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To My Colleagues in the Great Unmatched

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To my colleagues in the Great Unmatched: welcome to one of the worst moments of your professional career. It’s excruciating. Most of us didn’t expect to be here, and most of us — even if we made good plans for how to escape in SOAP or whatever — didn’t have a particularly solid plan for “now what?”

I’ve seen situations ranging from faculty and administration riding to the rescue, saying, “don’t worry about a thing; we’ll sit down, review your options, and find you a slot in something somewhere,” to schools of medicine, program directors, and program chairs shrugging and saying, “sucks to be you.” And to the faculty and administration in the first column, I thank you for being the heroes your students need you to be in the moment. For those in the second column, in the interest of professionalism, I’ll hold my tongue.

In the meantime, if you’re reading this and walking this path, you’re surrounded by friends and family who desperately want to help, and I don’t know what to tell them either. You’re reading the same plaintive missives I am that talk (correctly) about how it doesn’t do us any good if — although we have plenty of graduating and competent MDs and DOs — we don’t have the capacity to train them all and make them all practicing physicians. And as much as these words are appreciated, and as I hope these issues of supply and demand are rectified quickly, it doesn’t do anyone in this situation a whole lot of good in the short term.

In any particular order, my companions in the Great Unmatched, this kind of low point ranks up there with bad breakups, deaths in the family, and any other traumatic experience you care to compare it to. I can’t speak for you, but I felt like any combination of a failure, a fraud, terrified, ashamed, crushed, a bad husband, a bad father, a bad son, and a bad friend. I contemplated my situation while I sat on a small mortgage's worth of debt to go with my piece of paper that says “MD” on it.

As the oldest guy in my class (and in my second career), allow me — if you would — to offer some words, and they’re worth exactly what you’re paying for them. If you can use them, do it. If you can’t, blow them off. 

Soul-crushing moments are a part of life. If this is your first one, you’ve been doing well. If this isn’t your first one, you know this feeling from other experiences. Life doesn’t care anything about your background, your dreams, or whatever else you’ve been through; when it decides to humble you, it is one of the cruelest forces in nature. It is the Leviathan itself, and it is here to remind you who’s boss (spoiler alert: nature is the boss).

The thing about it is, though, that these moments are inflection points in life. There is a segment of the population that fetishizes victimhood — that defines itself by awful experiences — and there is a segment of the population that reveres survival and overcoming adversity. I would urge you — as Class Dad — to choose the second path. Nobody asks for these moments to happen, but I would urge you to not let this moment define you; I would urge you to succeed in spite of this moment. Let that be what defines the end of this story.

For some, this moment will mean taking an extra year, doing something to fill in the time, and simply reapplying next year. For others, it will mean taking a deep breath and figuring out what else in medicine you can live with doing. And for still others, it will mean exploring the “adjacent possible” to the medical field — what you can do outside of clinical and academic medicine with your MD or DO, and letting go of residency or clinical practice. Nobody can tell you what the answer is; you have to decide that.

My friends in the Great Unmatched, you aren’t the first to go through this, and you won’t be the last. You have a great deal to mourn about today, but there is an opportunity to be found. The Chinese symbol for “crisis” is a combination of the characters for “danger” and “opportunity.” You will have to take risks and be introspective to find the answers you’re looking for. Mourn, because you need to but do not be paralyzed by this. Find your allies and ask for help, get your materials together if you’re going to carry on (vacancies happen in residencies all the time), and get your applications in for other degrees or research programs if that’s the path you’re choosing. Whatever your plan is, I urge you to go.

Do not shrink from this moment and let it define you in the context of failure; attack this moment by wiping the dirt off your face, smiling, and asking life, “what else have you got?”

I leave you with this anecdote from the 1994 Eastern Conference Finals in the Stanley Cup Playoffs. The New York Rangers were leading 1-0 in Game 7 against the New Jersey Devils, and New Jersey’s Valeri Zelepukin scored with seven seconds left in regulation to send the game to overtime. Ranger goaltender (and Hockey Hall of Fame) goaltender Mike Richter said in an interview, “…walk into the locker room — dead silence. No (team captain Mark Messier) speech, no anything, not much to say. (Veteran defenseman and Hall of Famer) Kevin Lowe says, ‘Hey, man, we’re gonna be fine. If it wasn’t so hard, it wouldn’t be so much fun when we do it.’ That’s the only thing I remember anyone saying — we knew what we had to do. We had to respond, and we did.”

Before I sign off, I want to remind you that if you need help and you’re thinking about hurting yourself, please do not do that. Reach out for help to your Office of Student Affairs, or call (800) 273-8255 (the National Suicide Hotline). You are not a failure, and your friends and family still need you and care about you.

How did you feel when you did not match? What helped you through it? Help those who are going through the same experience by sharing your answers below.

Thomas Irwin is a fourth-year student at the University of Kansas School of Medicine’s MD/MBA program and was a professional opera singer for 20 years prior to going to medical school.

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