What to do When you Match into a Different Specialty than you Planned

By Luke Murray

Susan sat in the front of every class, was the first to approach the teacher with questions between classes, and, not surprisingly, ended up at the top of the class.

Because of her positive attitude and bubbly personality, Susan was able to pull this off without being labeled a ‘gunner’ or being generally shunned for the insane and occasionally obnoxious amount of effort she put in to being the best medical student she could be.

After the first two years, Susan took all that front-of-the-classroom energy into her pursuit of the residency she ‘knew’ would fit her best: orthopedic surgery.  She spent three months of her 4th year working 80+ hrs a week at away rotations, showing how sharp she was, how far above the expectations she would go, and ultimately putting herself in a position to have the best shot possible to match into what she knew was one of the most competitive specialties. Not surprisingly she got AOA and graduated summa cum laude.

As a classmate looking at Susan’s academic career from the outside, it seemed a forgone conclusion that she would match where she wanted – maybe not her first choice, but definitely in her preferred specialty.

And then, she didn’t.

Of the 13 places Susan interviewed she ended up matching at zero of them.

But as I sat there talking about it with her a month or so after Match Day, Susan had recovered remarkably well. She had matched into a residency spot in radiology, in an area of the country with some old friends and good national parks (she and her soon-to-be fiancée both loved hiking and rock climbing), and she was genuinely excited about the new direction and new opportunity she had in front of her.

While the nuts and bolts of the SOAP & the pre- and post-match processes have been covered in other posts (here, here, and here), I want to talk about what Susan did emotionally to deal with not matching into her specialty of choice, and how you could be more excited than you perhaps currently are about this ‘new opportunity’ in front of you.

Go ahead and pout…but not for too long. Susan was hurt, confused, and overwhelmed with grief the day she found out she didn’t match. She called her best friend to come over to her place and be with her. Plenty of tears were shed and curses said at the residents that chose not advocate for her, the programs that rejected her, and what seemed like the general conspiracy of the world against the dreams she had earned the right to see come to fruition.

This is healthy. It’s part of the normal stages of any grieving process. But it’s something that Susan was able to proactively manage by creating a deadline for each stage of the grieving processes. Because the alternative was worse. You’re going to eventually be working in that ‘second choice’ specialty soon, and if you’re still feeling sorry for yourself and being generally negative it’s going turn a ‘bad’ situation and make it worse. So start planning out now the days when you’ll take each individual step necessary to ‘get over it.’

Be thankful you have a job. This is probably hard to do, especially at first, but in 2013, 40,335 people applied for 26,392 PGY1 spots. That means that over 14,000 people did not match at all. You have a job, an opportunity to graduate as a US-trained physician. You didn’t get exactly what you wanted, but you got the opportunity to practice medicine, one of the biggest professional and personal privileges in the world.

You are NOT ALONE. If you ranked two different specialties, you aren’t the only person to not get the first choice of the two. Overall, in 2011, one out of every 10 students ended up not getting their first specialty match choice. If you ended up not matching and had to SOAP/scramble into a different specialty than your original plan, you’re also in plentiful company. For certain specialties, a LARGE percentage of those that applied did not get it. In Susan’s case, 33% (693/1,038) of applicants to ortho didn’t match into that specialty.

Look for the upside of your situation. When I talked with Susan about how she felt about radiology, she was already focused on all the good things it would provide her that life as an orthopedic resident would not have provided. She wanted to start having kids. She wanted to spend more time with her new husband. She was already growing weary of the male-dominated orthopedic scene and the difficulty of fitting into that as a bubbly, sweet-voiced girl. Radiology had none of that. And there was even the opportunity to do some procedures via interventional radiology. She didn’t think of these things at first. This new opportunity was all ‘worse’ than her original plan at first. But some time and consciously positive re-evaluation of her situation helped Susan form not just rose-colored glasses, but ones through which she could clearly see her professional and personal lives coming together.

If it makes sense, don’t give up on your specialty. I know a girl that has dreamed of becoming a pediatrician literally since she has any recollection of considering careers. But, she matched into family medicine. She has followed all the advice above. But she’s DEAD SET on peds. So she’s going back into the match this year. Yes, she’ll have to redo intern year, and yes, it will extend her training that much longer, but for her, it’s worth it to keep on trying.

Got a story about how a match other than the one you wished for ended up making more sense in the long run? Let us know about it.