The unmatched residency blues: Next steps if you didn't secure a job

Published April 17, 2023

Key Takeaways

  • Despite the increasing number of medical school and residency positions, some medical school graduates may be unable to secure a residency job.

  • If you didn't match in the Main Residency Match, act fast and apply for the SOAP program, which allows you to apply for up to 45 unfilled residency positions.

  • To increase your chances of matching in the future, stay positive, seek feedback, find a clinical job or research fellowship, go for USMLE Step 3, and consider broadening your options.

Although medical schools in the United States have increased their enrollment in MD programs by 35% from 2002 to 2020, national residency programs have not kept up with this expansion.[] This means that an increasing number of medical school graduates will be unable to secure a residency job. 

While medical students gear up for the National Resident Matching Program (NRMP) every year, there's always a fear of not matching with a program. This can occur to any applicant from any school, although it is more prevalent among DOs than MDs, and even more so among international medical graduates and foreign medical graduates.

In 2023, 42,952 applicants actively participated in the NRMP, but only 40,375 certified positions were available.[] For those who receive the unfortunate news that they didn't match, it can be a devastating blow. But options are still available to pursue your dream of practicing as a physician.

Here are some tips on making the most of the coming year and improving your chances of matching the next time.

SOAP®- Supplemental Offer and Acceptance Program

SOAP, also known as the Supplemental Offer and Acceptance Program, offers a second chance to medical students who have been left unmatched or partially matched during the NRMP residency match. It allows them to apply for unfilled residency positions and potentially receive offers during the match week.

SOAP allows you to apply for up to 45 vacant residency seats.

In 2023, SOAP filled around 91% of the 2,658 unfilled positions from the main matching program, which were assigned to the supplementary program. This was a 17.5% increase from the previous year.[]

Stay connected with your medical school

Don't be embarrassed or ashamed to tell others about your situation. Instead, contact your medical school and seek their guidance. Search for mentors in your desired field and offer your services with a research project. You can also consider a research fellowship.

These experiences will not only keep your expertise up to date, but they will also make you a more appealing prospect during the next residency match.

Find a job in a clinical setting

Get clinical employment to keep your clinical skills sharp. Even if you are not allowed to provide direct patient care, you can work as a scribe or an electronic health record (EHR) trainer. Such positions showcase your dedication to the field and convince program directors that you've maintained your abilities up to date.

Go for USMLE Step 3

Passing the United States Medical Licensing Test (USMLE) Step 3 can help you stand out as a candidate. It assesses more in-depth clinical knowledge and decision-making than the earlier tests, so taking it when your knowledge is fresh might pay off. Step 3 can boost program directors' confidence in your talents, increasing your chances of matching.

For foreign medical graduates, finishing Step 3 allows you to pursue a physician exchange visa (J1) supported by the Educational Commission for Foreign Medical Graduates (ECFMG), as well as a high-skilled worker visa (H1b) supported by a hospital.

Broaden your residency program options

When applying to residency programs the next year, don't limit yourself to a specialty or geographic location. 

Be open to different opportunities, and consider applying to multiple specialties or programs.

It may be costly, but it increases your chances of matching and helps you explore different areas of medicine.

You can also utilize tools like FRIEDA™ and FindAResident™ to find open residency and fellowship positions.

Remember, you have 6 months after the Main Residency Match before applying again, so use this time to implement your next steps and prepare for a successful residency match in the future.

What this means for you

It can be disheartening not to match for a residency, but remember that options are still available. By staying connected with your medical school, finding a job in a clinical setting, passing the USMLE Step 3 exam, and considering a different approach while applying and interviewing, you can improve your chances of matching the next time around.

Read Next: Switching your residency? Here's what to know

Share with emailShare to FacebookShare to LinkedInShare to Twitter