt my chances at a lot of programs and I won’t get a lot of interviews despite having applied to so many, but I am just going to keep my faith and keep pressing. God didn’t bring me this far to leave me and I know the best is yet to come! Hopefully my next post will be an interview invite update, but right now I have two minutes left on the clock and I am ready to go home! Good night!

10/23/2020 2:31pm

Well it’s officially day 3 of ERAS applications being open, and already this year is different from previous ones. Last night shortly after leaving work, I was fortunate enough to receive a supplemental application link from the [retracted] Surgery residency program and a few hours later I received a link to complete [retracted]’s assessment. There’s a high chance that these were probably sent out to everyone who applied to these programs, but there were two things that stuck out to me: 

  • The email I received from [retracted] started off as “Dear Dr. Ward”. I don’t have the “Dr” salutation listed in my application, so either they actually took the time to review my application and see that I am already a physician, or they call everyone doctor. I’m going to tell myself the former, and that alone makes me smile just a little. 

  • The first line of the [retracted] email read as “Congratulations! The General Surgery Residency Program at [retracted] has reviewed your application and determined you are a high potential candidate for our program.” This email came at 11:31pm last night, and even if they sent this message to everyone who applied, what a way to make a girl feel good!

Both institutions had assessments that were very different. [Retracted] had a super fun survey that really focused on my interests and individuality outside of medicine. [Retracted]’s assessment took me exactly 40 minutes to complete and it was basically a list of scenarios with me rating what I thought was most effective and personality questions. It also included an optional “passion index” survey which rated my overall passion for surgery as high with the breakdown as a high harmonious passion and moderate consuming passion. I’ll take it :)

As for interview invites, none yet. I did receive my first rejection today, and ironically it was from [retracted]’s general surgery program which is in my state. Their loss. I also discovered that plastic surgery programs have a unified date that they offer interviews (December 4th) which is designed to give programs time to review applications. This means there will probably be radio silence on the PRS end until then, but if I do receive interviews, I will be notified of everything that day. The only negative I can see coming from this is since interviews will start December 7th and my work schedule will already be set for the month, I may end up giving up a lot of shifts. Luckily I’ll have received a few more paychecks by that time, so it won’t hurt if I need to take off work or work less shifts for a month or two in order to interview.

That’s it for this post. I don’t expect any interview invites to happen for at least a week or two from the programs that actually review applications and don’t just screen by numbers, which means you’ll likely have to wait for that kind of good news. We’ll see what happens!

4/17/2021 4:06pm

The best is most certainly yet to come and I'm excited for what's in store as I enter plastic and reconstructive surgery residency! Reading these two posts makes me kinda sad I didn't write more because the whole process is now a blur in my mind. Even if I don't post regularly when I start my training, I think I'm going to either record my daily thoughts or just keep a journal and jot down daily musings, because I truly enjoy looking back over my journey. Shoutout to everyone who has stuck around and followed my journey through the blog over the years. Life is about to get real!

Tuesday, April 13, 2021

Featured in Forbes!!!!

Click picture to read the full article

Disclaimer: This is a bit of a late post, but I wanted to have a record of this moment on the blog, so copying and pasting the first part of this from my previous Instagram post :)

 I am beyond humbled, honored, and excited to be included in a Forbes article highlighting women of color medical students and graduates who matched this year! Even better is the fact that I personally know a few of the phenomenal women featured alongside me and can vouch for their awesomeness 💕⁣⁣

My journey up to this point has been full of ups and downs, but I am thankful for every single moment. Over the years, I was told by many people that I should give up on my dreams. First, I was told that as a single mother with a low GPA and MCAT that I would never make it into medical school. Well, it took five years, three application cycles, a graduate degree, and a career in research before I was accepted into medical school, but I made it through and thrived.⁣
After finishing medical school and failing to match more than once, I was told there would be no way I could ever achieve my dream of becoming a surgeon. Well, that also took a while (I even became an urgent care physician along the way), but now I am finally on the road to achieving my dream of becoming a Plastic & Reconstructive Surgeon. ⁣
I write all of this to say don't ever let anyone tell you that your dreams are impossible or your goals are unachievable. Sure you might have to fight a little harder, take a few detours, make sacrifices, and work your butt off all while trying to ignore the naysayers, but what is meant to be will be. Just as long as you don't give up.⁣

Just want to take the time to say THANK YOU to everyone reading this post who has been following along on my blog over the years. It's definitely been quite the journey and while a lot of people dismissed my dreams and gave up on me, I continued to receive a lot of encouragement and supportive emails from my followers. Y'all helped give me the push I needed to keep  going, and while the journey is far from over, I know I'll be able to count on the support of my readers during this next chapter. I am appreciative beyond words and hope to make everyone proud. Excited for what's to come! 

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