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What Happens if You Don’t Match Into a Residency?


Every year, graduating medical students anxiously await Match Day to find out if they have been accepted into their choice of residency program. But what happens if you don’t match? What are your options? First things first: don’t panic. Read on to find out what action steps you can take to make sure you still get into a residency program.

What Happens if you don’t Match into a Residency Program?

If you didn’t match into residency, chances are you’re probably disappointed, but you aren’t alone. According to the National Resident Matching Program (NRMP), 91.3% of residents were matched, leaving 8.7% of residents unmatched, in 2021. Luckily, going unmatched does not mean the end of your medical career. You still have options, but you will need to move fast in order to take advantage of them.

Step one? Take a breath. Step two? Consider why you went unmatched.

Why you may have gone unmatched

Understanding why you didn’t match into a residency program can help you figure out what you can do to make yourself a better candidate. Some common reasons people don’t match include:

  • Low test scores (including failed board exams) – If you have low test scores, you may find that less residency programs are willing to offer you a position than your peers. You can retake your boards, which, if you pass, can help you potentially match in the future.
  • Your specialty is competitive – Certain specialties are more popular than others, so you’ll be competing with more of your peers. Dermatology and surgical specialties tend to be the most competitive specialties, making them more difficult to match into.
  • You had too few residency interviews – If you didn’t participate in many residency interviews, you may have unknowingly shrunk the pool of potential programs to match with. While it’s important not to over interview, you do want to find a healthy balance.
  • Your interview skills were poor – If your interview skills leave something to be desired, it’s likely that residency programs picked up on that. You need to make improving these skills a priority.
  • Your letters of recommendation are insufficient – If you weren’t able to secure enough faculty recommendations during medical school, this could paint you in a poor light when it comes time to match.
  • Your rank order list didn’t cast a wide enough geographical web – If you only apply to a few residency programs, hoping to get matched in a certain geographic area, you’re doing yourself a disservice. When creating a rank order list in the future, consider the programs themselves and put less focus on where they’re located.

What To Do if You Don’t Match

If you don’t match into a residency program, you still have options! Start by considering these next steps:

Participate in SOAP

The Post-Match Supplemental Offer and Acceptance Program® (SOAP®), was developed by the National Resident Matching Program® (NRMP®) alongside the American Association of Medical Colleges (AAMC). It gives partially unmatched (those who only matched into a PGY-1 or PGY-2 transitional position, but not an entire residency program) and unmatched residency applicants a second chance. They assist applicants in matching with unfilled residency positions. To participate in SOAP®, you’ll have to act fast after learning that you weren’t matched, as the program begins during Match Week. To be eligible, you must:

  • Be registered in NRMP’s Main Residency Match
  • Be partially matched or fully unmatched during the Monday of Match
  • Be able to enter your residency by July 1st

Once deemed eligible, you’ll participate in multiple rounds of interviews with graduate medical programs that have open positions to fill. If offered a position, you’ll need to make the decision on whether or not to accept it on the spot.

Create a game plan with your medical school advisor

If you participated in SOAP® and still haven’t matched with a residency program, work with your medical school advisor to try to find positions that are unfilled. To do this, you can search databases like FREIDA™ for vacant positions. If you can’t find an open position that’s suitable for you, your advisor may give you some additional options, including:

  • A transitional slot – A transitional slot allows you to essentially repeat your fourth year of medical school. From there, you can apply for the Match the next year with more experience under your belt.
  • A research fellowship – Research fellowships allow you to do research within your specialty, or one that you are interested in, while increasing your competitiveness as a candidate for the next Match.
  • Another degree program – Going back to school to get another degree, especially in something that would complement your medical specialty, can help you become a more desirable candidate in the future.

Focus on enhancing your application and interview skills

If you plan on applying to residency programs during the next Match, spend the next year strengthening your application and interview skills. If you’re unsure of how your application can be improved, consider the following:

  • Strengthen your personal statement – Your personal statement should be just that, personal. Make sure that your statement is well written, reflects who you are, and is original.
  • Evaluate your letters of recommendation – Letters of recommendation should always describe you in your best light. Plus, they should be written in the last few years by those who know you well. You’ll gain bonus points if your letters are written by well-respected physicians and educators.
  • Gain more experience – Gaining more experience, especially in clinical settings, can make you more desirable to residency programs. If you are an international medical graduate (IMG) student with little clinical experience, this is extra important.

If your application is fine, but your interview skills aren’t, consider speaking with your school advisor. Oftentimes, they can set up mock interviews to help you practice and even recommend courses that could help sharpen your skills.

Take the USMLE Step 3

Was your USMLE score not so great? Residency programs won’t be very impressed and unfortunately, you can’t retake them. To impress potential matches next time, taking the USMLE Step 3 early could do just that. The USMLE Step 3 tests candidates’ ability to apply their medical, bio-medical, and clinical science knowledge and skills while unsupervised. Since most candidates take the USMLE Step 3 during residency, you’ll be at a disadvantage by taking it early. To be successful, you’ll need to dedicate a significant amount of time to studying, as well as be ready to pay the $895 fee.

Consider how your student loans will be affected

If you don’t match into residency, one of your first thoughts might be: how will this affect my student loans? The answer depends on what type of loans you have.

Public student loans

If you have federal student loans, chances are you have a grace period built-in so you don’t need to make payments immediately following medical school. For federal Direct Loans, the grace period will be six months and for Perkins Loans the grace period will be nine months. This can give you some leeway until you find a residency program to match with and start making income.

Private student loans

If you have private loans, your lender will be the one to determine when repayment starts. You may already have been paying while in medical school. If this is the case, your only option will be to contact your lender and ask to postpone your payments. If you’re struggling financially, you may be able to put your loans into forbearance or deferment until you’re back on your feet. Again, your lender will be the one to determine if you’re eligible for either of these options. For more insights on ways to approach your student debt, check out this article from LeverageRx partner, Physician on FIRE.