Matching the Unmatched: The Role of the Medical Student Career Advisor

By Marlene Welch, MD

I was not sure I wanted to go to medical school. As an undergraduate studio art major, I worried about make a living sculpting and print-making—the typical starving artist. Naively, I believed that medicine was a sure thing. I thought if I could get into medical school, I would be guaranteed a residency and a stable career as a physician. So I applied.

When I entered medical school in 1989, there were 748 more residency positions than applicants (19,955 positions for 19,207 applicants). But by the time I registered for Match Day in 1994, the odds had changed: There were 1,580 more applicants than residency positions (22,352 applicants for 20,772 positions). Fortunately, 93 percent of United States medical school seniors matched, and I was able to match into a surgical residency.

Fast-forward 18 years. In 2012, a record-high 38,377 applicants registered for Match Day for 26,772 open residency positions—over 18,000 more applicants than positions available. Of these applicants, 16,527 were senior medical students in the United States. Their match rate was 95.1 percent, also a record high. There were only 815 unmatched United States seniors, which was the fewest in almost a decade.

In 2013, the National Resident Matching Program (NRMP) will adopt the “All-In Policy,” whereby any program participating in the Match must register all of their positions through the Match. The effect of the new policy should add up to 1,400 new positions; however, this will be offset by the increased number (1,200 more expected) of medical school seniors in the 2013 Match.

As career advisors for medical students, how do we advise our students about these trends? When advising medical students at risk for not matching, we must also be prepared with data. The NRMP provides the “Charting the Outcomes of the Match” document, which serves as a guide for students and advisors to assess the likelihood that a student can match in his or her preferred specialty. Additionally, we need to factor in the less competitive applicant reaching for the highly competitive specialty. While no one wants to deny someone their dream of becoming an orthopedic surgeon, it is critical that an alternate plan is in place.

My recent attendance at the 2012 Association of American Medical Colleges (AAMC) Careers in Medicine roundtable brought up some approaches that some medical schools are implementing to address the issue of unmatched students. Several medical schools are proactively contacting the students who either failed Step I on their first attempt or passed with a marginal score. Other medical schools have compiled extensive school-specific match information that they share with their students to assess their chances for matching in a particular specialty. Of course, unmatched students have the opportunity to do research or enter graduate school, then reapply the subsequent year. Unfortunately, the match results for these graduates are as low as 40 percent.

While we remain hopeful about 2013 after the record-breaking Match Day in 2012, we know that, historically, approximately 1,500 United States fourth-years and graduates will be unmatched. We will need to be anticipatory about who is at-risk and support them with concrete opportunities for alternate plans. If a student does not secure a residency position, even after a placement through the Supplemental Offer and Acceptance Program (SOAP), the options are limited. Some students pursue research or additional degree programs, such as an MPH or MBA. A few states may allow medical school graduates to take Step III and apply for a medical license without residency training, but these opportunities are not common.

Ultimately, the onus is on us as career advisors to identify at-risk students and provide them with objective data and present them with alternate opportunities. Unfortunately, as the competition for limited training positions becomes steeper, we might see an increase in the number of medical school graduates who will not be able to complete residency training.

???— Marlene C. Welch, MD, PhD, FACS is Chief, Division of Plastic Surgery, University of Toledo Medical Center; and Assistant Dean for Student Affairs, University of Toledo College of Medicine. She can be reached at

6 thoughts on “Matching the Unmatched: The Role of the Medical Student Career Advisor

  1. Dr. Welch’s post is timely and important. There is an important missing clarification: Is she talking about allopathic and osteopathic graduates seeking first year residency slots or just allopathic? It is important to think about them together. ACGME residencies accept both MD and DO applicants and for at least most of the past decade more than half of DO graduates have sought and been accepted into ACGME residencies. (American Osteopathic Association accreditation requirements prohibit the acceptance of MD graduates into OGME programs.) Other competitors for first year ACGME residency positions include USIMGs and IMGs. Their numbers are also increasing while the number of ACGME and OGME positions is fixed for practical purposes and will remain so until Congress authorizes and appropriates increased funding for GME. This is so even though Medicare pays for less than half of the aggregate cost of GME in the US.

    An added important factor increasing the competition for ACGME positions is that the numbers of DO schools and DO graduates has been growing, and continues to grow, at a much faster rate than the numbers of MD graduates from US schools.

    James E. Lewis, Sr., Ph.D.

    1. Dr. Lewis, thank you for raising some important clarifications. The numbers I quoted from the 2012 NRMP Results and Data Report were for U.S. allopathic students and graduates only. You are correct that the number of osteopathic students and graduates in the match is growing. The number of osteopathic students and graduates in the 2012 match was the highest ever, with 2,360 applying. The match rate for osteopathic students and graduates was 74.7%. According to the NRMP this was the highest rate in thirty years. In addition, as you pointed out, the increasing number of non-US and US IMGs in the match continues to increase. As medical student advisors, we all need to be aware of these trends so that we can provide support and concrete plans for our at risk students as the competition for residency positions continues to increase.

  2. Reblogged this on ReadyToHeal and commented:
    Dr. Welch’s provocative essay calls medical advisors to provide objective data and a kind of “gut check” to students with borderline board performance competing in an increasingly competitive residency arena. Her conclusion that increasing numbers of graduates may be unable to complete residency training begs a question that is itself a kind of “gut check”: why are we educating (and indebting) more medical students than we can train? In a time when current and anticipated physician shortages outstrip our capacity to train graduates, isn’t it time to recalibrate training, either to increase GME or alternate routes to medical licensure? Are medical school deans, many with expanding class sizes. ready to look incoming students in the eye and say, “We need more doctors, but fewer of you will become physicians”?

  3. Once one does not match, they are considered shit. These shit students should not be allowed to practice medicine. They just don’t belong.

  4. Having had two residents commit suicide–one with an air bubble and one with a gun–there may be some undiscovered flaws within those who do match. All we know about those who don’t match, is that they didn’t match yet. You sound a little Waspish (“just don’t belong”) and you surely were absent on the day that compassion and empathy were discussed, presumably you matched at the top of your class.

  5. Wrong. I was at the bottom, left behind because I didn’t belong. This is what the system tells you. If you do not match, you are shit. You should be happy that you even get to practice medicine at all, plebian mistake. You are a serf, so go to primary care, shut up and smile.

    All of the fluff that’s spouted from the mouths of the so-called empathetic, compassionate physicians means little when speaking of those of their kind who don’t fit. Out of the way we go.

    I am now in the slime, and it is impossible to crawl out of it.

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