Last week, Match applicants learned if they matched into a residency program. Posts celebrating the 2023 Match results flooded social media, with many expressing happiness and excitement about the future. This is because the Match is not just any other day -- it culminates the medical school experience and confirms many students' identity as future physicians. But this isn't the case for everyone.
That same day each year, many qualified applicants go unmatched. They may feel alone and sad as they scroll through the successes of their peers posted on social media. They may feel like a disappointment as medical schools publicize Match lists and Match statistics as an almost expected success. For a group that has been succeeding their whole life and struggles with imperfection, this feels like a failure. The worst part is, we don't hear their stories as loudly and often neglect to support their experiences. Instead, they are often scrambling for a position through the Supplemental Offer and Acceptance Program (SOAP) process, behind closed doors and in silence.
But these students are far from alone in their experiences. Per the National Resident Matching Program (NRMP), for the 2023 Residency Match, of those applicants who certified a rank list, 81.1% matched into a first-year position. There were 3,049 applicants who did not submit a rank list, likely because they did not get any interviews. For Match 2023, many U.S. allopathic and osteopathic medical students matched (93.7% and 91.6% respectively). In contrast, the match rate was lower among international medical graduates (IMGs): U.S. citizen IMGs had a match rate of 67.6% and non-U.S. citizen IMGs had a match rate of 59.4%.
For those who didn't match, we must normalize discussions about not matching and find all opportunities to support these applicants in their subsequent decisions. Even more importantly, we suggest that medical schools take a proactive approach to discussing the possibility of going unmatched with their students. These institutions should be responsible for providing more robust education and support.
Recently, social media has become a place for these conversations using the #unmatched or #SOAP2023 hashtags, which helps normalize rather than stigmatize not matching. Online we see many applicants receiving support from attendings who previously went unmatched, as well as programs looking to fill slots for research positions, for example. Yet, social media should not be the only, or even primary, place that unmatched applicants have to turn for support. For one thing, not everyone is on social media and even if they are, many do not feel able to openly discuss their challenges with the Match.
This is why medical schools and national organizations can help play a bigger role.
It should not solely be up to the unmatched student to have to figure out the next steps in the process in the acute setting of being unmatched. One solution is for medical schools and national organizations to hold a formal webinar series in February to prepare applicants for the potential outcome of not matching. While no medical school can guarantee an applicant will match into residency, they can better educate students about possible alternative pathways to practicing clinical medicine. A few topics to discuss upfront include:
- Adjusting their career trajectory in a realistic manner
- How to approach repaying loans despite not Matching into residency
- The option of going through the SOAP process to find a position in their preferred specialty
- The possibility of applying to a different field to increase the likelihood of finding a position
- Exploring opportunities for a job or research position, and reapplying to the Match in the future
All of it should be presented as a possibility, not a failure.
Additionally, it is critical for schools to provide structured mental health support and resources in advance of the Match. While data on the impact of the Match on mental health is limited, subjectively we have heard many stories of worsening mental health during this process. There are even past reports of suicide following Match Day. As such, schools and national organizations can distribute mental health resources, like the Physician Support Line number, to all applicants, and should offer easier access to a list of emergency counseling services. Prevention is an important approach for mental, emotional, and behavioral health in the same way as treatment. Medical schools can consider taking preventive steps by offering opt-out mental health services or stress reduction skills training earlier on in medical education.
Ultimately, the Match is a time of personal and professional development, and for unmatched applicants there are opportunities for the medical community to provide greater support and guidance. People should not feel shunned, they should feel embraced. We need to improve the culture of help-seeking and dialogue about being unmatched, and reduce the stigma.
Simone A. Bernstein, MD, is a resident physician at Washington University School of Medicine in St. Louis, and a co-founder of Inside the Match. Alex Gu, MD, is a resident physician at George Washington University School of Medicine and Health Sciences. Kamran M. Mirza, MD, PhD, is an associate professor, vice chair of education in the Department of Pathology and Laboratory Medicine, and assistant dean of Diversity, Equity, and Inclusion at the Loyola University Chicago Stritch School of Medicine. Jessi A. Gold, MD, MS, is an assistant professor and director of Wellness, Engagement, and Outreach in the Department of Psychiatry at Washington University in St. Louis, and a member of the MedPage Today editorial board.