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I applied to a ENT and recently went unmatched. Right now, there are no spots in second iteration that I am interested in, and my school is trying to convince me to apply to whatever is available.  Now, I was happy to settle for IM - but even IM is not an available option this year. I really don't know what to do and I feel uneasy doing another year with a high chance of going unmatched again given the limited chance of doing electives due to the restrictions. For people who settled with FM, did you manage to like it? People are convincing me to apply to it - given that having a job is better than having no job whatsoever.  What if I don't end up liking FM- what are my options? I m scared that I will be doing FM forever- but I will always feel that it is field that I am not passionate about and don't want to contribute to. My only reasoning to continue with FM is to not be unemployed. 

Friends are also telling me to do a FM residency - with potential to write USMLE while getting a salary and with a chance to transfer to even Gen Surgery/or other surgical specialties next year. 

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If you have the financial capability to easily survive (i.e. come from a family with some decent money) and you feel you have a good shot at your home ENT/IM program (i.e. you have connections that you could deepen) you could attempt another shot at ENT or IM after doing a research year.

Otherwise I'd say take FM and try and find a niche you're interested in.

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11 minutes ago, 1D7 said:

If you have the financial capability to easily survive (i.e. come from a family with some decent money) and you feel you have a good shot at your home ENT/IM program (i.e. you have connections that you could deepen) you could attempt another shot at ENT or IM after doing a research year.

Otherwise I'd say take FM and try and find a niche you're interested in.

I have no connections with any field other than ENT. If ENT rejected me after doing a month of electives with them at my home school, there is no reason why they wont reject me again.

I am also so disappointed that IM is not an option this year. I really want to specialize and not be a generalist. I really do feel out of options.

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1 hour ago, unmatchingsucks said:

Friends are also telling me to do a FM residency - with potential to write USMLE while getting a salary and with a chance to transfer to even Gen Surgery/or other surgical specialties next year. 

ENT is also very competitive in the US. Only a 75 percent match rate for US MD's and it has a median Step1 of 248 and Step2 of 256. Those step numbers are pretty close to Plastics and Neurosurgery. Additionally, 89 percent of those who matched were graduating US MD's, that's slightly more than NSx and slightly less than Integrated Plastics for reference. Matching to ENT in the US is nontrivial. No Canadian has applied or matched to ENT since 2016(that's how far back the interactive data goes). I'm not saying it's impossible but those are the sort of numbers and odds that you're dealing with. 

IM though is much easier to match into in the US than it is in Canada. Only 40 percent of those in IM residency are US MDs. The median Step1  score for US MD's is a 235, and 248 for Step2. There are examples of Canadians applying and matching to IM in the US. If you want IM and get decent scores on the Steps, you'll probably get it. Canadians are 4/5 since 2016 for matching to IM. 

If you want to look at the data yourself:

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/06/MM_Results_and-Data_2020-1.pdf

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/07/Charting-Outcomes-in-the-Match-2020_MD-Senior_final.pdf

https://public.tableau.com/profile/national.resident.matching.program#!/vizhome/ChartingOutcomes2020/ChartingOutcomes

https://www.usmle.org/pdfs/transcripts/USMLE_Step_Examination_Score_Interpretation_Guidelines.pdf

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This is supposedly the last year with non P/F Step 1 - it is a difficult test, more so for CMGs, as there is no teaching towards.  I think it would take at least 2-3 months of very dedicated studying to be able to do well in it and even that could be an underestimate; it's not uncommon for IMGs to mention studying 6 months for it.  

I would suggest, if thinking of applying to the US, to begin with Step 2 as this will likely be the replacement to Step 1 and it's more clinical.  If you can do well on that relatively quickly (i.e 1-2 months), then consider going for Step 1 to try to be able to make US deadline in September/October.  Otherwise, I think it would take at least another year which is a big commitment, especially considering good Step score alone will not be sufficient to match to ENT (but may be for IM).  

I think matching to FM (or another discipline) and looking for a transfer to IM (or less likely ENT) is your best decision.  

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If you don't see yourself being happy with FM then don't apply this year. Med school advisors just want to preserve their total match rates. Delay graduation, and do electives in IM/whatever else you could see yourself doing. Feel free to apply ENT but also put forward a strong application for IM/whatever. Next year you will take whatever you can get. The question is if you also apply FM as a third choice and rank it at the end where you at least might have a shot at competitive programs/location that you want, or put all your effort into IM/whatever and then scramble for a second round FM spot in the end if you're unsuccessful again. It's risky, but I think personally I would switch gears and put ENT behind me entirely and focus on IM/gen surg/whatever your second choice is and also do some FM electives to have that in my back pocket, then apply everywhere in my primary and then to a few FM spots as a backup, because you HAVE to match next year, somewhere.

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Sorry to hear you went unmatched.

Option 1 is to do another year of med school, research/electives, ace USMLE, and apply to Carms & ERAS for ENT, internal med, and FM. Give it your best shot. If you match to an IM program in the USA you can subspecialize later on and avoid being a generalist.

Option 2 is to match FM in Canada and find your niche during residency. Most will go for a +1. Some like myself have left medicine post-residency, but these opportunities are mostly in the US too.

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9 hours ago, 1029384756md said:

Option 1 is to do another year of med school, research/electives, ace USMLE, and apply to Carms & ERAS for ENT, internal med, and FM. Give it your best shot. If you match to an IM program in the USA you can subspecialize later on and avoid being a generalist.

Option 2 is to match FM in Canada and find your niche during residency. Most will go for a +1. Some like myself have left medicine post-residency, but these opportunities are mostly in the US too.

