DIP Episode 448 - What to do if you did not match + Some ERAS 2023/2024 recommendations

Welcome, my name is Divine. This is a episode 448 of the Divine Intervention Podcast. And to this podcast I'm going to be addressing the topic what to do if you don't match. What to do if you don't match. And I'll also give some advice for the upcoming match cycle. So what do you do if you don't match? I'm just going to go right into it. Number one, you need to figure out why. Why, why, why. Many times the good first point of call is to reach out to a program. The programs that you interview that. That will have any feedback for you. That you know, you're very likely going to go through the process again. What feedback do they have? All they recommend that you do in the future to improve yourself. You'll be surprised but you can get some very good information from those people. And wherever possible, honestly try to speak to people over the phone. Over the phone, people will likely give you honest advice and just tell you as it is, that some well crafted email that some program coordinator or program secretary crafts for people. Now also in terms of asking yourself why you need to do an honest self-assessment. The thing is you can light your like at the end of the day, you got to tell yourself the truth. Maybe let me put it that way. You had to tell yourself the truth. Many people, they don't tell themselves the truth. And then they wonder why things are going a certain way. You need to tell yourself the truth. It's very easy sometimes to overestimate your capabilities.

Believe it or not, you know, because again I've worked in many cycles with tons of students from all over the world. And you see some people be really overestimate how good the application is. You see them, they're talking themselves of a storm, saying, or I want to match into these very competitive specialties. In these very competitive parts of the country, or I've always had this as a dream. Don't get me wrong, I'm not saying that. I mean, again, it's okay to dream. But you also sometimes have to be realistic with what you have. If you have a dream, you need to work towards that dream. But you see some people, you know, they have like very mid-link scores or they fail the USMEL exam or two. They have no connections, no research, nothing. And they've graduated from med school for years. And then they magically believe that they can match into diagnostic radiology. That's just not the way life works. Again, I'm not going to come here, sit here and sugar good things for you. No, I'm just going to tell you the truth. That's just because, you know, many times you see people, they're like, oh, you found a severe and if I pass severe or match, the thing is you may be able to match, but you just need to change your ways. You need to change certain things and be realistic. At some point, you kind of need to ask yourself, do I want to have a job or do I want to have a job? Or do I want to match into this dream specialty for me?

If you want to match into this dream specialty for you and you've tried and you notice that it's not working. If you try again with the same approach, you're probably going to get the same outcome. Again, going to be blunt in this podcast. So do I own a self-assessment? Ask yourself, was it a problem with my scores? And I will give some advice on what to do in that circumstance down later in this podcast. Was it my scores? Was it my application? In fact, I'm telling you this, whenever you see a person that has really good scores, but they have a very poor, you know, they have lots of interviews and they end up not matching. It is almost always some personal factor. What do I mean by personal factors? Either the way they structure the applications or the way they structure their interviews. They basically took those scores, they got into their heads, they became really proud, and they have obfuscated the way they presented themselves. I'm telling you this as a person that has been on an admissions committee. You see some people, they have the strongest scores, but without flinching, you know that these people should not be in your program. Without flinching, like literally, you attend one of these meetings. And within the first five minutes, talking about this person, you're like, yes, this person is perfect in every way. They have the scores, they have the research, they have the experiences, but this will be an absolute disaster in our program.

So you need to humble yourself and again, assess what went wrong. What went wrong? Don't keep again overestimating your capabilities. You need to humble yourself because that's the thing. Actually, many people that go into medicine have extremely strong egos and sometimes those egos can prevent them from making headwind life. So you've got to humble yourself. Okay, did I scroll? Or you even see some people, like for example, I've seen some IM Gs and English is not their first language. And you know, they have good scores, but then you will, and they tell you that, man, divine, I have good scores, but I didn't get any interviews. And then you start looking through the application, read over the grammatical errors, or they do certain things that you see as advice online, but it's actually like really wrong to do. Like, honestly, I tell many people this, be wary of what you read online, because people will never give you the full story. And the thing is you cannot take a person's circumstances, and extrapolate the circumstances to yours, because their personal circumstances may, they may have similar scores to you, but their personal circumstances may be very different. Like for example, you see people, they see some individual, oh, this person matched into radiology with two 20s on step one, and two 30s on step two, and no research. And they're like, hmm, you know, my story is very similar to this person.

