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General Question About Residency Match


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Hey ladies and gents. Long time viewer, but first time poster. I just started medical school a couple of months ago. Therefore, I am fairly unfamiliar with things that are outside of the realm of premed. I have read a lot of things along the lines of "I accepted my second choice, third choice, etc. specialty because It's better than not matching". I am wondering, what is the consequence of not matching to any specialty. For example, if you do not match to field X one year and it is your first choice, can you take an entire year to bump up your application and apply to same specialty next year? Besides the extra year, what is the disadvantageous of going unmatched? Does going unmatched somehow screw you up for the subsequent Carms cycle? Id greatly appreciate if someone would be able to clarify this for me. Thanks guys! 

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Thanks @Lactic Folly, I have given these links a read (except the queens one, I cant open that for some reason). I have actually seen a couple of these before as well. A lot of the information available online just tells you why people don't match, how reform can improve match rates, etc. 

I wish to gain more insight into a different topic. As mentioned in the first link: "Unfortunately, their chances of being successfully matched the following year are not optimistic either. Over the past three years, an average of 41% of prior–year CMGs failed to match, compared with only 3.5% of current–year CMGs."  
I wish to know the exact reasons for this statement above. Why does reapplying the subsequent year reduce your chances? I would logically assume that another year would allow one to improve an application (by doing more research for example) and therefore improve match success. Why is this not the case?

Also, anyone who knows about this topic please feel free to chime in :) 

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Stigma (referred to in the comments of the blog you were unable to access). The CaRMS application actually allows programs to filter their applications and choose to look at current year grads only. How many actually use this as a criterion, I can't comment, but the perception of "damaged goods" is definitely there, no matter how unfair it might be.

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1 hour ago, clopidogrel said:

That reason makes sense. Are there any other reasons why going unmatching is bad? For example,  with a subsequent attempt I imagine they might forget about you because it's been longer since you did electives at that place? Is this also a factor or can you just volunteer at places etc. to stay fresh in their minds? @Lactic Folly

Stigma is a percentage of it. However, understand that one of the biggest "risk factors" of going unmatched is having previously gone unmatched. There will be some percentage of candidates who have red flags on their CV or aren't going to be desired by residency programs in general. Unfortunately for them, this will always be there. Sometimes its as simple as a bad eval, maybe they lost their temper, were rude, made a racist comment etc. Othertimes it could be a consistent pattern of misbehaviour. It could even be a criminal matter. Or much more innocently, it could be a personality issue, work ethic, lack of insight issue. This is all a very small percentage of candidates, less than 1% of med students, but still enough to be a dozen or so students across Canada a year probably. That will probably also factor into why subsequent match rates are low. 

Programs aren't looking at candidates on a purely numbers level. They are looking at your potential growth as well. In fact, that is probably what they care about more. Just taking an extra year to do more research is not going to make you a better candidate for a competitive specialty unless a specialty somehow had doubts about your commitment to the specialty but loved you otherwise. Another possibility is that it was a very competitive year and the following year your chances might be better. 

The way I see it, there are three main reasons a program might select you after a gap year: 1. you changed specialties last minute, they didn't see enough commitment to the specialty but they thought you were otherwise a strong candidate, in this case doing research, elective etc. will help 2. you applied to small specialty and by a freak accident it was a competitive year (this is less common than people are told, a lot of programs will say this, but in reality unless the program is very small like under 10 spots a year, it is unlikely that there is much year to year variation in competitiveness) - in that case applying the next year might help 3. candidate factors - i.e. you didn't rank enough programs, you didn't apply broadly enough etc. 

 

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9 hours ago, MDinCanada said:

What if you just decided you want to do get experience in something else before starting residency?

It's unfortunate that there's such stigma... In the end, it just disadvantages everyone.

In that case, you should delay your graduation while you undertake your enrichment year, so that you can graduate and match the same year.

4 minutes ago, clopidogrel said:

That reason makes sense. Are there any other reasons why going unmatching is bad? For example,  with a subsequent attempt I imagine they might forget about you because it's been longer since you did electives at that place? Is this also a factor or can you just volunteer at places etc. to stay fresh in their minds? @Lactic Folly

As you may have read, one strategy after going unmatched is to work closely with a department, in hopes of gaining a spot there next round.

Otherwise, I'm not sure that being remembered as an unmatched candidate is all that desirable, especially when you are competing against a fresh cohort of potential stars...

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OP your school should provide you most of this information by the time you start clerkship or soon after.

Reasons going unmatched is bad:

  • You have a significantly lower chance of successfully matching the next year into any specialty and if you go unmatched again after that, your chances further drop.
  • Some schools may not let you go past a 5th year.
  • Without clinical exposure, your skills will further atrophy.
  • Social/mental health reasons (imagine literally every classmate and med school friend you know moving on in something they love, while you're playing the slots machine hoping to match to anything).
  • You must demonstrate you're not a fuckup to a program to have a decent shot at matching.
  • Your money will run dry at some point since most schools will make you continue paying full tuition.
  • Most unmatched applicants were probably non-family med/pathology applicants but for most unmatched their best shot the next cycle becomes family med or pathology.

As for why programs discriminate against the unmatched, from their perspective of the program/PD, an applicant who has gone unmatched in their cohort may have something wrong with them. This may be a red flag on their application, being unprofessional at an interview, being the bottom-of-the-barrel from their class, etc. Of course in reality most unmatched applicants would not have issues as residents, but the probabilistic risk of having a problematic/subpar resident is higher when selecting from the pool of unmatched vs the new CaRMS cohort.

An additional concern from the perspective of the program is that even if the resident performs well, if it wasn't his/her original specialty of interest then they may just be using the funding to try and transfer out. This would be highly disruptive to smaller/surgical programs.

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On 11/20/2019 at 11:12 PM, clopidogrel said:

 with a subsequent attempt I imagine they might forget about you because it's been longer since you did electives at that place?

Don't count on institutional amnesia as part of your match strategy.

I once walked into a fellowship interview at a school where I didn't match for residency, and a member of the interview panel was the PD of the residency that I didn't match to. 

He remembered me.  It was awkward.

 

 

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16 hours ago, ploughboy said:

Don't count on institutional amnesia as part of your match strategy.

I once walked into a fellowship interview at a school where I didn't match for residency, and a member of the interview panel was the PD of the residency that I didn't match to. 

He remembered me.  It was awkward.

 

 

Oops my apologies for the lack of clarity. What I meant is the opposite. It is harder to match at spots where you did your electives because they forget about you during ur gap/unmatched year? I was asking if this is one of the reasons that matching in subsequent cycles is harder; the institutions don't remember you too well compared to current year grads. Is this a possible reason?

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No, what we are saying that you do not want to be remembered as someone who didn't match. There is stigma attached to the fact that the program evidently liked other candidates better than you (therefore you did not match there the first time around). That is why ploughboy's encounter was awkward. It would be better for you if the program did not know you were a prior year grad at all, and were meeting you for the first time along with the current year grads (but this is not possible).

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On 11/25/2019 at 9:08 PM, Lactic Folly said:

No, what we are saying that you do not want to be remembered as someone who didn't match. There is stigma attached to the fact that the program evidently liked other candidates better than you (therefore you did not match there the first time around). That is why ploughboy's encounter was awkward. It would be better for you if the program did not know you were a prior year grad at all, and were meeting you for the first time along with the current year grads (but this is not possible).

stupid long term memories ha

It is kind of variable the impact - many places it counts against you - sometimes quite a bit. There a few places where showing persistency by reapplying may help (and I mean just a few - mostly in areas where a high failure rate in an attempt is expected).  

 

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