How to Manage Un-matching in U.S Residency Training Program

USMLE is a tough task. One starts planning for USMLE by the end of graduation years at medical school. It begins with extremely demanding and mind boggling preparation of STEP 1. You are locked inside the reading room, your thoughts occupied by exam scenario and daily activities just limited to reading Kaplan books and solving U-World questions. Once STEP 1 is aced, there comes another monster, STEP 2 CK. After scoring well on STEP 1, another courage booster is required to go through same pain staking exam preparation for STEP 2, for another period of 4-5 months. Then come visa application, traveling to USA, adjusting to challenging situation in a new country, appearing in Clinical Skills exam after weeks and weeks of repetitive case preparations, searching for places to join clinical rotations, sit again for marathon STEP 3 and finally facing the mind cracking pressure of residency interview season.

Now, if anyone of my colleagues is unmatched, just relax for a moment, take a deep breath, and remind that he has already gone through all those extremely challenging tasks that I recalled in the beginning. Today, he is just a single step away from the final goal. He demonstrated his endurance and determination from the day he started preparing USMLE. Another test of courage is ready for him. And he has documented proof in the form of his previous performances that his rock solid valor is there to survive the monstrous challenge of un-matching. Remaining unmatched is not a stigma. It just gives us a message that the goals we are aiming at need a bit more endeavor. Remember, huge tasks have huge risks and need huge efforts for huge success. Un-matching means that you just need to add-on few more effort spells to your residency application and there you go, US residency program is waiting for you.

Evidence based treatment of remaining Un-matched in US residency program:
Here I present to you, the most comprehensive way to treat un-matching. It is the time to apply all the knowledge you got from USMLE preps, but in a slightly different way. Follow the scheme,

Statistical analysis:
Look at the data of the match result. Gather the information regarding number of matched and unmatched candidates in the specialties you applied for. Try to gather data of your colleagues who remain unmatched. You will shortlist the factors which were common in those candidates who matched. And highlight the shortcomings in CVs of all those colleagues who remained unmatched. Define the trend.

After defining the shortcoming of those who remain unmatched, try to find out what can be your reason for remaining unmatched. Identify the loopholes.
Non-modifiable risk factors.

  • Low USMLE exam scores
  • Delays and long past year of graduation.
  • Failed exams

Modifiable risk factors.
  • Improperly written personal statement
  • Limited/less U.S clinical experience
  •  Weak communication skills
  • Irregularly directed personal CV,(not specialty oriented)
  • Weak L.o.Rs , which are not following ECFMG recommendations
  • Applying in programs which do not match your CV.
  • Poor networking with colleagues already working there in US hospitals, lack of guidance.

Have a look at the credentials of candidates who got matched in the programs you ranked. It is a time taking procedure but if any of your colleagues is there in your ranked programs, just contact him/her. Ask for the help in this regard. Another way to investigate is to present your ERAS Application to senior residents in US residency programs. Senior residents have huge bulk of useful information about converting a dull CV into an eye catching resume. By the time you have reached this point, you will already have a lot of information about your shortcomings – from residency application errors to weakness in communication skills.

Evidenced based treatment:
Final step is treatment. You have already differentiated modifiable and non-modifiable risk factors that resulted in un-matching. Again have a look at the previous records to find out what used to be the most common treatment for commonly faced factors. You have to work on symptomatic relief as well as proper cure of root cause based on well defined recommendations.

Steps for symptomatic relief from stress of remaining unmatched involve: 

  1. Ø  -Try to socialize and remain in touch. Do not consider it as a failure but take it as a challenge to overcome. Contact your fellows who matched.
  2. Ø  -Get yourself busy. Find some work you enjoy to do. You can work on your hobbies to remain comfortable, join on-line web courses on various Medicine related topics or join some job/research.
  3. Ø  -Communicate with your prime family members. In this USMLE track, one stays segregated from family while preparing for exams. Now it’s a break time. Spend it with revitalizing communication with your closed ones. That will remarkably decrease the stress.
  4. Ø  -You are about to gear up for another challenging task ahead of you. Life goes on, so should you. Refresh yourself, reload the energy and just forget about sad days you left behind. Move On.