The person has similar scores to me, so I'm just going to do exactly what he did, and it's going to guarantee that I match. But then that person may not see online, just for private series, he's like, oh, wait, my dad, has actually practiced as a physician for 20 years, and he knows like 10 different program directors, and this, and that, and this, and that. Or I did my research project with a program director, and the program that I matched into. They won't say all those things, because they don't want to identify themselves. Like I'm telling you this, the people that I've seen for the most, and getting to trouble the most, with what somebody said online, and they used it, accepting a hookline and sinker, and they just blocked the applications at IM Gs. So again, just be careful of what you read online. Just be careful of what you read online. So do some serious self-reflection, and the thing is, be methodical about it. Where did I screw up in my application? How may I have screwed up in my interviews? What feedback did I obtain from people? What do my scores look like? What does my research look like? You know, just break things down in that way, and then just be honest with yourself. Or, hmm, did I apply to programs that were too competitive, giving my scores? Or was I too geographically restricted? Or did I ignore the importance of something seemingly small, but something that's quite important?

Like, many people did just kind of blow off the supplemental application, but it ends up being very critical. Or you see people, they failed USML exams, and they don't explain it in their personal statement. No one is going to trust you. If you're a person that, well, you failed a USML, and you didn't fail the need to explain it in your personal statement, that's just really poor form. But again, many of these things, you won't see people talk about them. So again, there are many reasons. And sometimes, if you notice that you're like, man, I've looked at all these things and I can't find any clear reasons. Speak with someone that is experienced. Just find a program director that, you know, you can just say, please, I just need someone to honestly assess my application and tell me where things went wrong. Again, it's always helpful to kind of keep that in mind. So that's the first thing you should do. Now, the second thing I will say to you if you don't match, if you're a US medical student, I'm strongly considered a deline graduation. Strongly considered a deline graduation, you know, because if you've not graduated, then you can still have that tag of being a medical student. So what can you do within that year you take off? Hopefully your medical is the one that doesn't make you a pituition for that extra year.

But do things like research, you know, research fellowship will be very helpful, especially again, if it's related to what you're attempting to match into before your application, before your application, you know, you can do a fellowship or research fellowship, you can do an extra degree like an MBA or an MPH, although those are probably low yield than doing research and working within the discipline that you're trying to match into. And you know, you can even do a clinical job that is related to what you'll be reapplying into. So say for example, you want to become, want to go into plastic surgery and you don't match. You know, consider working at a plastic surgery office. And again, like try to be high yield about these experiences, make them relatable to what you want to go into. And try to be in positions that put you in close contact with people that have pool in that field, like program directors or major attendants in a department or chairman of department, that can always help you. And also to be honest with you, before you start doing all these crazy things, go and visit your dean. You'll be amazed with the kind of pool your dean has, honestly, like at many of these big named match schools, they can almost create a residency spot for you. It may not necessarily be like a full-blown residency spot, but it can be like a prelim spot. You may just notice that, wow, a program has ACGME-Ly-Centure to handle 20 prelims. But you know, the only 0.15 spots.

And they can say, you know, we don't need those five spots, but you speak to your med school, and they can say, you know, let's work something out for you. One of those five spots is going to open them up for you. You'll be surprised with what you can, with what you can get. So those are things I would recommend that a US medical USMT student does. And for an IMG, here's what I'm going to say. For an IMG, you cannot afford to be choosy. But if you, the match process has gotten a lot more brutal, for IMG's over the last two, three years. There's definitely been a big shift in the outcomes of the match since 2021 for IM Gs compared to every year before 2021. Basically, since COVID happened, I don't know what's going on. I mean, there are many factors of kind of explaining this in other podcasts like, you know, the ease with which people can do more interviews than they need, or people applying to tons of programs, and programs seeing more applications than they used to before because most things on Zoom these days. But I'm telling you, if you're an IMG, you're walking into a brutal process. Is it impossible to match as an IMG? No. But are you going to have to put in like your best foot and the second feet and your arms, your hands, and everything? Absolutely. So the thing is for an IMG, just be diverse. You know, don't be choosy. Like you see, the IM Gs, they have middle-end scores, and they are like, oh, you know, I only want to concentrate on this part of the country.

