As a medical student, matching to a residency position is a thrill. Yet there is no guarantee that things will work out according to your plan come Match Day next month, in terms of landing your No. 1 ranked choice of residency program. And when they do not, you may feel as though you’re alone in your disappointment.
But that is not so. It is not at all unusual for medical students to feel some form of disappointment after the Match.
“If something feels off or feels wrong, it’s really common. A lot of unexpected things can happen and no one really has control over the algorithm,” said AMA member Laura E. Halpin, MD, who completed her psychiatry residency and fellowship training at the University of California, Los Angeles, Semel Institute for Neuroscience and Behavior.
“The disappointment is a real challenge. … It’s easy to feel you failed or did something wrong if you don’t get your top choice.”
When plan A doesn’t come through
According to data on the 2023 medicine Match compiled by the National Resident Matching Program (NRMP), 48% of seniors from U.S. allopathic medical schools got the top choice on their rank-order list, while 73% wound up in one of their top three on Match Day. The numbers for seniors from osteopathic schools were similar, with 46% landing at their top choice and 75% getting one of their top three spots.
Based on that math—which is typical of the breakdown on an annual basis—students are often advised to envision living and training at any of their top five choices prior to Match Day. But for some, it is difficult not to get fixated on No. 1.
As a medical student at Texas Tech University Health Sciences Center School of Medicine, Myphuong Phan, MD, MPH, had her heart set on returning to Houston, her hometown, for residency. But things did not go as planned.
Upon reading her Match letter, Dr. Phan “literally froze for 30 seconds—it was like I was not reading what I was reading,” she said. “I didn’t see ‘Houston’ and I was shocked. I found myself crying and it took a few minutes to calm down and be OK.”
Dr. Phan, an AMA member, ended up at her No. 3 choice, the family medicine program at Dell Medical School at the University of Texas at Austin (UT). Instead of being a few minutes from family as she hoped, she was a few hours away.
Yet she found several positives with the structure of that program. For instance, the program at UT was smaller than her top choices—taking about seven residents per year. She discovered that working with a smaller team of residents creates a solid support system.
“I’m challenged, and I’m growing in ways that I’m happy with,” said Dr. Phan during her residency. She is now practicing sports medicine in the Houston area.
“I do think that the opportunities I have here are different from what I would’ve had at my No. 1 program,” Dr. Phan said, noting that he was able to take part in the relatively new, innovative Dell Medical School. “There [are] so many added bonuses with that.”
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The wrong specialty
Dr. Halpin ended up in a program she wanted to go to for general surgery, her preferred specialty in her Match rankings. From the start, however, it just did not feel right.
“On Match Day, I looked around and saw happy people and didn’t feel that happy,” she said. “I didn’t understand what was off at the time. A few months into the program, I realized that it [general surgery] wasn’t the specialty choice that I wanted.”
She began to explore the possibility of leaving the specialty. For residents who take this step, Dr. Halpin cautioned, you must read your employment contract at your program and with the NRMP. Anyone who matches through the NRMP is required to remain in the training program for 45 days after their contract takes effect. Failure to do so could prevent an applicant from being able to re-enter the Match.
Eventually, with help from her medical school advisers, Dr. Halpin identified psychiatry as her preferred specialty. She left her first residency program and re-entered the Match. The following spring, she wound up matching with her current program.
“My Match Day the second time around was me at work opening an email. I was super excited, but it wasn’t the same,” Dr. Halpin said during her residency. She now practices child and adolescent psychiatry in the Los Angeles area.
“In the end, the place I’m at now is a perfect fit for what I want to do as far as specialty and career,” Dr. Halpin noted.
For those who don’t match
Typically, less than 10% of U.S. medical school graduates experience the much greater disappointment of not matching at all. In 2023, the number was 7% for senior graduates of U.S. MD-granting schools, and the same for graduates of DO-granting schools.
During Match Week, unmatched applicants and unfilled programs will work to match with one another through the National Resident Matching Program’s existing Supplemental Offer and Acceptance Program (SOAP). Four rounds of SOAP are planned for 2024.
FREIDA™, the AMA Residency & Fellowship Database® (registration required), enables unmatched students to research residencies from more than 13,000 programs both during and following SOAP. Access is free, but extra benefits—such as a dashboard that helps users save, rank and keep notes on each program—are available to AMA members.