The next parallel step is curing the root cause.  This involves a multifaceted approach.
  •  > It ranges from strengthening your U.S clinical experience to enhance your interpersonal communication skills.
  •  > Keep on thinking about various topics you will discuss in your next residency interview season.
  •  > Refresh your personal statement. This time you have experience of remaining un-matched with you. Utilize your thoughts to add the required sensational attraction to your personal statement. Take advice from seniors on it.
  •  > Practice to present your ides in the best possible and comprehensive way to your listener.
 And finally, the most important and time tested cure is to strengthen your belief in Allah. From my personal experience, I had never been so close to Allah, Almighty as I was during the tie when I was facing un-matching. Be thankful for whatever you have with you till now, and be confident to get the next coming success with a smiling face.

Dr. Faran Ahmad
King Edward Medical University (2004-2010).

People Who Are Not Matched :
Uptil now , all the posts were for those who got matched by the blessing of Allah. But what about those who are not matched ? Are they not blessed by Him?
Is USA out of question for them ?
What options they have?
What should be their strategy?
What is likelihood that they will be matched next year ?
What does it mean financially ?
All these questions will be in minds of those who remain unmatched . I will try to explain all of them in this post .
Why people remain Unmatched ?
Following are reasons in descending order .
1- big category of unmatched people are those who don't apply with full application with all steps in time and USCE .
2- people with attempt in Cs or step 3
3- people with low step 1 score <225
4- people with no USCE
5- people with poor interview skills
Is USA merely a dream option for Unmatched anymore?
Out of 39/49 people who matched this year , about 14 were those who were unmatched last year. If they had been disappointed , they would not have been part of this 39 number . So unmatched people have 50-60 % of chance of being matched next year.
What are the options for Unmatched after March 21 2014:
1- they should take one month of , calm their nerves ; look into their cv; discuss with seniors and matched candidates and figure out the reason for being unmatched . 80 % of the cases , they will find one of the reasons mentioned above
2- they should look for USCE in terms of observership/ externship at least 2 month .
3- the unmatched people have very low threshold for going into research; I will encourage it only if you are promised publication before next match ; otherwise clinical rotations are better than research ; research people exploit such unmatched people
4- if no USCE found in USA , then research without publication is next step down as it gives you gap fill and chance to make contacts .
5-if still nothing in USA , go to Pak and join Fcps if part 1 is done - this gives you mental satisfaction and fills gap in your cv- more important is that don't let any gap be part of your CV
6- if you got Qatar residency and did not get USCE ; go to Qatar instead of Pak as it gives you not only mental satisfaction but also lot of money to apply for next match. There are examples when Qatar residents reapplied match and got matched
7-If you don't have fcps part 1 or Qatar ; go to MO job in Pak ; and apply next year - it will fill gap
8-if it is not possible , you can apply for residency at
Shoukat khanam;
agha khan ;
Army medical services as they prefer MD and steps
9-if you have no house job and don't get anything in USA ( neither research or USCE ) ; start house job so that next year you may have more options
What does it mean Financially :
Applying re match costs another 6000-7000 dollars interms of accommodation , match fees and travel
Summary is that blessed are those who got matched but unmatched people are not away from His blessings as He will choose something better for you next year . There are examples when people in first attempt have very small programs and in next match they ended up in universities . So believe in Him
"As if you believe ; you receive !"

Article by:
Dr. Waqas Nawaz MD


  1. Hello.

    I am an FMG. My YOG is 2009
    Step I - 249 (1st attempt)
    Step II - 252 (1st attempt)
    CS - 1st attempt
    Planning to take Step 3 soon.
    Have 1 month of US externship at a Physicians office and one US LOR.

    Have completed a Post graduate course in Pharmacology and Therapeutics (3yrs) and working as a general practitioner since 8 months.
    8 publications.

    My wife's profile is same as mine but her scores are:
    Step I - 219 (1st attempt)
    Step II - 222 (1st attempt)
    CS - 1st attempt

    We had applied for the 2014 match (IM) in the Couple's match category, but didn't match. I had 6 IVs and she had 3 IVs.

    We are planning to apply for the 2015 match. Do we stand a chance? What should we do to improve our chances? (Doing an observership/externship doesn't seem to be possible). Will giving the Step 3 significantly increase our chances?

    Thanks in advance.


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