Rajani Katta MD and Samir Desai MD
What to Do If You Don't Match into a Residency: Important Next Steps
Updated: Mar 2
As we are writing this, it’s March of 2023 and Match Day is right around the corner. Unfortunately, as with every single match, thousands of highly qualified physicians and students will not match. This post outlines some next steps that you can take if you find yourself in this position.
1. Give yourself permission to grieve
Not matching can be a severe professional disappointment, and it’s important that you give yourself permission to grieve. You may have pictured a certain professional outcome, and it can be a heavy, heavy blow to be thrown back into an uncertain professional future.
Give yourself the time and the space to respond to this disappointment. At the same time, it’s important not to internalize this particular outcome. You are not your career. This one particular day does not reflect upon your worth as an individual, or your worth as a physician, and it definitely doesn’t reflect upon your chances for a successful match in the future.
Once you’re ready to think about next steps, please keep reading to learn how other individuals have responded and rebounded from one or two (or three or more) failures to match to an ultimately successful residency match.
2. Pay extra attention to caring for yourself during this time
This can be an incredibly stressful time, and it’s important to focus even more heavily on caring for yourself. This means caring for your physical health and it means caring for your mental health.
Regular exercise, good nutrition, and strong social connections are the foundation for better physical and mental health.
Of these, I find that social connections are often the first to fall by the wayside. Especially when you’re dealing with a heavy disappointment, making plans with your friends may seem like the last thing you really want to be doing. If I had one piece of advice to emphasize, it would be to seek out support from your family and friends. Those connections are incredibly important.
It takes serious brainpower and focus in order to make the hard decisions on what to do next, and everything that you can do right now to help strengthen that brainpower and focus will help.
3. Start letting everybody know that you didn’t match
For some of our students, this feels counterintuitive. This feels like a failure, and it’s not generally within human nature to start sharing failures with everyone.
This is one time, however, when it’s really, really important to share your match outcome.
You need to let your colleagues know. You need to let your letter writers know. You need to let any faculty with whom you’ve previously worked or developed a connection with know.
There are multiple residency positions that open up every single year outside of the match, and it’s important that you have an entire team of people that are keeping their ears open to hear about these positions. More on that in a moment.
4. Diagnosis before treatment: it’s important to do a deep dive analysis of your entire residency application
It’s just like treating a patient. Before you prescribe treatment, you need to make a diagnosis first.
What were the factors that led to your unsuccessful match?
This is one part of the process where it’s very helpful to have a third-party objective evaluation of your entire application. You need to look at every single component of your application.
Sometimes the factors leading to an unsuccessful match are outside of your control. Other times, they may be factors that you just overlooked.
Regardless, almost every single factor can be tweaked, revised, or treated in order to improve your chances for next time.
5. Start talking to trusted advisers about your next steps
Once you’ve made a “diagnosis”, it’s time to start thinking about therapeutics.
What can you do to improve or revise those factors that lead to your failure to match?
This is where we recommend speaking to trusted advisers about your next steps. You might need to speak to your dean, faculty members, department advisers, residents in the field, or other individuals to help you determine your next steps.
This is an area in which it's hard to generalize, because the next steps are so specific to the individual. Our last book on the residency match was over 600 pages long because there are so many factors that go into a successful residency match.
In dermatology, I’ve seen many fantastic applicants fail to match because of the randomness of the process. I can outline next steps for these individuals because I know what’s worked for multiple other students.
If you have low board scores, there are steps that you can take to lessen the impact of those scores.
For IMGs, more extensive US clinical experience, stronger letters of recommendation, and the intervention of an advocate who knows you and your work very well can make all the difference.
The bottom line here is that your next steps will be highly specific to you and your background.
6. Create a plan
This step is the next clear step, once you’ve done an analysis and then determined next steps. How will you implement those next steps? What is your plan of action?
Remember, you have approximately six months before you will be applying again. What will you do during that time? In other words, what needs to be done differently for the next application cycle?
Some US medical students may consider extending medical school
Some students start considering research fellowships
IMGs may consider additional US clinical rotations
IMGs may also consider taking Step 3
All applicants may consider the need to revamp their application materials
Some applicants may consider new letters of recommendation
Some applicants may need additional research
7. Make sure you are always kept updated on open residency positions
Every year, across the country and in every field, residency positions open up.
Dermatology is a small field overall, and yet every year we have several residency positions that open up across the country.
Accepted residents may not be able to start or may choose not to start their dermatology residency
Some residents obtain a waiver to not start at a specific residency program
Some incoming residents have visa issues
Some residency programs obtain funding for an additional residency position that is available to start outside of the match
There are multiple other reasons for new residency positions that may open up outside of the match
And this applies to every single field
How can you be kept informed of these positions? Many of them open up outside of formal channels, so one of the most important pieces of advice that I have for you is to stay in touch with your faculty and advisors.
In dermatology, our chairman would receive emails listing newly open positions through an email listserv that he would then share with all of the faculty members. Residents in the field may also hear of these positions.
Websites such as www.unmatchedmd.com are also helpful.
I'll share with you one example where the odds of matching at a specific program fell from 1 in 100 to just 1 in 4.
At one program, a residency position opened up outside of the match. They sent out an email to a listserv for dermatology professors across the country. They then received four applications for their newly open dermatology position. The position was ultimately filled by an applicant who had significantly lower board scores than would be typical for dermatology, but who had the advantage of currently working in a dermatology research fellowship. She also had an extremely strong letter of recommendation from her faculty advisor.
By comparison, keep in mind that in a typical year, most dermatology programs receive about 100 applications for a single position.
We can both share multiple stories of applicants who have matched, sometimes at the last minute, and to open residency positions outside of the match, so it's extremely important to stay on the lookout for open spots.
The bottom line
It can be devastating, and at the very least incredibly stressful, to experience an unsuccessful residency match. However, we know many, many physicians who experienced this initially and then have gone on to successfully match and develop very full and highly successful careers as physicians.
The key is to start taking those next steps to set yourself up for success for the next cycle, once you take the time to process this disappointment and to fully take care of yourself. We wish you all the best as you think about and implement your residency application plan.
Dr. Rajani Katta is the creator of The Residency Interview 101, the online course that helps applicants quickly and confidently prepare for their residency interviews. She is also the co-author of The Successful Match: Rules to Succeed in the Residency Match and served as Professor of Dermatology at the Baylor College of Medicine for over 17 years.
Dr. Samir Desai is the author of 20 books, including The Successful Match and The Clinician's Guide to Laboratory Medicine. He has been a faculty member in the Department of Internal Medicine at the Baylor College of Medicine for over 20 years and has won numerous teaching awards.