Residency Match Day: What to Do If You Don't Match

Updated March 12, 2021

By Friday, March 19th, medical students across the country will have anxiously awaited what is perhaps the most important news of their medical careers. It's Match Day, the day they find out if they matched into the residency program of their choice. The anticipation can reach such a fever pitch that a successful match can produce much elation while an unsuccessful match can be a crushing defeat.

But what do you do if that happens, if you don’t match? We’re here to tell you there’s no need to worry, that success is still within reach. It’s not the end of your career and doesn’t make you a less worthy doctor—and you definitely won’t be the only one who doesn't. According to the National Resident Matching Program numbers, almost two thousand medical students didn’t match in 2020 and were offered positions during the NRMP Match Week Supplemental Offer and Acceptance Program®. 

First, let’s talk about why you didn’t match

According to Dan Pelzman, a resident at the University of Pittsburgh Medical Center, “the most common reason for not matching is poor scores on national board exams, applying to a specialty that’s too competitive for the applicant’s academic standing, poor interviewing or interpersonal skills and having to repeat the board exam multiple times to pass.”

However, even with so many graduates unable to successfully match, there is still hope. Most U.S. medical school graduates often spend a year doing research or complete a fifth year of medical school and then apply to the match the following year. Results of a study published by JAMA, indicate more than 99% of U.S. medical students end up practicing medicine within six years of graduating. 

So, assess your situation and be objective about which scenario best relates to yours. Then, go through these possible next steps and get back on track.

1. Build your profile and try again

Dr. Pelzman points out that “the two most important factors in obtaining a dream residency spot are a solid academic base (e.g. grades and Step scores) and networking. It goes without saying that everyone should study hard for Step I and II and perform at a high level during their clerkships. Networking, however, can be a difference-maker in your application. Strong letters of recommendation from prominent academic physicians can be a foot in the door at the most competitive residencies. For smaller residencies, doing an away rotation at your dream program can be far and away the most important component of your application!”

2. Look for vacancies through SOAP

Another option for med school graduates is the NRMP Match Week Supplemental Offer and Acceptance Program® (SOAP), an organization which helps unmatched applicants find open spots. In the SOAP, applicants can apply to a maximum of 45 programs (30 programs during the first cycle (Monday), 10 programs during the second cycle (Wednesday), and five programs on the third cycle (Thursday). The positions go quickly because most programs review applications speedily to choose the most desirable candidates within the SOAP system.

3. Practice as an assistant physician in under-staffed states

States such as Missouri, Kansas, and Arkansas have passed laws which allow unmatched graduates to work in medically under-served areas without doing a residency. In fact, Missouri has a  category of licensed professionals—“assistant physicians”—which assists medical school graduates who have passed key exams yet have failed to match. Since Missouri is experiencing a significant shortage in short and primary care physicians, this law seems to be the answer for certain urban communities and rural counties in desperate need of medical professionals.

4. Taking pre-match steps to prepare for uncertainty

Even medical schools are taking action. The University of Illinois College of Medicine has started a residency preparedness initiative with the goal of ensuring students are as prepared for the Match as possible. Part of the initiative involves a mandatory course all medical students must take, which requires them to develop a strategic plan for the Match or alternate career paths. The school has also implemented a loan assistance program, ensuring graduates with medical school debt who have participated in the residency preparedness initiative and haven’t secured a residency position, will not have to assume interest on their school loans for up to one year. 

If you're applying for residencies, check out our Residency Applications Clerkship Survival Guide to get tips & tricks for a successful match.