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!

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