I wish all the best. You've got to be diverse. You literally cannot be a chooser. That's just the truth. You literally cannot be a chooser. Again, I've kind of explained this in other match related podcasts that I've made, but I've kind of described the technicalities of why things have gotten difficult for IM Gs over the last two years, over the last two cycles. So really, for IM Gs, and honestly, not even just for IM Gs alone, but for US medical students, applied to as many programs as you can afford. Again, you still see this advice out there, oh, you know, if you have very strong scores, just apply 20 programs, you're solid. Again, that was the case back in the day. That's not really the case right now. You'd be shocked at the number of people that have very high scores that didn't get many interviews at all, or got a small number of interviews and ended up not matching. So really, apply to as many programs as you can afford. And also, consider applying to easier to match disciplines, depending on how you are. Right? And the thing is, many people, some things that, some disciplines that people say, oh, if you have a pulse, you can match into. Honestly, that's not really the case anymore. Again, I'm not going to mention in specific disciplines. This is a public podcast, but there are some disciplines before that people say, oh, if you have a pulse, you can match into. That's not the case anymore. There are some of those disciplines.

Again, you can probably read it within the lines of what I'm saying. But some of those disciplines that, wow, it wasn't really desirable before. But now, people have noticed that the hours of those disciplines are really good, and the pay is really good. So people are like, hmm, man, I can work 40, 50 hours a week and earn a couple hundred thousand dollars. Why should I not understand is easy to match into. At least that's the story still out there. Why shouldn't I go into those? Well, as time goes on, demand for those disciplines goes up. As that demand goes up, then it's going to get harder and harder to match into those disciplines. So just be careful. These are, suppose that disciplines that you can match with, match into if you have just the pulse, that doesn't really work anymore. So just kind of be mindful of that. So, you know, apply to as many programs as you can afford, because we're applying to, again, easier to match into disciplines, even dual applying is not a bad idea. And let me tell you this. If you're a person that is reapplying into residency, US medical student, IMG doesn't matter. You need to apply to prelims and transitional years. I'll say that again. You need to apply to prelims and transitional years, all over the country. The thing is, many people say, oh, if I don't match into my chosen discipline, I don't want to bother doing a prelim. That's a huge, massive, solid mistake. The thing is, you want to at least get into the system.

You want to at least get into the system. First things first, if you're matching to a prelim, you're going to earn a paycheck for that year. Secondly, you then give yourself another short-add-impressant, especially like an IMG. For some IM Gs, that prelim year is the thing that really makes them become very clinically sound and presents a strong case for them to show people in the US that way. Yes, I'm an IMG, but look at my portfolio for my prelim year. Look at my portfolio for my intern year. I'm doing really well. I'm getting really solid evils. I can do well as a resident. It's almost like a good way to audition as a good resident. But also in a low-risk environment. So I'll strongly encourage you to don't despise prelims, even prelims surgery. Prelims surgery, prelim medicine, prelimpids, transitional years. Don't despise those things. Honestly, I'm telling you many times people that are reapplying, they just need to humble themselves. That's the truth. You know, it's not something you necessarily want to do, but you got to do it. You got to do it. And another benefit of also joining a prelim is, if you do a prelim year and you've taken step three, you can get a full-on restricted medical license. That's not something you're going to be able to do without a prelim year. So if you have a prelim year, you can do that. And you can become at the very least. Let's say you never match again. You can become like a general practitioner. You can do telemedicine.

You can maybe even go into some consulting jobs. You can open your own private clinic that attends to very minor medical complaints and make some money. You can even do disability evaluations and make money that way. So there are many things you can do with an unrestricted medical license. Now, the next one I'll go into is, what should you do when you're reapplying? Where are we applying with wisdom? Again, be very broad in your applying. You know, if you need to apply to 500 programs, again, that's a lot of money. But again, do you want to go on matched or do you want to get into a career? So be very broad in your application. Apply to new disciplines. If you know you didn't match into a particular discipline before, it's just wisdom to apply to a new... You can say, okay, let me reapply into that old discipline. We also need to apply into a new discipline. So you're going to need new personal statements, new rec letters for that discipline and things like that. And let me say something. Put out a much better application than the last one. Honestly, one of the most mind-boggling things I have seen as a person that has a value-thread applications and works with people on personal statements and mocking reviews and everything, is you see people, they literally submit an application that is almost identical to what they have submitted in the past. And then I asked them, how did you expect that things would be different this year?

