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    What it’s like to not match into a residency program

    Sophia Matos, MD, didn’t match the first time. The next year, she matched into medicine’s most competitive specialty — otolaryngology. Here’s how she turned her application around.

    Sophia Matos, MD, poses with her parents after her graduation from Southern Illinois University School of Medicine. She is now an ENT resident at SIU.
    Sophia Matos, MD, poses with her parents after her graduation from Southern Illinois University School of Medicine. She is now an ENT resident at SIU.
    Courtesy of Sophia Matos, MD

    Just before 9 a.m. on the Monday of Match Week 2021, Sophia Matos got a call from the dean of students at Southern Illinois University School of Medicine. She knew what he was calling about, as it was customary for the dean to call all students who didn’t match and tell them the news directly.

    “So I got that phone call and I thought: ‘Oh, no. I know what this means,’” Matos recalls. “The first reaction is you don’t really believe it.”

    Matos had applied to otolaryngology, one of the most competitive specialties in medicine. In 2021, 28.0% of U.S. MD graduates who chose otolaryngology as their only choice of specialty did not match, higher than orthopedic surgery (21.7%) and plastic surgery (20.1%), according to the National Resident Matching Program® (NRMP).

    In hindsight, Matos could see where her application had lacked depth. She originally applied only to dermatology programs but changed her mind a week after applications were due, after she finally had an opportunity to do an in-person rotation in the ear, nose, and throat (ENT) department. COVID had thrown off the original timeline for specialty rotations.

    In March 2020, “we had finished all of our core rotations and we were about to go into elective rotations, which is when I would have been able to rotate on the specialties that I was interested in, which included ENT, dermatology, and plastics,” Matos says. “But with COVID, all those opportunities were canceled.

    Sophia Matos, MD, poses with a poster she presented during her research year.
    Sophia Matos, MD, poses with a poster she presented during her research year.
    Courtesy of Sophia Matos, MD

    “I had been doing dermatology research since my second year, and I had a couple of great mentors in the dermatology department, so I applied where I felt most comfortable,” she says. “Then I had a rotation in ENT, which is when I realized, ‘Oh, these are my people. This is what I’d really like to do.’”

    Matos withdrew completely from dermatology, scrambled to get new letters of recommendation, and emailed each ENT program individually, explaining her decision. She got five interviews and, afterward, felt pretty good about it all.

    Then came the phone call from the dean, followed by the email from the NRMP® saying she didn’t match.

    “I was just very disappointed,” Matos says. “But I have a good support system. My family is in town. I have really good mentors … I was able to speak with my ENT mentor right away and we talked about what my application lacked and where I could stand to grow the most in the upcoming year.”

    She had three options: Go through the Supplemental Offer and Acceptance Program® (SOAP®) process (and possibly match into a different specialty); do an ENT research year; or do a transitional year in general surgery. “Everyone I talked to said a different thing: They said: ‘Oh, you’ll never match if you do a research year’ or ‘You’ll never match if you do a transitional year.’ So you just have to decide and make the best of it.”

    Her ENT mentor felt she would do best with a research year, so she spent the next week applying to research programs. “It’s a lot of pressure, a lot of anxiety. I had to redo my CV for the applications for the research programs, and I just remember writing and then breaking down crying. … For people who are high achievers, who tend to be most medical students, it’s probably the first time that something didn’t work out how they wanted it, so it feels like a huge failure.”

    But Matos had a gut feeling that otolaryngology was the right specialty for her, and over the ensuing months, she threw herself into learning more. She deferred her medical school graduation until November 2021, which allowed her to do an away rotation at the University of Tennessee Health Sciences Center in Memphis. And she also did extensive research, including five projects that she published or presented at national conferences.

    The next fall, when application season rolled around, she rewrote her personal statement to acknowledge that she hadn’t matched the first time around, but that she had spent the year immersing herself in ENT research and enhancing the skills that she lacked in her first application.

    “I felt more confident the second time around because I knew that I had done everything in my power to get in,” she says.

    She also dual applied to internal medicine and, between the two specialties, received enough interview invitations to feel optimistic about Match Day.

    The Monday of Match Week 2022, Matos was in the basic science lab by 6:30 a.m., unable to sleep and hoping that her work would distract her. At times, she found herself pacing the floor, glancing repeatedly at her phone, hoping she wouldn’t get that dreaded phone call.

    She didn’t.

    That day, she learned that she had, indeed, matched. And that Friday, March 18, 2022, she learned that she had matched into the ENT program at Southern Illinois University, her home institution.

    “It just felt really validating,” Matos says. “And then I got the phone call from the department and I knew I had a lot to look forward to in the upcoming year.”

    That was one year ago this week, and Matos says she has no regrets about holding out for her dream residency. “I love ENT. It’s amazing,” she says. “Every day is a new challenge. There’s so much to learn but I just love all of it.”

    Her advice for other students who learn they don’t match? “The first thing they should do is reach out to a mentor in their chosen field. The ideal scenario would be they get to sit down with them or talk to them about what’s lacking in their application and if [their mentor] thinks they are a good candidate for a reapplication.

    “I didn’t want to go through the application process again if my numbers weren’t good enough or, objectively, if I was just not good enough to get in,” she says. “I think it’s important to be honest with yourself.”

    Then: Be aware of your options. Should you SOAP? Do a transitional year? Do a research year?

    “It’s always going to be an individual decision,” Matos says. “There will be a lot of different opinions about what you can and should do. But the main thing is to be confident [in choosing your path]. If you make the most out of the opportunity that you have, I think that’s the best anyone can ask for in an applicant.”