How to support friends who are not happy?

[Anon_67]

Unfortunately, one of my best friends who wanted IM this year ended up matching to their backup specialty (family). They are not happy with their CARMS result. They did have some restrictions geographically when making their rank list so they only ended up ranking programs in Ontario. They have been expressing to me that they feel unhappy and not good enough. I have been messaging them to offer support. What can I say or do to help them feel better? If anyone has been in a similar scenario, I would really appreciate their perspective. Thanks.

[Edict]

I would just be there to listen to them, you don't need to say anything. 

[Bambi]

Your friend purposefully selected to rank this backup and the location. At the time of ranking, your friend understood with his/her eyes wide open the commitment being made, and was not under duress. Had your friend been prepared to go unmatched, FM would not have been chosen as an option.  When I applied at CaRMS, I knew that I would not accept a residency spot outside of one city and therefore, I restricted my applications to one city only, to 2 specialties and FM. I would have been happy with any of these options. Had I not been prepared to devote my entire career to FM, I would not have applied, interviewed and ranked it. I also realized that the chances were high that I would go unmatched and was prepared for this. As it happened, I was chosen for a competitive surgical specialty (where I was the least qualified applicant, but had good soft skills), however, I would have been equally happy at the time with FM. 

The feeling of not being good enough is unjustified and adjusting to not being selected for one's first choice is part of the game where luck is also involved in this lottery. Edict is entirely correct that by listening and hearing your friend out, you are being supportive. No doubt, your friend will explore any possibility of an eventual transfer.  

[frenchpress]

Not getting what you want in CaRMS sucks.

I ended up far down my rank list and no where near the location I wanted to be. I was devastated. When people told me they were surprised, or that I was a strong student or that carms wasn’t fair, etc etc. it just made me feel worse. And when people told me “it’s only X number of year, you’ll be OK” I wanted to scream. Because they kept missing the point. All I could think about was that I gave/continue to give years of my life to medicine and the profession doesn’t care at all about my personal needs, my families needs, etc. The whole experience made me feel so disempowered. 

I didn’t feel good enough when it happened, and many years later I STILL continue to experience that feeling intermittently, along with a deep, painful rage at the losses I suffered because of how things turned out. And I feel those things at the same time as I often feel joy about the things I have enjoyed about my residency, the friends I have made, the positive experiences I have had in the city in which I live now, etc. 

The reality of the match is that many of us can’t get what we want, and many just end up with something we have to find a way to live with. Which is easier for some than others. Medicine chews up and spits out many of us. It’s no wonder there are so many jaded, burnt out doctors. Of course we can’t all have exactly what we want. But the system could be better. And for some reason we all continue to go along with it like it’s the only way to do things. That’s my perspective. 

Anyways, with respect to what your friend is going through and how to help them… Think of it like a grieving process - it will takes time for them to come to terms with it, however they might end up doing that. Listen, and ask them how you can help. For me, I found it helpful when my friends invited me to do things like go for a walk or get dinner or really any activity that I enjoy in my non-medical life. It reminded me I had things outside medicine I could still enjoy and be happy about. 

Edit: I also did personally find it helpful when people told me it was OK to be pissed off, to rage, to cry. That I didn’t have to pretend to be happy, and they would just listen and let me have my sadness. 

[Intrepid86]

I don't have much to add other than this is exactly the reason why people shouldn't be ranking things they don't actually want.

[indefatigable]

Everyone processes grief differently - some people like to talk about loss and others prefer to do anything but talk about the issue itself.  Most people appreciate support though through presence and listening.  Refocusing attention to non-medical aspects of life can help people get over their loss as mentioned above.  Like everything, time has a habit of numbing one to the emotions associated with loss and eventually memories became more and more faded until disappointment is just part of the past.  

However, your friend is also making a value judgement on their own self worth based on a process over which they have very limited control.  At the same time as encouraging acceptance and getting over their grief, I would also encourage your friend to perform strongly in PGY 1 to help position themselves for a possible transfer.   If they are still really passionate about their first choice in IM, then I think FM to IM is probably the most common FM to RC switch and there seem to be open positions if your friend is willing to potentially learn in a less desirable location.  

But, I also agree that medicine normalizes sacrifices of all other aspects of life including living away from family and friends with no acknowledgement that work should only be one part of life and that living wherever can lead to dissatisfaction in other areas of life.  Of course the flip side is that some people do get both their number one choice and end up living where they want to live.  So experiences can obviously greatly differ.  

There was a recent business article in the G&M suggesting that luck plays the biggest role in financial success versus merit or talent.   This included noting that the most talented individuals do not necessarily experience the most financial success.   Extrapolating to medicine suggests that probably luck probably plays a greater role in CaRMS than is commonly acknowledged (and that would include the luck of having parents in the business, etc..).  Like in life, CaRMS winners may disproportionately reap rewards.

https://www.theglobeandmail.com/business/commentary/article-rich-and-successful-its-likely-youre-just-lucky/?utm_source=dlvr.it&utm_medium=twitter

[upadacitinib]

9 minutes ago, Intrepid86 said:

I don't have much to add other than this is exactly the reason why people shouldn't be ranking things they don't actually want.