I don't think Option 1 for the US is realistic unless you mean an application to ERAS in 2022 (which would be better as Step 1 is then P/F).  I think OP would need to have both excellent Step 1 & 2 which in of itself would take at least 5-6 months before the effective application deadline in Sept/October.  There is no way to do elective and research at the same time.

12 hours ago, bearded frog said:

If you don't see yourself being happy with FM then don't apply this year. Med school advisors just want to preserve their total match rates. Delay graduation, and do electives in IM/whatever else you could see yourself doing. Feel free to apply ENT but also put forward a strong application for IM/whatever. Next year you will take whatever you can get. The question is if you also apply FM as a third choice and rank it at the end where you at least might have a shot at competitive programs/location that you want, or put all your effort into IM/whatever and then scramble for a second round FM spot in the end if you're unsuccessful again. It's risky, but I think personally I would switch gears and put ENT behind me entirely and focus on IM/gen surg/whatever your second choice is and also do some FM electives to have that in my back pocket, then apply everywhere in my primary and then to a few FM spots as a backup, because you HAVE to match next year, somewhere.

  This is could be a reasonable approach if your school does allow a graduation delay AND additional electives.  Given that there are NO away electives and you have already done home-school ENT electives then if you would much prefer IM/gen surg.. over FM that could be a good approach.  I don't think you would have a future great chance at ENT, unfortunately.  

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17 hours ago, unmatchingsucks said:

I have no connections with any field other than ENT. If ENT rejected me after doing a month of electives with them at my home school, there is no reason why they wont reject me again.

I am also so disappointed that IM is not an option this year. I really want to specialize and not be a generalist. I really do feel out of options.

You're right, I completely forgot there are still no away electives permitted. This drastically reduces your chances at matching ENT if you re-apply (realistically this is out of reach, esp since ENT rarely has 2nd round spots at all).

I agree with others that IM or another specialty (that is traditionally less competitive/uncompetitive) is still possible. Though taking the risk of re-applying the next year puts you at risk for being unmatched again. Like I said, if you have the money to tolerate this sort of risk then it's a possible risk to take if you really can't stomach doing FM.

If you have any known red flags in your application then you should probably be happy with FM/pathology.

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1 hour ago, NoMatchNoProblem said:

You can't predict the level of interest for the specialty either, and sometimes it might just work out in your favour (i.e. this year there was 1 left over cardiac surgery position, which never happens). I was shook this year to discover that all of the programs that I was interested in had decreased their number of positions relative to my first carms. Had I known that would happen, I would have probably been extremely discouraged and never tried a second time. Even at that, still made it.  

Is it really a "left-over"?  

It wouldn't be the first time that there is a talented cardiac surgery candidate that would be able to match to the spot in Round 2 (maybe from in a different residency program? or IMG?).  

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Anecdotally I've heard ENT is not a specialty that's friendly to second time applicants (as opposited to ophtho). At least the number of ENT residents I've interacted with, all were first round CMG matches. 

You could consider FM with an aim to become a surgical assist. There are FM who do full time surg assist, it's not a bad option. You bill by the hour, have less responsibility than the main surgeon, and can do other gigs in FM on the side if you wish.

I don't necessarily advocate you apply to pathology unless you have previous exposure to it. It's a very different style of approach/work flow than surgery. Pathology's visual pattern recognition approach is more in line with derm/rad.

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3 hours ago, indefatigable said:

Is it really a "left-over"?  

It wouldn't be the first time that there is a talented cardiac surgery candidate that would be able to match to the spot in Round 2 (maybe from in a different residency program? or IMG?).  

It's still a "left-over" spot after the 1st iteration, which was not the case in previous 1st iterations.

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43 minutes ago, Davinci said:

It's still a "left-over" spot after the 1st iteration, which was not the case in previous 1st iterations.

Except for the famous case at UBC in 2013:

https://thetyee.ca/News/2015/02/06/Former-Cabinet-Minister-Wins-UBC-Residency/

https://forums.premed101.com/topic/81812-how-son-of-former-cabinet-minister-won-a-coveted-ubc-residency/

In the past some IMG spots in ON would sometimes go unfilled for similar reasons.  

I'm wondering if there is a talented candidate that wasn't able to participate in the first round will happen to end up matching to this one which is why I put quotation marks around "left over".

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Either way, this situation is a win-win.

 

1. Pursuing FM this round

You will undoubtedly expand your horizons in FM. The time you will gain, the breadth of medicine you will be exposed, and the shortened time to becoming staff will all enable you to live a well-rounded life. I've personally met several unmatched applicants to competitive surgical specialties including ENT and plastics, and they've all been very happy in FM. 

It's difficult to really assess what will matter to you in 5, 10, and 15 years down the road. On average, people realize more and more that work is a part of life and fulfillment is increasingly derived from what you do outside of work. Therefore, I struggle with the advice of "taking the year off to do what you want to for the rest of your life vs. settle" because you don't know what you'll want for the rest of your life. You can only go by the average trends, if that. And the average person, and majority of life wisdom, leans to a well rounded life, one that surgical specialities suspend for 5-7 years, and possibly longer.

 

2. Pursue ENT next year

There is definitely something to say for pursuing one's goals. This year will be challenging emotionally and mentally, but you will grow a ton in the meantime. Unless you commit to projects that occupy every waking minute, you will have ample time reflecting on what matters to you. Like others have mentioned, you may find interest in other specialities. Whether or not you match to ENT, willfully or not, you will have grown a lot, and that's awesome.

 

If I were you, I would take FM. And I'm speaking from the perspective of a matched incoming surgical resident. 

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What is it about ENT that drew you to it? Anatomy, pathology, surgical interventions,??? 
 

Can you find another specialty that shares some of those attributes? ENT brachy therapy is rare (but exists), but rad oncs see/treat a lot of head and neck cancers, and scope their patients. So some hands on procedures that are shared.

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