Going unmatched

[CutaneousManifesto]

Curious as to what some of you have or have heard of people doing when they don't match into their desired specialty?

[1D7]

9 hours ago, CutaneousManifesto said:

Curious as to what some of you have or have heard of people doing when they don't match into their desired specialty?

There are a lot of old threads related to this topic, try the search function. Some of the info is also school specific, so ask your school's admin/dean.

Short answer:

If unmatched in 1st iteration, apply to FM and/or path in 2nd iteration.

If unmatched in 2nd iteration, do electives and research, then apply to CaRMS a 2nd time. For most people, you should just do FM or pathology since they're the least competitive. If you're ballsy and wealthy enough, you can probably afford to try matching to your original specialty of choice even though you'll probably go unmatched. Note you will probably pay full tuition for this extra year.

If unmatched again, repeat the last step and re-apply to CaRMS.

Long answer:

In general if you don't match to what you want in 1st iteration, you apply broadly in 2nd iteration (usually to family medicine +/- whatever else is remaining you could stomach doing). Keep in mind that it's often possible to transfer from a 5 year residency to FM since it's only a 2 year residency. Pathology is usually the easiest 5 year residency to match into. Transfers are easiest to arrange within a school.

If you don't match after 2nd iteration, you delay graduation to pursue electives as a M5 to network and try to enroll yourself in some sort of research related to the field you are pursuing (ideally family medicine or pathology to maximize your chances at matching). Most schools now help you do this, though I believe there are a few out there that still basically leave you to fend for yourself, meaning no electives and no help with research. Pray you're in one of the schools that helps you. At the end of this, you apply a 2nd time to CaRMS.

In the 2nd time going through CaRMS, it seems pretty hard to go unmatched again if you are applying broadly to FM. Of course, some people feel they have to fight for their dreams and dual apply to include the specialty they originally wanted—if you do this you risk going unmatched again since you've probably split your application. To be successful in applying to competitive specialties during your 2nd run through CaRMS, you probably should have something else going for you outside the normal important stuff (e.g. nepotism, extreme luck, being really attractive, amazing social skills, etc.). Ideally you should probably just try for FM or path if you want to match. I think IM/psych are the only specialties where it might be possible to dual apply without hurting yourself too much since you can mix and match electives in these specialties and still look like you want FM.

If you go unmatched in both iterations in your 2nd time through CaRMS, your school will either force you to graduate or allow you to pay another year of full tuition to go through more electives. If you do graduate, you will probably not have any professional insurance, meaning you will not be able to do any more electives (unless you have $$$ to pay for it yourself), only observerships/shadowing. If you don't graduate, then it's just repeating the process again. Hopefully if you have to apply a 3rd time, you will realize that having a job in FM or path is much better than not having a job and you'll do a better job focusing your application on one of these specialties.

[CutaneousManifesto]

Thanks for the thoughtful answer! What do you think about taking the USMLEs and applying to the US?

[1D7]

52 minutes ago, CutaneousManifesto said:

Thanks for the thoughtful answer! What do you think about taking the USMLEs and applying to the US? 

Always a good idea for M1s/M2s applying to anything really competitive, assuming they value career over geography. Ideally these students finish Step 1/2 in the summers of your preclinical years (probably M2 summer).

For students who find out they're unmatched and have not done USMLEs, there is still a high chance to match the next round of applications if they focus their  application on FM+apply broadly+don't have a major red flag (i.e. gross professionalism or legal issue). Personally I would only recommend USMLEs for people re-applying for FM if geography matters a lot for residency (e.g. prefer Detroit FM>>>>rural Sask FM).

Students who want to re-apply for something competitive after being unmatched only stand a chance at places they do electives at anyway, so they have to evaluate whether taking time to study, do USMLEs, and do American electives is even worth it. These students should have probably done USMLEs earlier on in M1/M2.

[Edict]

Also the issue with applying to the US, would they ask why it took you an extra year to graduate. Also not sure if you have to declare on ERAS that you've previously applied to CaRMS or not. Not sure. Ofc at that point, you'd probably be applying to programs that won't mind too much. 

[indefatigable]

On 3/27/2019 at 12:43 AM, 1D7 said:

Always a good idea for M1s/M2s applying to anything really competitive, assuming they value career over geography. Ideally these students finish Step 1/2 in the summers of your preclinical years (probably M2 summer).

...

These students should have probably done USMLEs earlier on in M1/M2.

For both Step1 + 2 - I think that's a little ambitious.  US med students aren't radically different than Canadians - and they're both gunning and learning material for Step 1, usually taken at the end of M2, now writing even later at some places.  Plus - they've generally been doing standardized tests since PSAT (gaming the fingerprint system for the MCAT may be a little harder than the "small time" SAT bribing that's popped-up)..

