A Post for the Unmatched (Match Day 2022)

From unmatched to matched! 

I’ve been slacking on posts this year, mainly due to busy rotations and studying for my most recent in-service exam, but today I felt compelled to write. For those who aren’t aware, today is Match Day where thousands of 4th year medical students and graduates find out if they have secured a residency position. For many, this is a joyous day filled with celebrations and sighs of relief, but for the unmatched, this can be one of the most depressing experiences of an entire medical school career.

Most of you reading this already know that I was previously one of those students who failed to match, but if you weren’t aware, I’ll post links to my original Match Day experiences at the end of this blog post. My story isn’t one of not matching one year and then going on to match the following year. I actually failed to match twice! I still vividly remember how gut-wrenching it felt opening a “You Did Not Match” email as I was sitting at a stoplight on the way to my rotation as a fourth-year medical student, and how hard it was to fake positivity during phone interviews that day when all I wanted to do was curl up in a corner and cry. The second time I didn’t match, I was in the middle of my original intern year on a busy surgery service. I was fortunate to know in advance I would not be matching, but having to manage patients and scrub into cases in between going through the process of applying to unfilled programs didn’t make things any better.

In the end, everything worked out perfectly in my favor, and I was shown that God’s timing is always perfect. After not matching the first time around, I was blessed with a position for a General Surgery based Traditional Rotating Internship. It was a grueling year, but I definitely came out stronger and it opened so many doors for me. After I didn’t match the second time, I had the benefit of having passed all my medical board exams and I was almost done with twelve months of post-graduate training which allowed me to obtain a medical license and start working. My two years spent working as an urgent care physician allowed me to become comfortable managing acute issues on my own, gave me the freedom to enjoy life on my own terms, and provided the financial means to apply to as many surgery programs as possible during my third application cycle.

Tomorrow marks exactly one year from when I found out I matched into Plastic Surgery. It was probably one of the happiest moments of my life, but to be honest, the whole match process still gives me a little PTSD. I remember the weeks leading up to receiving the “Congratulations, You Have Matched!” email and how incredibly stressed out and defeated I felt. I honestly didn’t even want to open the email when it came because I was sure it would be another year of disappointment, and I only did so because I wanted to be ready for the process of applying to unfilled positions.

For those who may not have matched today, I’m just going to keep it real with you. Not matching sucks, and unless someone has been in your shoes, they probably won’t understand your pain. You’ve busted your ass working towards your goal, have most likely spent an insane amount of money applying to residency programs, and sacrificed so much in the process. It’s also probably hard to envision your future right now. Trust me, I’ve been there. But please know that this is not the end of the road for you. This is just a minor setback for a major comeback. Take the time to grieve and experience your feelings, and afterwards, get ready to get back in the fight. It isn’t over yet. There is still time this week to secure one of the unfilled residency positions via the process known as SOAP. There may also be positions that open up until July, and if you’re someone who is going unmatched after completing a preliminary year, keep in mind there may be a chance to jump into an unfilled PGY2 position. As I’ve said before, delay does not equal denial, and chances are you will either get to where you want to be eventually or find something even better that you probably never could have imagined. Let my story inspire you to know that anything is possible.

My DMs are open and I’m rooting for you.

 

My Previous Match Day experiences:

2018 - Not matching as a 4th year medical student

2019 Part One: Not Matching for the 2nd time (Part one)

2019 Part Two: Not matching a 2nd time (Part Two)

2021 - I finally matched!

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!