Always have a Plan B (and perhaps even a Plan C :)) (even if you are confident you don't need it!):

Lessons Learned from the 2022 NRMP Residency Match Cycle:

This year was a successful one. 100% of the osteopathic medical students I was fortunate to advise through the match process in the role of an Assistant Dean matched/placed into a residency program. I had held my breath throughout the year (as I do each year) as NRMP Match Week approached with the knowledge that residency matching is becoming increasingly competitive. With several existing residency match processes (e.g. NRMP, Military, Urology, SF), the NRMP Match is the one with the greatest participation, as it encompasses the majority of available specialties. Unlike in years past when Match Day was followed by a Scramble process (that was truly a scramble/free for all), the Match and Scramble process have morphed in the past several years to "NRMP Match Week", incorporating an organized SOAP (Supplemental Offer and Acceptance Program) within it to optimize the number of matches between applicants and programs.

Now that I have had time to reflect again on the outcomes of this year's Match, I think about what it is that optimizes an applicant's opportunity to match into and have the opportunity to train in a residency program. What prevents a medical student from becoming one of many (knowing that even one unmatched student is too many) that remain post-SOAP, searching for other options until they either obtain a position outside of the Match, pursue alternate opportunities, or plan to participate in the Match again the following year. The impact that this stressful transition from UME (Undergraduate Medical Education or medical school) to GME (Graduate Medical Education or residency/fellowship) poses is tremendous for those having to walk this difficult path, with the uncertainty of whether they will be able to ultimately practice clinical medicine as physicians.

The conclusion, from years of reflection and wisdom gleaned from those involved in UME and GME, is that match success is based upon a multitude of factors. The hard work by the medical student is first and foremost! The 3+ years of medical school reflected in their applications to residency programs are at the crux of their success. As we know though, it is not just what is "on paper" (e.g. ERAS application, LoRs, PS), but, perhaps even more importantly, interpersonal communication skills that are relayed during the interview process and through written communications with programs. Students with only a handful of interviews match and those with 15+ interviews may not (I have seen both of these occur, many times). In order to mitigate issues with matching based upon applicant presentation, careful preparation is necessary both for what is submitted in the overall residency application and for strong interview performance. The final critical aspect of residency applicant success is the presence of medical student professionalism. One of the most highly considered factors (as per the 2020 and 2021 NRMP Program Director Survey) in applicant selection is the demonstration of professional behaviors.

However, almost equally important to a medical student's academic/clinical performance and professionalism, is strategy! Being prepared with what had previously been considered a "back up plan" but is now more aptly termed a "parallel plan" has been the saving grace for many. For students applying to competitive specialties (or perhaps better stated as specialties which do not match one's personal competitiveness), applying to an alternate specialty that is a better competitiveness match is important. For those who are at-risk for not matching based upon any concerns or red flags on their application, another approach outside of applying to another specialty is to increase the number of applications submitted (in a thoughtful manner) by selecting programs that are "within range" (e.g. "safety", "target"). In some cases, both strategies (e.g. applying to a second specialty and increased number of applications) would be advised.

Is there a downside to having a "parallel plan"? The primary one is financial based upon the cost of an increased number of applications (though perhaps a drop in the bucket compared to medical student debt load). Another downside is the fact that by applying to either more than one specialty or to more programs, applicants are adding to issue of excessive application numbers. To avoid doing so, the recommendation is always to apply smart (not haphazardly to all programs). It is not the absolute number of applications that leads to matching but applying to programs that are a good fit and have a greater probability of resulting in match success.

Is there a benefit to having a "parallel plan"? Yes! I believe the greatest benefit may be peace of mind. When interviews are granted during interview season, if an applicant does not receive interview invites from their first choice specialty, having interviews from another specialty that is of interest and perhaps even geographically desirable for the applicant can be a great relief. There are further considerations and intricacies that can be discussed (contact me to do so:)) but perhaps the focus on wellness and decreased anxiety is one of the most important benefits of having a contingency plan.

So, as students are striving to excel in their didactic pursuits and clinical performance (while simultaneously exhibiting exemplary professionalism), the importance of strategy and preparedness during the residency application process cannot be overemphasized. I have been there with students as they learn that they have not matched. I have had students regret their decision to not consider Plan Bs and Cs. I have spoken with students who have apologized for not considering the advice given or being prepared for the SOAP and post-SOAP processes. I have had students who were insistent that they were meant to be an _______ (fill in the blank with your dream specialty)______ since they were in utero, who, when facing the option of no residency or an alternate specialty, always chose any available training option remaining. Having walked the difficult walk of medical school and residency, my hope is for all medical students to succeed, and to do so without facing significant barriers (or angst) along their path.

For those of you in medical school considering your options, please be prepared with a Plan B (and C). You will be glad you did.

As of today, I have transitioned fully to consulting as it is my hope to spend more time with a sole focus on individual student coaching. Please feel free to reach out if you would like guidance (rupalvoramd@gmail.com).

Wishing you the very best in your journey,

Sincerely,

Dr. Vora