But if you think that the 500-1000/hr prep that US med students typically do for Step 1 (with thousands of UWorld, etc questions) can be sidestepped, or crammed in non-US focused curriculums, on top of ECs, shadowing, research, and whatever else then great!  I'm sure colleagues in the US would be interested in hearing as well!

[ZBL]

On 3/26/2019 at 10:25 PM, CutaneousManifesto said:

Thanks for the thoughtful answer! What do you think about taking the USMLEs and applying to the US?

My philosophy on the USMLE during med school is dependent on specialty of interest and reason for applying to the US. 

 

Reasons to do the USMLE:

- If the US is your first choice place to match

- if you are worried about going unmatched in Canada and wanting some backup FM/IM options in the US (may be less important if you are aiming for something less competitive in Canada to begin with)

- if you are interested in a specialty with poor job prospects in Canada 

- you want to work in the US one day but not sure what state or the rules

 

note the above all require diffetent levels levels of success on the USMLE

 

Reasons to not do the USMLE

- you are using US applications to a competitive specialty as s back up - anyone who can match something competitive in US should easily be able to do so in Canada (I.e. plastics, derm etc in the USA ARE NEVER a reasonable backup plan). 

- you have no intention of ever working in the US or figure you’ll cross that bridge if/when it comes up

- you are confident in your Canadian match  chances or just don’t give a damn

 

 

[GrouchoMarx]

pathology

 

some of our strongest residents are the left-behinds.

[GrouchoMarx]

12 hours ago, ZBL said:

My philosophy on the USMLE during med school is dependent on specialty of interest and reason for applying to the US. 

 

Reasons to do the USMLE:

- If the US is your first choice place to match

- if you are worried about going unmatched in Canada and wanting some backup FM/IM options in the US (may be less important if you are aiming for something less competitive in Canada to begin with)

- if you are interested in a specialty with poor job prospects in Canada 

- you want to work in the US one day but not sure what state or the rules

 

note the above all require diffetent levels levels of success on the USMLE

 

Reasons to not do the USMLE

- you are using US applications to a competitive specialty as s back up - anyone who can match something competitive in US should easily be able to do so in Canada (I.e. plastics, derm etc in the USA ARE NEVER a reasonable backup plan). 

- you have no intention of ever working in the US or figure you’ll cross that bridge if/when it comes up

- you are confident in your Canadian match  chances or just don’t give a damn

 

 

The bolded is incorrect.

 

A stellar score and some good references will open up doors to any other specialties down there.

 

Unlike in Canada, the USA does not expect students to do audition rotations, seeing them as the wastes of time, money and energy they are.

 

For instance if you prepared a great radiology applicatio but the numbers are against you up here there is no reason why the USA would not be a reasonable backup provided you have killer scores.

Plastics/derm are hypercompetitive on both sides of the border, so things like nepotism and sexiness come into play. Still, the USA gives you another flip of the coin even with these fields, provided your application is strong in other ways and your scores are stellar.

[indefatigable]

31 minutes ago, GrouchoMarx said:

For instance if you prepared a great radiology applicatio but the numbers are against you up here there is no reason why the USA would not be a reasonable backup provided you have killer scores.

Plastics/derm are hypercompetitive on both sides of the border, so things like nepotism and sexiness come into play. Still, the USA gives you another flip of the coin even with these fields, provided your application is strong in other ways and your scores are stellar.

Specialty dependent - scores are necessary but not sufficient for some highly competitive specialties.  They're looking for the whole package - scores, clinical, letters, research, etc...  plus a great interview.

That said, there are more options than in Canada - with some programs either leading clinical/research centers and others.. well.. having trouble.  So in that sense, the US could give one a second kick at the can...  CMGs won't in general be preferred over USMGs everything else being equal.  And US citizens will be preferred over non-US citizens, all else being equal 

[1D7]

15 hours ago, tere said:

For both Step1 + 2 - I think that's a little ambitious.  US med students aren't radically different than Canadians - and they're both gunning and learning material for Step 1, usually taken at the end of M2, now writing even later at some places.  Plus - they've generally been doing standardized tests since PSAT (gaming the fingerprint system for the MCAT may be a little harder than the "small time" SAT bribing that's popped-up)..

But if you think that the 500-1000/hr prep that US med students typically do for Step 1 (with thousands of UWorld, etc questions) can be sidestepped, or crammed in non-US focused curriculums, on top of ECs, shadowing, research, and whatever else then great!  I'm sure colleagues in the US would be interested in hearing as well!

I don't think it's unreasonable to write the Step 1 by M2 and Step 2 some time in M3 or 4. American medical school lectures typically don't teach directly for Steps, just like we don't teach directly for the MCCQE.

