As a residency reapplicant, it is normal to wonder how to improve residency application after going unmatched. You might have done everything in your power to prepare for your residency applications but even the most minor errors or oversights can negatively affect your candidacy. According to the latest NRMP data, around 5% of MD applicants do not match, so you are definitely not alone.

Whether you are reapplying to the most competitive or least competitive residencies, being a reapplicant can be difficult for your confidence. Do not lose hope! We are here to share with you our top tips for improving your residency application after going unmatched and our expert advice on what else you can do to increase your chances to match.


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Reasons for Not Matching Residency

Before you begin your plan for reapplication, consider your options after going unmatched. The most important one to keep in mind is the Supplemental Offer and Acceptance Program (SOAP) offered by the National Residency Matching Program (NRMP), which provides opportunities for eligible unmatched applicants to apply for positions that were not filled during the main match. All residency applicants typically receive an email notifying them of the SOAP option Friday before the Match week.

While SOAP can be your Hail Mary for the current application season, keep in mind that you might need to make some hard choices if you choose to enter SOAP. For example, you might have to pursue a different specialty from the one you initially applied for.

If you choose not to enter SOAP and reapply to your chosen programs and specialties again next year, we are here for you. Firstly, you should not despair or be ashamed of your reapplicant status. As we already mentioned, around 5% of allopathic residency applicants do not match, and according to some statistics, this number is nearly doubled for DO applicants. Instead of losing hope, focus on analyzing your application and what potential weaknesses led to you being left unmatched.

This is a challenging process. You worked very hard to put your application together, writing the residency personal statement, gathering stellar ERAS recommendation letters, and shining in your rotations and electives. However, it is time to face that something was missing from your profile that led programs not to choose you. There are dozens of reasons that may have affected their decision, but let’s go over the most obvious ones that can be easily eliminated during reapplication. Ask yourself the following questions:

  1. How many residency programs did you apply to? You might have applied to too few. While there is no universal ideal number of residency programs you must apply to, you must broaden your chances by applying to enough programs. We recommend applying to around 30 programs per your chosen specialty. The number can fluctuate between 15 to 35 depending on the strength of your application and the competitiveness of your specialty.
  2. Did you apply to the right specialty? How to choose a medical specialty is a question every medical school student asks themselves. It is important to reflect on your strengths and weaknesses, experience a variety of specialties, and be true to your interests when it comes to this choice. But is it possible that you applied to specialties where you had little to no experience? For example, maybe you applied to dermatology without ever taking an elective in this specialty? Or what if you applied to anaesthesiology but did not have support from a fellow anesthesiologist in the form of a reference? If your application stated that you were interested in one specialty, but all your experiences and supporting documents indicated that you pursued a different specialty throughout medical school, this would be a huge red flag for program directors. Your application must demonstrate that you took a serious initiative to learn about and participate in the specialty you are applying for. If you had no supporting evidence of your true interest in the specialty, this might have been the reason programs left you out.
  3. Did you proofread your application components? You might be scoffing at this question as you read it, but programs want near perfection when it comes to your application components. You might have read through your personal statement and residency CV a couple of times, but you need to make sure that they are flawless. Any typos, errors, inconsistencies will be a reason to chuck your application out. While you might think that small typos are not a big deal, remember that you are competing with thousands of other applicants – you do not want to give them a competitive edge by being sloppy with your application.

We can go on and on about the possible reasons an application was not a success. The reasons we list above may not be your case at all, but they are some of the easiest to detect. You must do your own analysis and identify where your application can be improved and how you can go about improving it. Below we list some of the strategies you can implement to enhance your residency application after going unmatched.

Tip: before you continue with reapplication, make sure to use our Residency Match Calculator to see how competitive you are for your chosen programs!

Reconsidering your medical specialty? Check out this infographic to help you decide what's best for you:

Step-by-Step Guide to Improving Your Residency Application for Reapplication

After careful analysis of your application, it’s time to take action. Keep in mind that it is not enough to simply gain a few more clinical hours or to get an average score in your USMLE Step 3 exam – to increase your chances you must improve your application significantly. This means that the year you take between going unmatched and reapplying must be focused on making yourself the best and most irresistible candidate for your chosen programs.

Rebuild Your Application

Firstly, you will need to re-evaluate your personal statement. This short document must absolutely wow the program directors. According to the latest NRMP data, your personal statement is in the top 5 factors that influence program directors’ choice in selecting candidates for the interview. As a reapplicant, it would be unwise to resubmit the personal statement you applied with the year before. It is absolutely up to you to decide what story arch and experiences you include in your essay but going unmatched is an experience that should probably be mentioned in your personal statement. It was a significant event in your life and simply ignoring it as you reapply would be a huge mistake. You do not need to focus the entire statement on the fact that you did not match, but you must acknowledge it and address how it made you a better candidate this year. As an example, let’s review the intro to a reapplicant’s personal statement:

“Here I am, yet again. Last year I also applied for a position as an anesthesiology resident. Unfortunately, I was not selected. However, despite setbacks and rejection, I return, with additional knowledge, growth, and research, but the same diligence and perseverance.”

