Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

MATCH-2013 (If you didn’t match)

NRMP-2013MatchThere is a new process for securing a PGY-1 (or PGY-2) position in this year’s Match if you didn’t match outright. Please research the process and make sure that you get your application materials submitted correctly so that you can find a position should you receive a letter that states that you didn’t match or didn’t match to an advanced position. Contact your medical school and follow the instructions that come with your e-mail should you not match.

If you are still unmatched after the SOAP ends, you can submit an application through “Find A Resident” which is where programs that have emergency openings will search for residents that still remain unmatched. Sometimes illness or emergencies prevent a matched resident from starting their program thus there will be a late opening. These slots are usually preliminary but can turn into categorical slots should the resident hired turn out to perform at a very high level academically and clinically. There are not going to be very many openings through “Find A Resident” but there may be some out there. If you have an application on that site, a program director would be able to contact you directly.

For more information on the SOAP process see this link: <;


11 March, 2013 - Posted by | applying for Residency, Match Day, scramble | ,


  1. Hi,
    My significant other is an AMG who was able to match in 2013 at an anesthesiology program but was terminated due to personality issues halfway to the internship, so she was not able to finish her internship. she tried this cycle match 2015 for internal medicine with a passing score on step 3 but she was not successful as the previous pd did not want to write a letter for her. My question is what could you possibly suggest for her to keep going forward? My hope is on her since she has very good scores on USMLEs to make it through the system to practice as physician but I started become skeptical in reading a lot of bad stories. Do you think we should press a charge against her former residency program? I think the previous program director by refusing to release a letter even bad one as it could be is making door to other programs to think the worst scenario. A bad letter is going to be something to have on table for prospection on other residency programs for a frank discussion than not having one. what approach we should take now? is that even worthy trying next match without the letter from her program’s director? She went through about 10 interviews for Internal medicine but none of them ranked her or not ranked her high enough to match. I feel sorry that I am not able to get in residency as an AMG and she is not able to get in either, the only thing we have our educational loans getting really fat. with IMGs floating around with good credentials the PDs have more luxury to ruin a fellow citizen’s life to take an IMG who has not paid a single tax and most of the time an IMG feels like winning a jackpot by entering US healthcare system with zero loans except probable car’s loans. I would love to hear your suggestions if she should continue to seek position for the next 2016 match or just fight her previous residency program in court to get a letter. She tried to appeal the decision through the institution system but was not successful. The previous PD told her besides her internship’s evaluations and appeal hearing report there were nothing he could do besides that report. she had 24 evaluations by attendings failed only 6 out of 24.

    Comment by Reddick | 10 April, 2015 | Reply

    • To Reddick:
      Did your significant other (SO) get an unrestricted license with that Step 3 pass? If so, her PD had to write a letter. Use that letter in the next trip through the match. It is very difficult for anyone to get a match after being dismissed from a program especially mid-year. She is likely going to have to make an appointment with the PD and resolve the personality issues so that she can get a letter to move on. It is difficult to believe that an ethical PD after meeting with a previous trainee and coming to terms, would want to destroy a career because writing a poor letter (or even worse, no letter) is a career killer. PDs have tremendous power over a trainee’s career which is why a good PD will do everything possible to help a trainee get the best educational experience and if things don’t work out, they “cut their losses” and allow that person to do something else.

      If your SO didn’t finish the year, that’s a huge problem because she didn’t get credit for the year. This is why mid-year dismissals can be lethal and very difficult to overcome. I don’t want to paint a negative picture but your SO needs to find someone at the residency-faculty level who will advocate for her, explain her circumstances and “personality” difficulties with the PD and explain why she left. High board scores will not offset the impression that a trainee is a problem, which is the impression that the lack of a PD letter suggests.

      If you seek legal action against her former program, you need to have a good lawyer and good evidence that her rights were violated. If they have developed a “paper-trail” of problems with her and they are able to show that they attempted remediation of those problems, then you are going to have problems getting anything satisfying out of that program. Making the threat is not going to offset a paper trail if they are able to show that they attempted to work with her and she was not able to improve her performance. I can tell you that IMGs are not getting into residency programs because of the new system where they can’t match outside of the match. IMGs, except for those who have extraordinary credentials (loads of research and major papers) are not getting into program. There are simply too many AMGs out there.

