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What Happens if I Don’t Match?

An interview with Miriam O’Leary, MD

Why don’t some candidates match?
Graduating medical school is quite an accomplishment. You need to work hard and be consistent in order to achieve success as your education draws to a close. But instead of crossing the finish line, you need to focus on securing a residency through the Match. Adding to the stress is the fact that not every candidate matches into a program. It is very important to be as prepared as possible before you apply to The Match. I encourage students to work closely with an otolaryngology mentor—often the residency program director at your institution—to prepare, as it is time well spent. However, if you don’t match, there are things you can do to help your chances the second time around.

There are always students who go through the process and don’t end up matching to an otolaryngology residency program in the U.S. Many students ask me “Why didn’t I match?” Common factors include low test scores and/or grades, inadequate research, lack of robust letters of recommendation, or weak interview skills. It may also mean you did not apply to enough programs or that your couples matching was too narrow. Occasionally, a student does not match despite an outstanding application.

While you cannot receive direct feedback, I encourage students who did not match to sit down with their program director or other mentor to identify any factors in your application that can be improved before you apply again.

What is SOAP and how can that help me?
If you do not match, then you should participate in the Post-Match Supplemental Offer and Acceptance Program ®(SOAP). SOAP is an opportunity for eligible residency candidates who go unmatched during the main residency match to apply to residency programs with unfilled positions. You would need to register for SOAP, which takes place right after the main match concludes. You can apply to residency programs that did not fill all their slots and often do a phone interview and create a rank list. There is a match process later in the week where you will get another three opportunities to match.

What options do I have if I need clinical or research experience?
One option is to graduate and pursue a paid fellowship position. Some large otolaryngology departments have paid research positions available to work in a lab doing research related to otolaryngology. Some of these programs have clinical shadowing components. This option also helps when it comes to letters of recommendation, as the reviewer is able to comment on your clinical knowledge and ability, to write a stronger and more comprehensive letter of recommendation. While there is no central database of these opportunities, Otomatch (www.otomatch.com) lists some postings for these types of jobs. I have noticed more of these types of positions offered in recent years. Remember that some of these positions are posted and others are more informal. Build your network and stay in touch with mentors who are in a position to know about these opportunities.

Are there opportunities at my medical school?
Another opportunity is to extend your medical school training by a year and participate in research. You may also be able participate in more clinical rotations during this time. This avenue defers your student loans and gives you a chance to shore up your research experience on your CV. Many medical schools, like Tufts, offer this option. You would need to meet with your dean to find out the process through your medical school. Also seek advice from your program director regarding the research, sub-internships, and other rotations that you schedule for this year. Again, this type of opportunity is more likely to lead to stronger letters of recommendations on your research abilities and your overall qualifications.

You can also pursue a PGY-1 preliminary internship in general surgery. I would recommend participating in otolaryngology related research during this time, and to rotate or informally shadow with otolaryngologists if at all possible.

What other resources can help me?
I think it again goes back to what the issue was in your application. For example, some people have a quiet personality and may be perceived as passive in the interview setting. If that is the case, then ask your mentor or colleagues to help you with mock interviews and practice sessions.
You should plan on staying in touch with your medical school and consider asking the Dean for help finding a mentor. If you do not have an otolaryngology department, it is more challenging, but not impossible. I know that students who are in newer programs in Chicago, for example, have reached out and found a mentor at other local medical schools with an established department. Start with the dean but remember that will only take so you far. The Dean is expected to counsel all medical students, so ask for a reference to someone in the specialty or ask other medical students or residents for that referral.

Any final thoughts?
Candidates that don’t match the first time can have success in subsequently obtaining a residency position. It is more challenging, but there are things you can do to improve your chance of securing a spot. Do your best to elicit the reason(s) why you didn’t match and go from there. Tap into your program director or other mentor. Multiple strong letters of recommendation from different institutions are very helpful. Physicians that know you well and have observed your work are more likely to not only write you a strong letter but reach out and vouch for your abilities and provide a strong endorsement.

You need to advocate for yourself, have a back-up plan, build strong relationships, ask questions, stay in touch, and strategically plan your next steps.




About Miriam O’Leary, MD
Miriam O’Leary, MD, is assistant professor and the residency program director in the Tufts Department of Otolaryngology. She graduated from the University of Connecticut Medical School and completed an internship in General Surgery and otolaryngology residency at Boston University. In addition, Dr. O’Leary earned a fellowship in head and neck and microvascular surgery from the University of Miami.