The writer clearly acknowledges her setback but demonstrates dedication and the strength of her conviction to pursue anesthesiology as her medical specialty. This kind of opening leads us to wonder why this dedication is so strong, inviting us to read the statement to the end.

In addition to your personal statement, re-examine your references. According to the NRMP data, recommendation letters are the number two factor that influences directors' decisions for interview selections. This means that you must have strong support from professionals in your specialty to get that coveted interview. Make sure to have at least one letter from a specialist in your chosen field. This is a must. Remember that you have to demonstrate your suitability for the specialty you are applying for, and what can demonstrate your suitability better than a specialist’s support in your field? Your referee can be a rotation or elective attending, a physician you worked or volunteered for, or shadowed. Essentially, someone who can talk about your qualities and skills in relation to your chosen specialty.

Do not forget the number one rule of recommendation letters. Whether you are preparing medical school recommendation letters, residency references, or even job references, your recommendation must be stellar. Lukewarm or disinterested letters will only hurt your chances for an interview and match. So, keep in this mind as you reflect on whether you need to find new referees.

According to the latest NRMP data, your MSPE is the third most influential factor that affects the program directors’ choice for interview selections. It is possible and advisable to change your MSPE after a gap year between med school and residency reapplication. This is why it’s important to keep in touch with your medical school faculty and the dean. After you gain more experience and strengthen your applicant profile, you can ask your medical school faculty and dean to amend your MSPE by adding a few lines that demonstrate your improvements over the last year.

Want to know what the lengths of various residencies in medical specialties look like before making any decisions? Check out this infographic:

Clinical Work in Your Specialty

Clinical work should be the focus of your gap year. It's particularly important to work in the specialty you want to pursue. If you want to leave the program directors with no doubt of your suitability for the specialty you are applying for, then do everything you can to grow in skill and experience in that specialty. Start by reaching out to attendings you worked with or faculty members at your medical school to learn of available opportunities in your specialty of choice. If you previously shadowed a physician in your chosen specialty and you developed a friendly rapport, you can reach out to this physician to ask if they have any positions available.

Clinical experience in the US and Canada is especially important for international medical graduates (IMGs). You will have little chance of matching as an IMG if you have no clinical experience in the country where you want to practice. If you are still a student in a medical school abroad, consider setting up a clinical externship or exchange, or enroll in an elective program in a medical facility in the US or Canada. Some medical schools have developed programs in association with medical schools and institutions in the US and Canada. Make sure to check out if your medical school has any affiliations with institutions in the country where you want to attend residency and practice.

If you are already a graduate of an international medical school, consider shadowing or observership opportunities in the US and Canada.

IMGs should keep in mind that a quality clinical experience in the US and Canada can result in a recommendation. Support from professionals in your field, from the country where you want to practice, will be a great addition to your application.

USMLE Step 3

Your USMLE scores matter. According to the NRMP survey, USMLE Step 1 scores are the number one factor that influences directors’ decisions when it comes to selecting candidates for interviews, while USMLE Step 2 CK score is ranked as number four in the same decision-making process. As you might already know, if you passed your USMLE Step 1 and Step 2 components, you are not allowed to retake them. So even if you wanted to increase your scores in these 2 exams, you cannot if you received a passing score. What you can do is ace the USMLE Step 3 exam, which would be another component to add to your application when you reapply. A stellar USMLE Step 3 score can help outweigh average Step 1 and 2 scores, so do your best!

Participate in a Conference

We are sure that the news of not matching your chosen programs was a big blow to your confidence. You might even start wondering if you belong in this profession or whether you want to stay in this environment. But this is the wrong attitude! Instead of doubting yourself, you should focus on working on your weaknesses and emphasizing your strengths. One of the ways to further rebuild your confidence and sense of belonging is to attend a conference in your chosen specialty. Not only will you learn about the most current issues and exciting innovations in your specialty, but you will get to network with specialists in your chosen field!

Conferences can be an opportunity to make network connections that lead to observerships and shadowing, research projects, and even clinical work. Networking is a big part of staying on top of the most current news in your specialty, and this level of dedication to and knowledge of your chosen specialty will not go unnoticed by the program directors.

