What did you do when you went unmatched?

[scoobydoo]

This is to anyone out there who ever went unmatched in the first round of CaRMS.

 

What was your course of action?

 

Don your internet pseudonyms and share with us your ordeals. We will all be appreciative.

 

Peace.

[allycat0303]

Yeah. I'm afraid too. Kicking myself for not having put family medicine as a back up plan. But I keep saying that there might be something left open that I want to do more then family medicine. I figure if this happens, I am willing to move to avoid doing family medicine.

 

I know 2 people that went unmatched last year:

 

One girl chose family medicine at Mcgill in the second round (she had applied to micro and internal at only one school)

 

The other guy applied to ophthalmology, he decided to take a year off and reapply the next year because he really wanted ophthalmology (this time he was going to put family medicine as a back up plan).

[1357]

You can

-apply to things that are left over in the second round. There can be some surprising unfilled spots.

-take a "research" year and apply again.

-sometimes do ROS with some cities/provinces. For example, Regina will do this for some, but the ROS is 2:1 meaning you commit to 10 years post residency. Not sure if you would be able to get out of this somehow?

-match to family with the intent to try for a re-entry position.

-set yourself up to do residency in the states.

-talk to doctors/your references in your field, sometimes people know about other opportunities.

-some medical schools allow you to do another year of clerkship in which you would be able to do electives as a medical student, and re-enter carms (not sure which schools allow this and which don't). As far as I know it is basically impossible to do electives if you are not under the "medical student" umbrella.

[scoobydoo]

You can

-apply to things that are left over in the second round. There can be some surprising unfilled spots.

...you're right, but I doubt I'd be the only one applying to them. If I were unlucky, I'd be stuck in the second round every year thereafter

-take a "research" year and apply again.

I always feel a bit sketchy about this. Finding a good supervisor and a project that will result in a good publication is rare. Going unmatched would make it necessary to research with a top-dog in the field. Anyway, I think this is more about kissing butt than about interest.

-sometimes do ROS with some cities/provinces. For example, Regina will do this for some, but the ROS is 2:1 meaning you commit to 10 years post residency. Not sure if you would be able to get out of this somehow?

The only way to get out of an ROS is if you're rich. Anyway, ten years in Saskatchewan is ten years too much for me

-match to family with the intent to try for a re-entry position.

Re-entry positions are severely limited in both number and scope. You're also required to practice as an FP for a certain amount of time before you can apply. I'd rather just skip the middleman and go for the actual residency

-set yourself up to do residency in the states.

This seems like a logical step

-talk to doctors/your references in your field, sometimes people know about other opportunities.

Once someone goes unmatched, there appears to be this cloud of shame hanging around them. I doubt any program director would take a previous unmatched loser student over a fresh grad. After all, theres a reason why unmatched students are unmatched right(or so goes the conventional thinking)

-some medical schools allow you to do another year of clerkship in which you would be able to do electives as a medical student, and re-enter carms (not sure which schools allow this and which don't). As far as I know it is basically impossible to do electives if you are not under the "medical student" umbrella.

Can I buy my own student malpractice insurance

 

I appreciate your help and assistance.

 

I'm specifically looking for medical graduates who have experienced going unmatched first-hand. What did you do? What did you feel your options were? What were the challenges and barriers to your career choices at this point? Do you think it worked out for you? And what advice would you give someone who is in the same situation you were?

[1357]

Actually, you can enter the first round of carms after entering both rounds this year, if you went unmatched in the second round as well. You can always enter the first round as long as you have not been a resident or practiced as a doctor. You can email carms to clarify.

 

Going through those options I would say the best seems like going to the states (which is a pretty good option), or finding some weird loophole way to do something you would be happy doing.

 

I wouldn't say that going unmatched means a cloud of shame, especially more and more as even traditionally uncompetitive specialties become more competitive.

