Few days are as important as Match Day for a medical school student.
Dozens of videos on YouTube show students crying tears of joy and hugging classmates as they finally learn, this year on March 15, where they will spend the next three to seven years doing their residency. This day marks the unofficial end of medical school and the beginning of a career as a doctor.
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On the Monday of Match Week, students learn if they were matched with a residency program. This year there were approximately 40,000 registrants. Unmatched students – this month, 963 registrants were unmatched, according to the National Resident Matching Program – are automatically entered into the Supplemental Offer and Acceptance Program, a one-week process that allows them to apply for unfilled residency positions.
Residency offers through SOAP "continue through Friday of Match Week, and that process has been very efficient," says Hal Jenson, president-designate of the National Resident Matching Program.
Before SOAP was created, students went through a similar process called "the scramble." But even with coordinated, last-minute efforts to place students, some still find themselves without a residency.
After not matching in anesthesiology in 2010 and then failing to find a residency program through the scramble, one aspiring physician spent a year teaching anatomy, physiology and microbiology at a technical school until the next match.
"I still wanted to do anesthesiology, but I left it open to other fields as well. It sort of becomes a you-take-what-you-get type of deal," says the now second-year resident, who asked not to be identified. He settled for internal medicine.
"Initially you are disheartened, but what can you do about it? Either you sulk, or you fix it and figure out another situation," he says.
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Experts say there are typically two reasons students don't match. They apply for highly competitive residencies, such as dermatology or radiology, even though their medical school performance makes them unlikely candidates for those slots, or they place too few schools on their ranking list, which they give to the National Resident Matching Program.
While unmatched students can take alternative routes to residency, many in the medical field agree it's best to avoid the situation outright. One way is to rank several residency programs at which a student has interviewed.
"I tell medical students they should always put at least five places," says Stephen Klasko, dean of the University of South Florida Health's Morsani College of Medicine. He encourages students, particularly those who didn't initially match, to expand the number of hospitals they are willing to go within their chosen specialty, or consider choosing a different specialty.
Lynn Buckvar-Keltz, associate dean for student affairs at the NYU School of Medicine, says grades and exam scores matter when applying for residency, but those aren't the only factors.
"Being an engaged, enthusiastic member of the clinical teams during the clinical clerkship is an important part of the student's medical school experience and therefore their residency application as well."
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If an aspiring physician is unmatched, there are a few options.
Students can contact their medical school and ask for a transitional slot, which mimics the fourth year of school, or seek a research fellowship.
"If they do a transitional year or a research fellowship, they can then become more competitive in one of those specialties or they can decide to match in family medicine or general internal medicine where it's easier to get a slot," says Klasko.
Obtaining another degree could also increase a student's chances of matching in the next cycle, Klasko says.
"Now all of a sudden I'm a pretty cool candidate," he says. "It doesn't look like I'm somebody who failed. I'm somebody who decided to get a master's in public health or an MBA. Now I'm a differentiated candidate."
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Corrected 4/10/13: A previous version of this article misstated the name of the National Resident Matching Program.