What To Do if You Don't Match For Residency
The moment you press "submit" on PhORCAS, the doubting begins. It lives in the back of your mind. And it's scary as hell.
You try to go on about your day. You try not to think too much about it. You go work out. You play some Call of Duty. You binge-watch Downton Abbey. But like a small itch, there it is. Nagging you. The question lingers somewhere in your brain no matter what you do.
What if you don't match for residency?
Unfortunately, there is a very real chance that you won't match. Let's just get that out in the open. Now before you go accusing me of being a Negative Nancy (believe me, pessimism is NOT my game), look at the numbers. They don't lie.
In 2018, 6637 students applied for a PGY1 residency. Of them, 3635 matched.
Contrast that with the 2015 numbers (when this article was first written). 4358 students applied for residency, and 2811 matched.
The obvious trend here is that the number of applicants is growing a lot faster than the number of spots to accommodate them. It was hard to get a residency in 2015. It’s even harder now.
My goal in pointing this out isn’t to fear-monger or to tell you it’s hopeless. I’m not going to complain about “the system” or the number of schools or any of those other hot button issues.
I’m just trying to highlight one simple fact:
Every year, a lot of really, REALLY good residency candidates will not match.
It's not uncommon for an institution with two PGY1 spots to have 80 - 120 applicants. And to only interview 15 - 20. Those are some pretty grim looking numbers.
So, what do you do if you are one of the unlucky ones?
Your "I Didn't Match For Residency" Action Plan
This is a setback, yes. It is disappointing. But it is not the end. Your ship has not sailed. Your journey has not ended. Take a few days to reflect. Focus on other things and get your head somewhere else for a bit. Take a quick weekend getaway. Spend some time out in nature. Don't skip this. We'll wait here for you to get back.
You're back? OK, good. Cause it's time to go back to work.
2. Evaluate WHY you want to do residency in the first place.
What is your ultimate career goal? How does a residency fit into that? Be honest with yourself here. Did you just apply to satisfy a checkbox on your CV? Because one of your preceptors/professors told you that you "had" to?
According to an informal survey we conducted (citation needed), a surprising number of students claimed a well-rounded CV as the primary reason they applied for residency.
Nuts to that. If this sounds like you, go pop a bottle of champagne in celebration.
You have just been spared one of the worst years of your life.
Residency is hard enough when you want to be there.
If you had to go through it "just because" it would be like spending a year stuck inside an elevator. With the entire cast of "The Real Housewives of Beverly Hills." And Fuller from "Home Alone."
3a. Match Part Deux
Starting in 2016, PhORCAS began conducting a second match (cleverly titled “The Phase II Match”). Basically, it serves you in two ways. First, if you did not match originally (The Phase I Match), you will get another shot. How does this differ from the scramble? It's another organized (but faster) round of applications. As you'll learn below, the scramble is anything but organized.
Second, if you did not apply (or withdrew) from the Phase I Match, but have had a change of heart, you can apply now. This is a potential game-changer for those that were on the fence.
Maybe you had a handful of residencies that held your interest, but you decided not to apply. Then you see that a few are still available after the Phase I Match. You can throw your name in the pot now. You can apply.
Previously, you could not do this. Once you decided (back in January) not to apply to residency, you were done. Now you can change your mind as late as March/April.
It should be reiterated here that it is NOT worth it to apply to any and every available residency "just because you need one." Evaluate your career goals and make sure you're applying to available residencies that meet them.
You will have some time (a couple of weeks) to weigh your options and apply for the Phase II Match. You can check the most recent schedule/timeline at https://portal.phorcas.org/
So what if you go through the Phase II Match and STILL end up without a residency?
There are few things in life more chaotic than the scramble. Here's a quick rundown of what happens:
Unmatched Applicants (you) receive a list of Unmatched Programs
Unmatched Programs receive a list of Unmatched Applicants (still you)
Weird electronic dance party
The scramble is crazy, but the name is very fitting. Unmatched students and programs run around like the McCallister family the night before an early flight to France (BOOM! Second "Home Alone" reference!).
Residencies with empty slots want them filled. Unmatched students want residencies. In the madness that ensues, there will be phone interviews. Emails sent. Wheeling and dealing. Reference calls. It's a lot like a remote job fair, except the goal is to fill the positions ASAP. And by any means necessary.
How do you proceed? Your best bet is to be prepared going into the scramble. Have an updated electronic copy of your CV ready. Be available to talk to any and everyone on the phone, Skype, or email. This is the time to really lean on your professional network. Don't be afraid to ask professors and preceptors to lean on their networks. Don't be annoying. But be persistent.
You can even reach out to programs where you interviewed. You may not have matched there, but you still may have made a good impression. The residency program director may be willing to call around on your behalf.
Leave no stone unturned during the scramble. Exhaust every resource.
4. Determine if you are up for trying again.
Even after the scramble, there will be unfilled slots. Some programs will go short. And there are always more applicants than there are residency spots.
You can take a couple of weeks here. This is not a decision to make on a whim. You can definitely end up in any practice area without a residency. But nothing compares to a residency in terms of preparation. Plus the residency can shave years off your career ladder.
If you decide to go for round 2 next year, the earlier you start preparing the better. Here's what you do.
First, get a job. Don't spend the year idle. Try to get a job working in the practice area of the residency you are targeting. So if you want a hospital-based PGY1, try to work in a hospital. You may have to PRN to do this, but that's ok. You can work full time in the community setting while building your cred inside the hospital.
Second, find a professor or preceptor to work with you as a mentor. Get something published. Do a poster presentation at Midyear and/or local conferences. Find volunteer work. Keep up with practice updates.
It's a real mark of maturity in a candidate to spend a year in development and then reapply. You've shown that you can handle setbacks and recover from them. You've shown that you are genuine in wanting to do a residency (because no one working full time will "want" to take the salary reduction).
If you ask around your network, I'd bet you can find people that were initially rejected, and then made it on the second go-around. One of them wrote an article explaining how he did it here.
If you do it right, you can “sell” your initial rejection (and subsequent year of experience) as a real strength for your residency candidacy the following year.