 

Yes you can buy your own malpractice insurance but you can't go through CMPA. You need to go through a private insurance company (any company can basically offer you this) but that means they can also charge whatever they want. Even so you may still only be allowed to do "observerships" in most provinces since to do electives you also have to register with the college which becomes tricky when you have an MD but are not a resident. Maybe if more and more people go unmatched each year this will somehow become easier.

 

Good luck.

[Kirsteen]

Hi there,

 

One caveat: if you've gone unmatched in the first round of CaRMS and then you successfully matched in the second round, some centres will not allow you to try to switch specialties in the PGY-1 year when other residents are allowed to switch specialties. UofT is one school that will not permit this. So keep in mind that this might not be a possible plan B.

 

Cheers,

Kirsteen

[scoobydoo]

Hi there,

 

One caveat: if you've gone unmatched in the first round of CaRMS and then you successfully matched in the second round, some centres will not allow you to try to switch specialties in the PGY-1 year when other residents are allowed to switch specialties. UofT is one school that will not permit this. So keep in mind that this might not be a possible plan B.

 

Cheers,

Kirsteen

 

Once someone goes unmatched, there appears to be this cloud of shame hanging around them. I doubt any program director would take a previous unmatched loser student over a fresh grad. After all, theres a reason why unmatched students are unmatched right(or so goes the conventional thinking)

 

There you have it. Unmatched grads who plunk down in the 2nd round are considered second-class residents at UofT. After all, these loser residents should be happy that they matched in Toronto, or anywhere else for that matter. I mean, its TORONTO(gasp!). Right? This is sick.

 

I suppose they have that rule so that there isn't a storm of people trying to get out of the 2nd round program that they had begrudgingly matched to. But really, if there are so many people who are so miserable in their 2nd round program that they're trying to switch out, why even have a 2nd round at all?

 

Or is this all some sort of sick way to get debt-ridden medical students to practice rural family medicine? Sneaky!

 

The US is looking more and more like the only real plan B that I have.

 

Does anyone else have any experience in going unmatched? Any personal stories?

 

Thanks Kirsteen for that information.

[scoobydoo]

Some are poor candidates and have obvious red flags on their files...

 

What would make someone a poor candidate with obvious red flags? As far as I know, I dont have any red flags. But then again I may be lacking some objective outside opinions on that. Ive never failed anything or have been reprimanded for anything unprofessional. My evals in my desired specialty have always been exemplary. Id risk saying more but id compromise my anonymity.

 

Can anyone out there describe certain things that may be red flags or make someone a poor candidate?

 

 

 

As for the 2nd round. I can see programs wanting to protect themselves from 2nd rounders using them for funding. Of course, these 2nd rounders dont walk into their psych interviews saying that they want to use the psych funding to switch out. So, there must be a liberal amount of dishonesty during the 2nd round.

 

One thing that is more important to me than matching is my integrity. I wont lie to a 5 year program just to get funding. So Ill doubtfully match anything in the 2nd round, even if im desperate, because i just wouldnt be able to lie and say i could do so-and-so for a living.

[1357]

This is by no means an exclusive list but I imagine red flags include things like having gone before a professionalism, or academic misconduct committee or other things which may negatively reflect on you in your MSPR, having a reference say that you lied, or cheated, or were "dangerous" because you said you did things you didn't etc. Maybe failing courses or having to repeat a year, etc.

 

Scoobydoo it sounds like IF You went unmatched (which you still have not, and you DO have interviews...) then you would probably fall into the "unlucky" bunch. I think most people that have been through the match know or know of at least a handful of these stories. And it sucks. But like ffp mentioned above, those people aren't doing EXACTLY what they thought they would be but they are happy. And I would believe that most of them are genuinely happy. Also like FFP said, your references would most likely do whatever they could to help you IF you went unmatched. It may be hard to see the light at the end of the tunnel but I can reassure you that life does go on after carms and after going unmatched.

[Ian Wong]

Going unmatched is a painful and agonizing process. Generally, your options are relatively few. I went unmatched in CaRMS 2003 while applying only to Canadian ENT programs. I took the rest of the year off after opting against looking for other specialties in the second round.