And then they're like, they don't know how to answer that question. But you can put out the same application. Let me tell you this. Many times, people can pull up the same application you put out the previous year. If you notice that, man, there has really been no change between this year and last year. They won't even extend that interview to you in the first place. So I'm telling you this, when you're reapplying, your application has to be markedly different from what you put out. Even in the way you describe your experiences from the previous cycle, describe them a different way. Describe them a different way. You know, so that means you should have all the things like more research experiences, just something different. There has to be a unique spin on your new application. There's to be a unique spin. And the thing is, even your rec letters, it's not a bad idea to have them updated. Again, you don't want a recommendation letter from 2022 for a 2023-2024 cycle. Again, that is not good for it. And one good thing is you may actually be able to see some of the letters people wrote for you for the previous cycle. If you have weak letters, don't ask those people again. Find new, better, stronger letters. That's just the truth. That's the smart thing to keep in mind. And when you're writing your application, you need to obviously write a new personal statement. That new personal statement will include you commenting on you not matching.

Again, you cannot just hide these things. Program directors are not stupid. Again, it just kind of boggles my mind. And there are ways to explain these things, to where, because people are like, wow, if I put in my personal statement that I did not match, is he going to shoot down my chances? To be honest with you, it depends on how it is described. If you describe it in a good way, and describe a good combat story with no one, you can really help yourself in those circumstances. So don't throw those things away. Like you see people, it just boggles my mind that thinks people don't describe. Like, oh, wow, they're US medical students, and they have to take a year or two years off. And they just decide to not discuss in their personal statements. Mind boggling. Or you feel that you are a semi-exam, you don't discuss it. Mind boggling. Or you feel a few rotations in your med school, you don't discuss in your personal statement. That's pretty mind boggling. So again, just be kind of wise about these things. You know, many of these things are just common sense. Although I guess, as I've found out, I think that the common sense is not particularly common. And when you also apply the next year, you know, apply and also send out letters of interest. Heart-soft letters of interest. Not some mumbo jumbo, run-of-the-mail letter of interest. Just something to keep in mind.

Now, another thing to also keep in mind with, if you didn't match, is just looking for positions outside the match. Again, many of these things pop up. Even in pre-limit programs, there are many pre-limits that go unfilled. I'm telling you, some programs just want a warm body that can come, round on patients, you know, write some notes. So look for these outside of the match spots. And let me tell you this. When you get on the outside of the match spot, I think I want to comment on this especially. There are many people that kind of don't keep this in mind. So if you're matching to like a pre-limit, and you're like, man, I don't really want to be here. I don't really want to do this. So you become like a physical in your clinical responsibilities. You're shooting yourself in the photo. Let me tell you this. When you do a pre-limit year, or you do a year out of program, even if it's something you don't want to go into, do your very best. Do your very best. Why is that important? Well, the first reason why that's important is, the most important, one of the more important components in terms of letters for your reapplication is going to be the letter from the program director at the place that you're at. If they see that you're a horrible resident, they will not write you a good letter. If they don't write you a good letter, your reapplication is dead in the water. That's just the truth. So do well. Take step three. That's again, nothing that boggles my mind.

You see people they're reapplying, you know, they've graduated from med school or whatever. And step three is still undone. Like how do you think that's a wise decision? You absolutely, this is not like an optional thing. You absolutely need to take step three. Because again, it reduces your risk as an applicant. It just tells a program that, oh, even if this person doesn't match, at least they didn't match. At least they are done with the USML exams. So that when they start residency, they can focus fully, squarely and solely on the residency process. And even things like your evaluations, that's why you need to do well. If you're matching to a pretty more whatever, like you didn't really plan for it. Do well. Again, if you get solid evaluations, it can really help your claim. You'd be surprised that programs, they actually request your evaluation, let's say your program extends you an interview. They're like, okay, please, we'd like to see your evaluations from like your first three or four rotations in your pre-limit. And also in training exams, many pre-limit programs make the pre-limit students take the in-training exams. Many times it's going to be an internal medicine in training exam. Don't blow it off. First thing is first, it will help you build your clinical knowledge. But second of all, if you take those in-training exams and do very well on them, it kind of shows all right, let's say you're a person that wanted to go into DUR.

