On Monday, fourth-year medical students received news they've been anxiously awaiting for weeks: whether they matched into a residency program. Those who matched into a residency program will learn the institution at which they will continue their medical training on "Match Day" this Friday.
Those who receive good news — that they matched into a residency program — often announce it on social media, but a large number of this year's class are publicly announcing that they didn't get the news they were hoping for.
"This is by and large the worst day of my life. I see no positive way forward and I'm looking forward to nothing," tweeted one student.
"Did not Match!" one fourth-year student at Loyola Medical School in Chicago tweeted, "But grateful for every blessing in life."
Doctors across Twitter have responded by sharing their own experiences and setbacks, offering perspective and support.
Several physicians have offered their contact information to students, should they want to talk or strategize in advance of the Supplemental Offer and Acceptance Program (SOAP). This 5-day process is how students who didn't match "scramble" to find unfilled residency positions. One student tweeted that he had already completed 45 applications by Monday afternoon.
More than one physician responded to say that going unmatched is not an end, it's a beginning.
"I didn't Match," a Twitter user who goes by Dr. Spaar wrote. "Then didn't scramble successfully. Then I didn't match a second time. And then I scrambled into the most wonderful, nurturing residency that was truly meant to be. Have my own practice today and couldn't be happier."
The SOAP process is an attempt at addressing the fact that there simply aren't enough residency slots for the number of applicants seeking them.
The scramble is an extremely stressful time, as frenzied students vie for open spots. Some candidates change specialties — an experience many physicians tweeted about — to gain a position. Students can also wait to apply for the Match again in 2022, if they don't get into a program for their preferred specialty via SOAP.
Matching after reapplying is still not certain: A recent article in The New York Times estimated that as many as 10,000 medical school graduates in the US may be "chronically unmatched," meaning they've applied and not matched with a residency program year after year.
Representatives from the National Resident Matching Program (NRMP), which runs the Match and SOAP, were unavailable for comment due to Match week responsibilities.
"Removing the Stigma"
The transparency and resiliency of unmatched students — who have already endured their final year of medical school and the residency application process amid a pandemic — has won them admiration from some. "I think it's so interesting how [the students] are removing the stigma around not matching," said Andrea Merrill, MD, a surgical oncologist at Boston Medical who trains residents and was involved in the Twitter discussion. She says their courage and positive outlook in sharing their results could only be viewed as a good thing in their future applications.
Traditionally, students haven't shared these kind of match results out of fear that programs would downgrade their future applications or that others would judge them, says Julie Williamson, DO, former program director for anesthesiology at Emory.
In a tweet, Williamson said that she has had several students SOAP into anesthesiology after not matching in more competitive specialties like dermatology. She told Medscape that those students thrived and the failure to match ended up being a "twist of fate for them."
As a program director, Williamson said she didn't look at applicants' social media when evaluating them, but others do. She recommends against bitter or derisive posting, but what she's seeing on Twitter is brave students announcing their "non-match" to support and encourage their peers. They're normalizing the fact that "this is not a personal failure, it's a systemic failure," Williamson said.
Several doctors and students have commented on how the pandemic revealed additional flaws within the Match process. Among other issues, the virtual interview process allowed students to take a record number of interviews, more than if travel to multiple cities for interviews was necessary. Some are concerned that top-tier students took more interviews than in previous years, leaving fewer opportunities for other students. Many called for a cap on the number of interviews a student can take.
Others have expressed concern that some students may not have matched because they failed the Step 2 Clinical Skills exam and were unable to retake it because it was suspended during the pandemic. One student said she had spoken to multiple students in this situation who received few interviews and, ultimately, didn't match. The licensing exam has since been eliminated, so students who failed will not have an opportunity to pass. Some speculate filters in the electronic application and evaluation system used for the Match may be allowing program directors to exclude these applications, inhibiting the students from matching in the future.
Still other critics argue that there could be more residency slots, Merrill said. The limited number of training opportunities is "another way the medical system perpetuates the abuse of its trainees," she said. But the courage of these students in starting this conversation and supporting one another is a bright spot, Merril said. "Medicine is usually very competitive and it's nice to see everyone coming together to support each other."
One student, after announcing she didn't match, tweeted on a similar hopeful note : "I'm still going to be a heart surgeon one day, I'm just taking the scenic route. The vision is there. It always will be."
Donavyn Coffey is a freelance journalist who covers health and the environment from her home in the Bluegrass. Her work has appeared in Popular Science, Insider, and SELF.
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Cite this: Match Nightmares: Med Students Share Stories, Fight Stigma - Medscape - Mar 17, 2021.