 

Luckily enough, I discovered radiology as a possible specialty, and spent the spring and summer of 2003 making myself into a viable applicant for that specialty. That meant shadowing in the UBC department of radiology, as well as doing an educational project for them. I also studied harder than I'd ever studied at any point in my academic life, took the USMLE Steps 1 and 2, and got amazing scores in both, which opened up the option to apply to US radiology programs.

 

I subsequently applied to Canadian and US radiology programs, did my interviews, and ended up matching to the US. Because of the SARS epidemic, the elective schedules for Canadian med students were delayed, and as a result, the CaRMS 2004 match day was delayed so that the US match day came first. Since I decided to submit both my US and Canadian rank lists, the US list took precedence because the US Match Day came first.

 

As a result, I matched to the US first, and was withdrawn from the Canadian match. I sometimes wonder whether I would have matched in Canada had I not submitted my US rank list. However, I had interviewed at many wonderful programs in the US, and even if I had to do it all over again, I'd still have submitted that US list. I believe I've gotten a fantastic education at my program, and made many long-lasting friendships.

 

Anyway, as far as going unmatched, here are some of your options.

 

1) Get a spot in the second round. Usually, this involves ending up in a different specialty. If you can see yourself being happy in this other specialty, then you've got it made.

 

Otherwise, if you are tactically smart, you can try matching into a specialty that is at least as long as your desired specialty. This may make switching into your desired specialty slightly easier. I would caution that this can be a risky strategy, with no guarantee of success. I wouldn't match into any specialty that I couldn't realistically see myself doing, because if you can't switch out, you are HOSED.

 

2) Take the year off, and do research. Your job is to make real connections with people in that specialty department who can pull strings, and get you a residency spot the next year. This is very risky. If you didn't match the first time, if it was for reasons beyond your control to change (ie. your home program just doesn't like you), then all the research in the world isn't going to make you into a liked/preferred candidate.

 

3) Take the year off, and do a different degree. Go get an MPH or MBA, or something else that can enhance your application. This is even more risky than option 2. It was suggested to me by a former ENT program director. He said that he was always on the lookout for applicants who brought something different or extra into his program. Looking back at it, I'm glad I didn't do this.

 

4) Try to delay med school graduation somehow. UBC wouldn't let me do this. If you can arrange this somehow, this is best, as the only way you can really do clinical electives is if you are still under medical student status. It gives you access to the electives departments in your medical school and other medical schools, as well as medicolegal protection. It's extremely hard to set up electives if you are not a medical student.

 

5) Arrange a return of service contract. Sometimes this is a viable option. Find a funding source that needs your specialty, and arrange for a service contract with that source if they will fund your residency. You need to talk with your med school Dean of Student Affairs as they often have their ear to the ground for these sorts of things. Also, find out from your home specialty department whether they have any residents on a return of service contract, and then find those residents and get their advice.

 

6) Try to match to the same specialty in the US. The US has many times the number of residency positions for any given specialty compared to Canada. There are a few problems with this approach.

 

First, a huge part of your application will be determined by your USMLE Steps 1 and 2 scores. If you do poorly on these, your chances of matching into a competitive specialty diminish significantly.

 

Second, many US residencies are shorter then their Canadian counterparts. For example, Derm is 5 years in Canada, but only 1 year of internship + 3 years of residency in the US. Similarly, OB/GYN, Ophthalmology, General Pediatrics or General Internal Medicine, Psychiatry, and Anesthesiology are all 1 year shorter in training in the US compared to Canada. In order to work in Canada, you will need to find a way to make up that year of training. Emergency Medicine in the US is a 3 or 4 year program, whereas the full training in Canada is a 5 year dedicated residency.