Looking for tips to make your residency application really stand out this time around? Watch this video:

What Else You Can Do as a Reapplicant: Work on Your Interview Skills

If during your last application attempt you got to the interview stage of the selection process, then most likely your ERAS or CaRMS application was of good quality. You should still take the year to bolster your profile, but you should reflect on how strong your interview skills are. According to the latest NRMP data, your performance in the interview, specifically your interactions with faculty during the interview and visit, is the number one factor that determines the directors’ ranking of applicants. If you think that your interview performance negatively affected your standing, it’s time to seriously commit to your interview preparations.

ERAS interview prep or CaRMS interview prep is a huge undertaking. We have written extensively on these preparations processes, so we strongly recommend you review our blogs. However, to give you some context, we would like to emphasize that your residency interview is a lot more than a series of residency interview questions and answers. Note that according to the NRMP survey, directors are less concerned with how well you answer common questions like tell me about yourself, but rather focus on applicants’ interpersonal skills, their interactions with faculty, staff, and current residents. Having answer strategies for interview questions is of great importance, but so is your overall performance throughout the entire day. To do well in all segments of the interview day, you must build confidence and interpersonal skills. Your interview prep plan must include strategies that would help you develop and improve these important skills.

Would you like to see a summary of some key points in this blog? Take a look at this infographic:

Conclusion: Apply Early and to Appropriate Programs

How to improve residency application after going unmatched will depend on your initial application and interview performance. As we discussed throughout the article, there may be dozens of reasons why your application and interview did not leave a lasting impression on the programs’ directors and faculty. This is no reason to give up on becoming a physician in your chosen specialty.

As you prepare for reapplication to residency, keep a couple of tips in mind. Firstly, apply early. According to the ERAS timeline, applications are accepted starting in early September. This means that you should start working on your application components no later than May. Crafting the perfect statement, amending your CV and MSPE, and securing strong recommendations take time. Prepare all your components in advance and apply as soon as the application portal opens.

The last tip to keep in mind as you prepare for reapplication is to constantly ask yourself “why this specialty?”. Keep this question in mind as prepare each of your components. Programs will not be impressed with applications that are specialty-neutral or disinterested. They will also not enjoy applications that seem to be misaddressed, i.e., if your experiences and application seem to be more suitable for a different specialty. This does not mean that you cannot have a variety of experiences – you can and should experiment with specialties! – but make sure that your application tells a vivid story of why you’re a perfect candidate for this program and this specialty.

FAQs

1. I did not match residency. What should I do next?

Firstly, do not panic. This happens more often than you think. If you still want to try to match in this application cycle, you can try entering the Supplemental Offer and Acceptance Program (SOAP) to find a match with programs that could not fill all of their available positions.

If this does not work for you, plan for reapplication.

2. How many applicants do not match residency?

According to the latest NRMP data, around 5% of allopathic graduates do not match residency.

3. What’s the number one factor that affects my chances for a residency interview invite?

According to the latest NRMP data, USMLE Step 1 or COMLEX Level 1 scores are the most influential factor in determining which applicants get selected for an interview.

4. What’s the number one factor that affects programs’ ranking of applicants?

According to the latest NRMP data, applicants’ interaction with faculty during interviews and visits is the number one factor that influences the ranking order of the applicants.

5. What are the reasons for going unmatched?

There are dozens of reasons for going unmatched. We strongly advise you to review the section "Reasons for Not Matching Residency” in this blog. Your number one priority after receiving the bad news of going unmatched is to reflect on the strengths and weaknesses of your initial application. This analysis can help you determine what aspects of your application need work.

6. I do not understand why I went unmatched. What should I do?

It might be a good idea to reach out to a medical school advisor who can help you analyze your application and interview skills. They will help you point out any weaknesses and help you work on them.

7. What can I do to improve my application after going unmatched?

You should start by reviewing and reworking components of your application, such as your personal statement, CV, references, MSPE, and so on. You should find clinical work in the specialty that you are pursuing. This experience can be incorporated into your components when you reapply. For more information and tips, please carefully review the section “Step-by-Step Guide to Improving Your Residency Application for Reapplication” of this blog.

8. Should I reapply to a different specialty?

This depends on how strong your profile is for the specialty you are reapplying to. Do you have solid clinical experience in this specialty? If not, focus on gaining it during your gap year. Do you have a reference letter from a professional in this specialty? If not, make sure to get one for reapplication.

If you feel that you do not have enough background and support in a specialty, it might be a good idea to consider other specialties for which you are a more suitable candidate.

9. What else can I do to improve my chances of matching?

Make sure to do residency prep. Your interview performance is the number one factor that influences programs’ rankings, so make sure to prepare for your interviews well and in advance.  

To your success,

Your friends at BeMo

BeMo Academic Consulting

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