But then you, you want to be able to soak into a pre-limit surgery program. But then you do the pre-limit surgery program, and you do the surgery in training exam, and you just crush it. Even if it's not applicable to what you want to do, a program director that's reviewing that application will be like, man, this person took the in-training exam, and they got like in this very high percentile, for something that they're not even interested in. How much more, how much better would they even do in something that they're very interested in? It just says something about a person's work ethic, and it's something you can literally add to your application. So again, do not blow off these things. I'm telling you sometimes, is the thing that is very minor, that ends up becoming a major factor in getting you into a residency program. And also consider disciplines that don't use the match. They're searching disciplines that don't use the match, like preventive medicine, occupational medicine. There are some programs that you just applied to directly. You're just going to keep that in mind. Just going to keep that in mind. And then again, be realistic with yourself, and try very hard to get into anything. Because the thing is, the more times you reapply, the lower your chances of matching. Honestly, after a certain number of reapplications, you pretty much will not be able to match into a residency. So you're just going to keep that in mind.

And then the final thing I'll say is, if you're dual applying, just shut up. Don't tell anybody. Keep your application separate. You see people, you're dual applying to this and that, and detail every human being that has a listening ear. Again, you don't know, there's this part of the Bible that talks about how information travels. Just be careful. If you want to keep something secret, shut up. Like literally by shutting up, there are many problems you can kind of keep away from yourself. So just kind of be careful of that. Because again, you don't want a person from one program finding out that, wow, you also dual applying in this other thing. So just shut up. If something doesn't need to be said, you don't need to say it. And then obviously when you're reapplying, you know, do very good mock interviews. Just be yourself or pass an individual. You know, besides the research and everything, you know, maybe have some review or personal statement, have some review or recommendation letters. Do mock interviews. Make sure that you're really solid person, kind of going in, putting your best foot forward. And I, you know, pray that everything kind of goes well for you. So I'm going to go ahead and pause here. Again, as I do, I deliver every podcast. I took it off for a step one, to step three. Preclinical, medical exams, 30-ish-off exams. I have these podcasts on the major apps. Apple Podcast, Google Podcast, Spotify.

I have a You Tube channel, Divine Intervention, USML, Podcasts, and videos. I post the videos I make. I also offer review courses for step one. So 25 hour course for step two and step three. It's a 20 hour course. I also have an in-be-in-be-test-ticking strategy course, which is two and a half hours. Social Sciences and Ethics Review. That's a five hours. We really have one taking place this Saturday. And a biostatistics bootcamp. That's going to be, that's a four hour class. If you're interested in any of these classes, just shoot me an email. There are many people that are taking these classes and be funded to be tremendously helpful. And then I also have a new website called Divine Intervention Life lessons.com. It's a website where from a Biblical perspective, I upload two podcasts every week. There's actually an Apple Podcast associated with it as well, the Divine Intervention Life lessons podcast. And I just, from a Biblical perspective, I address a problem that people face. Right now we have almost 170 podcasts. Again, something you can just listen to on the go, very helpful. And then finally, I also work with people on applications with personal statements, rec letters, mock interviews. Just charting a plan for your application and things like that. So if you're interested, just shoot me an email through the website and I'll give you some more information. So thank you for listening to me. Until next time, have a wonderful week. Bye for now.

Figure out why; reach out to previously interviewed programs for honest feedback.

Overestimating their capabilities or being blinded by ego.

Do not be choosy; apply broadly and maintain diversity in geographic location and specialty.

The need to submit an application that is markedly different from the previous cycle.

They provide crucial clinical experience (auditioning ground), help build a portfolio, and can lead to obtaining an unrestricted medical license.

Take Step 3; it reduces the applicant's risk profile by showing they are finished with board exams.

Diversity and breadth of applications (cannot be choosy).

Proactively address the non-match status in a positive way; do not hide it.

It reduces risk and signals to programs that the applicant has completed USMLE requirements, allowing them to focus solely on residency readiness.

Gaining clinical experience/portfolio material and potentially obtaining an unrestricted medical license.

Seek new, stronger letters; do not rely on outdated recommendations from previous cycles.

Shut up (keep the information secret) to prevent program directors from finding out and creating complications.

Diversity and breadth of applications (cannot be choosy).

Proactively address the non-match status in a positive way; do not hide it.

It reduces risk and signals to programs that the applicant has completed USMLE requirements, allowing them to focus solely on residency readiness.

Gaining clinical experience/portfolio material and potentially obtaining an unrestricted medical license.

Seek new, stronger letters; do not rely on outdated recommendations from previous cycles.

Shut up (keep the information secret) to prevent program directors from finding out and creating complications.