 

Third, you run into potential problems with geographic bias, and citizenship issues. Many US programs, particularly those in competitive specialties, do not want to take wild-cards into their program. Coming from a Canadian program, you are a relatively unknown quantity (unless you happen to be coming from a "famous" med school like U of T, McGill, or UBC to a lesser extent). As well, unless you are a US citizen or hold a US green card, you will need your program to sponsor you for either an H1B or a J-1 visa in order to live in the US while you complete your residency training. Most competitive programs won't want to deal with either of these hassles, unless you are really bringing something extra to the program.

 

 

Overall, as mentioned before, going unmatched sucks. It is an incredibly depressing feeling to be at Match Day seeing all your friends take the next step in their medical careers, and to have to absorb this while realizing that your envisioned medical career has effectively run headlong into a brick wall. The amount of pity that you'll be receiving from friends and family on Match Day will also be overwhelming. It's a real kick to the groin to go over a hundred thousand dollars in debt and endure the pain and emotional roller-coaster that is 4 years of medical school, only to be told that you can't train in the specialty that you feel is your ideal career path.

 

Rightly or wrongly, a lot of medical students derive at least some part of their self-worth and identity from being in medicine, and more specifically, from their specialty of choice. When you go unmatched, that feels like a huge loss.

 

Having said that, it can definitely be a time to regather perspective on what it is exactly that has driven you to seek that specialty. In general, many of the people who go unmatched are those who are seeking a highly competitive specialty, and feel that having a backup specialty is either an unappealing option, or a downright dangerous option (because it may be perceived as a lack of commitment to the primary specialty). I think most of my classmates who went unmatched have found avenues to get to their primary specialty, or have otherwise found happiness in a different specialty.

 

For myself, I'm immensely grateful to have discovered radiology. It fits my interests, skills and career desires far better than what ENT can offer. I really consider myself one of the lucky ones. I'm a person who went unmatched in CaRMS, and yet still ended up in my perfect specialty.

 

Ian

[loving_medicine]

Thank you Ian for that amazing story. It is still definitely scary to be unmatched come March 9th this year, but after hearing your story, I am glad there is still hope at the end of the tunnel! Especially since I am going for one of the most competitive specialties... hopefully if I don't get in, I'll get to find another calling too.

[m0b1liz3]

I am likely to go unmatched this year simply because I am an IMG. I am Canadian and moved to Australia. My strategy was similar to that mentioned above for round 2 (ie. don't try for something you wont want to stay in). In my case I can live and work somewhere that has 300+ days of sunshine. Things will be much more drawn out in terms of training since it is based on the UK here but at least I have work and a nice place to live.

 

However that being said, most of us Canadians that moved to Australia hope to come back to Canada. It is a great lifestyle here but I ultimately want to come back to work in Canada. My strategy is different in that I can continue to work and obtain references here and even get a few papers published. The CaRMS system puts so much weight in those silly elective references that I feel that I am a little bit disadvantaged having only a few weeks elective time in Canada. I was thinking about coming back to spend some time on a Canadian research project.

 

Does anyone have any other recommendations that wont end up costing me so much lost income? I can spend my vacation time working on a project but I would imagine most research would take a minimum of 2 months so I would have to see about unpaid leave of absence. Any suggestions would be appreciated.

[Kirsteen]

Can anyone out there describe certain things that may be red flags or make someone a poor candidate?

Hi,

 

The interview can be a big deal-breaker. For example, when I was a clinical clerk, I worked with a PGY-1 who noted, "You can often predict who in your class won't match. Just spot the weirdos. They don't do well on interviews."

 

Over the years I've known a number of people who haven't matched in the first round of CaRMS. Certainly, at least one I know wasn't a "weirdo" but they didn't prepare for their interviews very well and despite securing quite a number of interviews, didn't match anywhere. Ultimately, many programs are interviewing you (whether it's formally, i.e., during the CaRMS interview period, or informally, i.e., during your elective) to see if you'll be a good fit for the program and if the program will be a good fit for you. If you don't project well in an interview than that can certainly scuttle your chances of matching to that (or any) program.

