From Unmatched to Top Pick: The Highs and Lows of a Year in Limbo

I had completed 4 years of medical school and dozens of research projects; applied to my dream specialty, dermatology; and secured a handful of interviews at top programs. It had been almost 2 weeks since I had submitted my rank list, contrary to rumors that it only takes 17 seconds for the National Residency Matching Program to run their matching algorithm, and I opened my email to read the sentence that turned my world upside-down: "We are sorry, you did not match to any position."

Ramie Fathy

Going unmatched was among the most challenging and humbling experiences that I had faced up to that point. I was left feeling alone despite endless support from family and mentors, inadequate, shocked, and most of all, ashamed. After decades of having a relatively clear plan for the future, I wasn't sure what the next year or years would look like — let alone which of several possible next steps was best.

Remembering how difficult and isolating the experience was, I wanted to share my story not to vaunt my success — going unmatched was truly an immensely humbling experience — but in the hope that it might help others who also go or have gone unmatched.

After unsuccessfully going through the Supplemental Offer and Acceptance Program process, I reached out to mentors at my medical school to help me strategize and find a productive way to use the year. I was extremely fortunate that my medical school allowed me to postpone graduation and stay on as a medical student without paying additional tuition. This is a major support to applicants in the difficult position of having not matched that, ideally, would be possible at all medical schools.

Ultimately, I was fortunate to have been taken under the wing of a superstar researcher, dedicated mentor, and major role model of mine, Esther Freeman, MD, PhD, at Harvard Medical School. Thankfully, my work with Dr Freeman was a better fit than I could have imagined, combining a variety of my research and nonclinical interests and translating to a number of publications that I could list on my reapplication.

Though the position was unfunded, because I still had the status of a medical student, I was permitted to apply for funding opportunities at my home institution — another reason medical schools should permit unmatched students to extend their schooling.

My status as a medical student also enabled me to complete additional clinical rotations at my school as well as a virtual elective and an away rotation. Together, these experiences provided a clearer sense of my interests within dermatology, which proved a great help when preparing my reapplication.

My approach to my reapplication was also significantly informed by feedback that I had directly solicited from mentors, research advisors, and faculty that I'd met on the interview trail. Some of the feedback was helpful, some of it less so, and some of it was downright hurtful and pessimistic. At one point, I was told not to reapply and even to consider nonclinical career paths.

The insights I'd gained from my rotations and the advice I'd received — combined with the additional research and extracurricular activities I pursued after going unmatched — translated into an application that I believe was much more cohesive and succinct.

Fortunately, I received about three times as many interviews after reapplying than in my original application cycle, which I solely credit to my family, advisors, and mentors, who all supported me throughout the process and who helped me identify ways to improve my application. In the end, I matched at my top choice dermatology program, Johns Hopkins Hospital, this year and I am incredibly excited and grateful.

Lessons Learned

Looking back, I don't think I would have believed anyone who told me that I would have grown so much from this failure. However, I think that the experiences that allowed me to improve my application simultaneously helped me develop my character and perspective on the future.

For starters, I grew much closer to my family, who stood by my side from the moment I found out that I didn't match. Shout-out to my father, who sat me down every night for 2 weeks to practice interview questions despite his not being in the medical field. My work with Dr Freeman showed me how I can combine my clinical and nonclinical interests in meaningful, impactful research efforts. The numerous email threads and Zoom calls to discuss potential issues with my application reminded me of the importance of feedback and mentorship.

Above all, however, I learned about the value of resilience and grit. Reading Angela Duckworth's Grit: The Power of Passion and Perseverance provided me with a new perspective on my unsuccessful application cycle and instilled in me the confidence and reassurance that I can still pursue the field that I know is the one for me. At the same time, it provided me with a framework to rethink my interests, how to prioritize them, and how I can merge them into a unified application and career. The book is one I would recommend to anyone who also did not match, if not to all medical students.

Key Takeaways

I recognize that, despite the misfortune of going unmatched, many times over the past year I got lucky. I had several close mentors and advocates on my side to help me find a way to spend the past 12 months as well as to help me figure out how I can adjust my application.

My institution allowed me to extend my time in medical school without introducing a major financial burden, and I had the resources available to complete an away rotation and live away from home so that I could take full advantage of my school's offerings. Too often, qualified applicants who go unmatched lack these resources (and at times may have to work for Uber) to support themselves as they reapply — an option I briefly considered myself.

Each year, there are thousands of individuals who have completed all of the requirements to begin training and providing care to patients who are unable to do so themselves. This is a barrier to entry for future doctors, especially at a time when the country is dealing with a major shortage of physicians. There are many factors that contribute to this issue, from an insufficient number of residency positions despite increasing enrollment in medical schools to a lack of mentorship and support to help students strategize as they progress through medical school.

Addressing this problem will require a multifaceted approach involving lobbying from institutions, such as the Association of American Medical Colleges; enhancing and expanding virtual mentorship programs to make them more accessible; and revamping the application process to prevent issues, including interview hoarding. The problem is not solely one that hurts our future doctors, but our patients as well.

To those for whom this cycle did not work out, I have this to say: This is not the end of the road. It is a temporary detour that will make you a better applicant, doctor, mentor, and person. Rather than a roadblock, it can be viewed as a part of the journey that, though unforeseen and undesired, can enrich your overall training experience.

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Cite this: From Unmatched to Top Pick: The Highs and Lows of a Year in Limbo - Medscape - Apr 20, 2022.