10 hours ago, Bambi said:

Your friend purposefully selected to rank this backup and the location. At the time of ranking, your friend understood with his/her eyes wide open the commitment being made, and was not under duress. Had your friend been prepared to go unmatched, FM would not have been chosen as an option.  When I applied at CaRMS, I knew that I would not accept a residency spot outside of one city and therefore, I restricted my applications to one city only, to 2 specialties and FM. I would have been happy with any of these options. Had I not been prepared to devote my entire career to FM, I would not have applied, interviewed and ranked it. I also realized that the chances were high that I would go unmatched and was prepared for this. As it happened, I was chosen for a competitive surgical specialty (where I was the least qualified applicant, but had good soft skills), however, I would have been equally happy at the time with FM. 

The feeling of not being good enough is unjustified and adjusting to not being selected for one's first choice is part of the game where luck is also involved in this lottery. Edict is entirely correct that by listening and hearing your friend out, you are being supportive. No doubt, your friend will explore any possibility of an eventual transfer.  

It really isn't that simple though. The alternative to matching to a back-up specialty is going unmatched, which entails paying an extra year of tuition and living expenses and going into further debt, with no guarantee of getting your choice of specialty/location the next year (or even matching to anything at all!). There are people in the PFI FB group who have maxed out their LOCs at the end of residency and are struggling to pay for RC exams with the current cost of living in HCOL cities and interest rates, even without having paid for an extra year of medical school. It often isn't affordable for people without family financial support to avoid taking a back-up specialty. 

I think the worst thing you could say to someone who is unhappy about their match is to blame them for ranking a back-up, rather than having compassion for those who fell through the cracks and had to take the lesser of two evils. Our system is designed to force a certain % of medical school graduates into family medicine whether they like it or not, as other specialties are becoming too competitive to rely on for parallel plans. 

OP, it sounds like you are a great friend and please continue to support them and check in on them throughout the next year. From personal experience, It is very difficult to start a residency when your heart isn't in it, while watching your classmates who got their preferred specialties launch their dream careers. And help them with reviewing their IM transfer applications next year!

[Bambi]

6 hours ago, indefatigable said:

There was a recent business article in the G&M suggesting that luck plays the biggest role in financial success versus merit or talent.   This included noting that the most talented individuals do not necessarily experience the most financial success.   Extrapolating to medicine suggests that probably luck probably plays a greater role in CaRMS than is commonly acknowledged (and that would include the luck of having parents in the business, etc..).  Like in life, CaRMS winners may disproportionately reap rewards.

https://www.theglobeandmail.com/business/commentary/article-rich-and-successful-its-likely-youre-just-lucky/?utm_source=dlvr.it&utm_medium=twitter

The above Article hits the nail on the head - Luck plays an absolutely critical role in our lives, in our future, far more than one would give credit for! 

[shikimate]

I think only time will help right now. It's too early to say how it will affect them, only time will tell

1) if they are serious about IM, they might try to transfer or apply in round 2 next year or after they're done FM.

2) they might go through FM and realize they like it more than they thought

3) or they might accept FM and go on with their lives

 

[1D7]

There will be a long period of rumination and excessive negative thoughts about themselves and the match. Not much you can do except be there to talk about it, and be cognizant when making comments about the match.

Most medical students make reasonable residents, but factors you have little control over play a significant part in the match process. And for competitive spots, it is like having 1 seat for 3 bus passengers; ultimately 2 will not have a seat regardless of selection process.

IMO the previous system of near non-capped electives allowed for greater control over your specialty of choice, as people had to commit significantly with their limited electives, thus surgery/radiology/anesthesia/psych applicants were more 'locked in' and IM/FM applicants had a greater relative advantage just by preferring that specialty. But the previous generation of student leaders had advocated for and preferred this current system.

[dooogs]

CaRMS is 50% luck, more for competitive specialities. I wonder how much worse this gets in residency for fellowship or jobs. At least if it gets too much community is an option. 

 

 

[1D7]

1 hour ago, dooogs said:

CaRMS is 50% luck, more for competitive specialities. I wonder how much worse this gets in residency for fellowship or jobs. At least if it gets too much community is an option.

Fellowship is generally worse from a process perspective, as you no longer have a match system (outside of IM). The benefit is that you are not stuck at a financial dead-end if you don't match (unlike the pre-med process or residency applications).

[shikimate]

5 hours ago, dooogs said:

CaRMS is 50% luck, more for competitive specialities. I wonder how much worse this gets in residency for fellowship or jobs. At least if it gets too much community is an option. 

 

 

fellowship can be worse, if competitive. Most programs prefer in-house. At least CaRMS is transparent about how many spots and how many applicants apply. A lot of fellowships don't tell you how many people apply there. 

jobs can also be tricky for specialties with weak demand. Again, either in-house or local connection. A lot of times lucky timing (old staff just happened to retire). Personally I know residents who waited from R1 to R5 for an old guy to retire and it still didn't work out lol. 

For jobs, some posted jobs are "ghost" jobs. Aka they already have someone in mind but for admin purpose they have to openly advertise it.

It all depends on which specialty, some have so many jobs that you get tired of recruiters. Others have so little jobs people do 2+ fellowships. 

Job market can also change fast, especially in small fields. When I was late in residency before COVID I was cold-emailing places trying to find jobs. A couple of years after COVID I was getting cold calls from places desperate to hire. Go figure.