 

Cheers,

Kirsteen

[scoobydoo]

How do you know if you're a weirdo? All the weirdos I see never know they're weirdos.

 

People like me and I have friends. I know I'm kind of quirky but not an antisocial guy or annoying or anything like that.

 

In last year's class there was one major weirdo - the kind of personality that hurts to be around. He didn't get interviews at any schools in which he had done electives. He ended up matching to the last pick of his backup choice.

 

The other unmatched people were normal and likable. One of them was a huge shock.

[Kirsteen]

Hi again,

 

If you're in the "weirdo" category then I think you've got more of an uphill battle when it comes to matching, unless you're of the sociopath variety.

 

As for shocks, those can certainly happen. I know at least two people who didn't match in the first round who seemed like great, all-round people. There can be many reasons for this, e.g., poor interview performance (due to a variety of factors) or post-interview ranking strategies that just didn't work out.

 

Cheers,

Kirsteen

 

How do you know if you're a weirdo? All the weirdos I see never know they're weirdos.

 

People like me and I have friends. I know I'm kind of quirky but not an antisocial guy or annoying or anything like that.

 

In last year's class there was one major weirdo - the kind of personality that hurts to be around. He didn't get interviews at any schools in which he had done electives. He ended up matching to the last pick of his backup choice.

 

The other unmatched people were normal and likable. One of them was a huge shock.

[Lactic Folly]

Personally, I haven't met many people in medical school that I would think come across "weird" in an interview (though of course there is variation in people's interview skills). The vast majority would get weeded out during medical school admissions.

 

What the medical school interview might not be able to detect is people that are not as great to work with - this might come out in clerkship evals and letters of reference (speculation only). But most people I think suffered from vagaries of application/ranking/ultracompetitive specialty.

[Talon01]

Are candidates informed they are unmatched prior to match day?

[ploughboy]

Are candidates informed they are unmatched prior to match day?

 

That happens in the States, but not in Canada.

[Talon01]

That happens in the States, but not in Canada.

 

Thanks for the prompt response!

[scoobydoo]

I knew this would happen.

 

Ian, how did you find radiology? I have never done any radiology before. Did you just walk in there and try to find a project and a supervisor?

 

Personally I would feel extremely embarassed walking into a department to tell them that I went unmatched and am searching for another avenue, of which their department might fit the bill.

 

I looked in the 2nd round and I do not think I'd be able to do any of those fields for the rest of my life. I need to find something else or try to find a way back on my original path.

 

The 2ndround file review opens wednesday. I dont even know if I'll submit anything. My school has been very little help with advice.

[0nsp]

I'm in the same boat you are. Pretty slim pickings for the second round, but taking the year off is a HUGE gamble. The stats for people matching after taking a year off are abysmal. You actually have better odds of matching to something then trying for a transfer. That being said, never match to anything that you can't see yourself doing since a transfer is only *maybe* possible.

 

As for me, I'm too far in debt to consider not ranking anything for round two. I am loathe to do family, but hey, there are always +1 options of emerg, anesthesia, sports med, etc.

[tishamiga]

Dear friends

do you think there is any chance in 2nd iteration for an old graduate IMG who is not canadian-born? I have good score in ee and qe1.

did you see anyone like me matched in 2nd iteration?

best

[p0tus]

Hey,

 

As far as I'm aware, CMG's and IMG's are looked upon equally during the 2nd round. There will be a subjective element of course (familiarity with Canadian system and the people involved) but for the most part it should be a free for all. Good luck!

[Calgarymed]

Check out the University of Manitoba Northern and Remote Family stream. Its a new thing, takes a long time but you have the chance to do another residency after family.

[bones]

Check out the University of Manitoba Northern and Remote Family stream. Its a new thing, takes a long time but you have the chance to do another residency after family.

 

Do you have any other info on this? Perhaps a website? I looked on the fam med website for U of M but all I saw was info on the R3 programs...