“We are sorry, you did not match to any position.”
How does one quantify adversity? And in the same sense, how does one measure the intensity of adverse events and their subjective effect on the one experiencing them? We’d like to preface with this thought-exercise because for us, not matching was the most devastating single event in our lives. We have different backgrounds. We each have endured our share of personal and professional hardship, but not matching left us both facing a crisis of identity. We had failed before, our aspirations were questioned, doubted at times, but nevertheless, we persisted. We were at the culmination of our medical education. We had achieved the milestones we had set for ourselves; we were about to be doctors. As competitive applicants, we were ready to test our mettle as categorical interns. But not matching left us questioning everything, including our place within medicine. Self-doubt and self-pity riddled our psyches. A retrospective upheaval of the mind lingered over the following week. We attempted to recall any interview that went awry. We developed doubts about whether we were meant to be surgeons. SOAP week was the longest and most painful week we had experienced. For months, we went to bed every night blaming ourselves. If you're in the same position, here's how to get through it.
Make a Contingency Plan
You will need time to process the events of March 16, 2020. It is OK to cry and feel vulnerable, but SOAP week does not afford the luxury of time to process. You will need to develop a plan, and fast. Now is a time when you reach out by any means necessary to your mentors, family, advisors — anyone you trust. You are empowered to unapologetically seek answers and identify the reasons you may have not matched. This is not the time to protect your ego but rather invoke honest feedback. We all have separate paths. A prelim year is only one option. Some may decide to choose a backup specialty, some will do research and position themselves for another go, others may decide to leave medicine altogether. SOAP week will force deep introspection. You will need to ask, “What is it that I truly want?” We chose to pursue a surgery prelim because we felt that it gave us the opportunity to prove to ourselves that we could exist and excel as physicians.
Understand That Not Matching Doesn't Mean You're a Failure
Your failures in life do not define your identity. After successfully completing a surgery internship, we can confidently tell you that not matching is not your fault. Your success is not dictated by a computer algorithm, an imperfect interview process, or antiquated advice from mentors/advisors 10–20 years out from the Match. Despite our knowledge of the imperfection inherent in the process, we will admit a sense of failure persisted for months within our minds. It’s true that not matching places you at a disadvantage compared to the MS4s applying the following year; however, an intern year provides a clean slate to which you can now ascribe yourself as a doctor. The perception of being at a disadvantage firmly placed a chip on our shoulders. We used this as motivation and recommend you do the same. As our clinical acumen increased and our surgical skills improved over time, that sense of confidence and purpose returned. That feeling of failure dissipated, replaced by a sense of accomplishment. Remember — in a few short weeks, you will be a physician, and with that comes the tremendous privilege to care for the sick and suffering for the remainder of your life.
You Can Still Succeed as a Preliminary Intern
When you start intern year, you will be surrounded by accomplished graduates from top medical schools. That does not matter. You are all starting on the same page. Nothing prepares you for residency like residency itself. First and foremost, believe in yourself and your training. You absolutely need to hit the ground running. Be compassionate toward your patients. Be eager to learn both at the hospital and independently. Earn the respect of your senior residents and attendings. You will find that if you dedicate yourself to the profession by being thoughtful, compassionate, and a team player, people will notice. Lead by example for medical students and other interns. Pick up good habits from those around you. You will experience growth as both a physician and a human. Support and allow yourself to be supported by your co-residents. They are your lifeblood. You are on this journey together. We confidently tell you that you will find lasting friendships and develop meaningful professional connections.
Plot the Answer to "Where Do I Go From Here?"
You will realistically have three months to identify mentors to support your reapplication. Actively seek faculty mentors and recruit their advocacy. Schedule an individual meeting with faculty outlining your goals, ask your senior residents to advocate and relay positive comments/feedback to them, or work 1:1 with them in clinic and operating room. Foster these connections, as you will likely ask them to make phone calls on your behalf later. Keep impressing even after applications are submitted. The world of medicine is small, and a word of confidence goes a long way.
Things tend to happen for a reason. How you respond to adversity distinguishes true success or failure. We both attest that not matching last year was the best thing to happen for our careers. We can’t tell you how many interviews we had this year where we shared genuine conversations with faculty members about the real challenges we’ve faced and how we overcame them. This year validated our vocational pursuit of surgery and demonstrated that we can be great. Your path may be altered, but you now control the direction. Remember, destinations change, but the journey defines us.
Alex and Jason are preliminary general surgery interns at the University of Washington who have become close friends over the course of the year as they grappled with the reality of going unmatched. They hope this article provides some guidance they wished they would have received last year. When they both have weekends off, you can find them at the Waterwheel Lounge enjoying Karaoke with the locals.