Most of the preparation is done on their own time self-studying using a few widely known study materials. While difficult and time consuming, 2 summers plus some studying during the school year is enough time to study for the Step 1 and obtain a competitive score. With Step 2, I don't see any issues at all. UWorld can be completed during clerkship. Personally I found it very useful and it made me one of the more knowledgeable students on certain rotations.

As for actually matching to a competitive position, yes I agree with the above that you are highly unlikely to obtain a derm or similarly competitive position However, this is still the best bet for students who want to increase their pool of programs—you are much more likely to do well on the Step than learn enough French to apply to Quebec. Additionally, there are a small number of IMGs that match to competitive American specialties each year; technically we are considered AMGs so we have a leg up on some of them.

Mainly it is helpful to backup into IM or another program of low-intermediate competitiveness that you would have more trouble here in Canada backing up into.

[indefatigable]

On 3/30/2019 at 3:10 PM, 1D7 said:

I don't think it's unreasonable to write the Step 1 by M2 and Step 2 some time in M3 or 4. American medical school lectures typically don't teach directly for Steps, just like we don't teach directly for the MCCQE.

Most of the preparation is done on their own time self-studying using a few widely known study materials. While difficult and time consuming, 2 summers plus some studying during the school year is enough time to study for the Step 1 and obtain a competitive score. With Step 2, I don't see any issues at all. UWorld can be completed during clerkship. Personally I found it very useful and it made me one of the more knowledgeable students on certain rotations.

As for actually matching to a competitive position, yes I agree with the above that you are highly unlikely to obtain a derm or similarly competitive position However, this is still the best bet for students who want to increase their pool of programs—you are much more likely to do well on the Step than learn enough French to apply to Quebec. There are a small number of IMGs that match to competitive American specialties each year; technically we are considered AMGs so we have a leg up on some of them.

Additionally, there are many intermediate competitiveness specialties (e.g. anesthesia) where it is realistic to match to an American program provided you have competitive Step scores.

I agree Step 2 is different and can be prepped during clerkship, and Canadian students have no issue with it at all, and can be used as a useful adjunct.  

 I also agree Step 1 material can be self-taught to some extent.  

However, I think it would be exceptional to write Step 1 before having done half the core blocks in M2.  Even US students don’t do that. Plus - at US schools, the trend is to start writing Step 1 later, during clerkship, even after M2.  

My own experience in US education, speaking with USMGs and examining detailed curricula of US med schools does to me suggest there is a significant difference between US and Canadian medical education, generally speaking.  It can depend on the Canadian, US school etc.., but the bottom line is US students are being prepped for Step 1.  Often there is explicit faculty led review- yeah it may not be as good, or on point, etc as other resources, but it's a whole different world than from some Canadian curricula.  They call this period "Dedicated". 

The reality is specialties like path have a large role in US medical education, but not in Canada (generally speaking).  Same with anatomy, embryology and lots of other subtle differences that add up.  

Again some schools may be closer to US model education - like historically McGill, where it's both known internally and have had many prominent successful US matches in the past.  Unfortunately, McGill did have a very tough CaRMS year this year, for sure, even though it did update its curriculum several years ago to be more clinically friendly.  

But I do agree with you 100% with Steps vs learning French enough to impress and land a residency spot, except in maybe very particular circumstances.  So I think we agree more than disagree, but still have some notable differences of opinion.  

[ZBL]

1 hour ago, GrouchoMarx said:

The bolded is incorrect.

 

A stellar score and some good references will open up doors to any other specialties down there.

 

Unlike in Canada, the USA does not expect students to do audition rotations, seeing them as the wastes of time, money and energy they are.

 

For instance if you prepared a great radiology applicatio but the numbers are against you up here there is no reason why the USA would not be a reasonable backup provided you have killer scores.

Plastics/derm are hypercompetitive on both sides of the border, so things like nepotism and sexiness come into play. Still, the USA gives you another flip of the coin even with these fields, provided your application is strong in other ways and your scores are stellar.

I meant more in the sense that it is statistically unlikely that most Canadians taking the USMLE will do well enough to be given a second look for most competitive specialties in the US. Therefore, when planning to write the USMLE, it’s unreasonable to do so with the expectation that you will automatically be able to apply to any specialty you want in the US, other than lesser competitive things as backups.

This comes back to my point further down: anyone who can match something competitive in the US can absolutely match something competitive in Canada, not the other way around. Derm, plastics, neuroSx, ortho are infinitely more competitive in the US by nature of the extreme USMLE scores needed, emphasis on coming from a good school, and way higher research expectations. The US is NEVER a backup option for those things - it’s not just another flip of the coin.