      My suggestions: Try to get an unrestricted license in some state. The PD has to write a letter fully explaining why or why not your SO is not suitable for licensure. Armed with something in print, she can counter the points or use that letter as a PDs letter. If not, try to make nice and get that PD to write something so she can match. It doesn’t have to be glowing but it should be something that isn’t harmful. Most ethical PDs won’t try to destroy a career intentionally. If your SO can’t get an unrestricted license, there isn’t going to be any circumstances where she can practice medicine in this country which means that she will have to look into training overseas (Cuba or Mexico because Canada is the same as the US). If she does go overseas for training, she would still have to go through residency here in the US before she could be board certified but she would have a better shot armed with training from overseas and letters. What ever she decides to do, she has to move very quickly because she is coming up on three years since graduation from medical school and most programs won’t take anyone who is more that three years out who has not been in a residency program during those three years. Last, leave Internal Medicine and look at Family Medicine or Psychiatry if she reapplies as she may be able to match into a community program in one of those specialties. Internal Medicine may be a reach given her difficulties. Good luck.

      Comment by drnjbmd | 10 April, 2015 | Reply

      • Thanks for the prompt response, she was terminated 6 or 7 months after starting internship. She did not finish the internship. Currently I don’t know which state can license medical graduate with only 6 months of post graduate internship. I will look for those licensing medical board authorities if there are some out there that can grant license with some internship experiences.

        Comment by Reddick | 10 April, 2015

      • To Reddick,
        Check all of the states and Puerto Rico/Virgin Islands too. Find any state that will take 6 months of PGY-1 and make sure your SO has documentation of that training. Once a license is obtained on one state, it’s easier to get an unrestricted license in other states but check the regulations for the state that you live in (or will move to). Good luck.

        Comment by drnjbmd | 11 April, 2015

  2. Sorry for a long post. I am an AMG who started medschool in 2008 and graduated in 2014. I’m from Africa and struggled with USMLE. I’m in the bottom of my class. I failed (1) step1 (194). I step 2 (194) and Failled CS 3 times and passed it last yr w/ accommodations. I have irregular behavior on my usmle’s transcript. So many red flags. As I’m writing this if my loans get compounded with interest rate I would be in 400K ++loan debts. I went through the match this cycle 2015 broadly( psych(80), FM(90), IM(50), Neuro(30), path(30)…) you might ask yourself how I managed to do this, but I took it as a full time job just to work on my applications and spent about 10,000$. I had 6 meaningful IVs( 5 psych and 1 path) and 1 categorical position in child neuro, in which ped department refused to grant IV and this categorical position flipped into Advanced position per the program director since I was not given an IV by Ped. Department. I had 2 more IV that were cancelled 1 week before the scheduled the iv dates. Therefore I only have 6IVs that could have led me to pgy1. Unfortunately I did not match to any positions. as I’m writing this my heart is crying in the middle smile. I am broke, without any resources left except credit cards. The sad thing is one of the programs that I Interviewed with did not rank me at all and I later found out they did not fill all their positions. I run out of options, I have MD degree with no meaningful use, as you can see I was limited to how many states I can apply to due to 3 attempts rules. Now I don’t know what to do, Psych program in my school offered me IV, I guess they did not rank me high enough to match there. other programs in my school they did not even bother giving me a complimentary interview, eventhough i begged for it. the pathology PD in my school bluntly told me they will not offer me an IV. I don’t know if i should face the match again for 2016 cycle as I’m not quite sure what I should do to improve my credentials. if my own school cannot take me who else can? I was hoping to get at least one year of prelim internship in surgery as I saw a lot of unfilled position in the soap, this way I can even start working in nursing home as assistant physician by Missouri new law if completed internship successfully, but no luck so far. I’m desperate to get at least prelim surg for me to have one year post graduate training covered but till now no call from soap yet. I don’t think I will be able to pay my loans without a doctor job. I will strongly appreciate it if you could give me your suggestions on my current situation, as you have been in this business long enough to tell me if psych is still possibility. What do you think I should do? Your suggestions are strongly needed. I feel more like I have been robbed by my own school with 55,000/yr tuition. I guess, the days of “don’t worry, if you just finish at a US school, you’ll get a residency somewhere” are pretty much over.

    Comment by SSS | 18 March, 2015 | Reply

    • To SSS:
      The days of guaranteed PGY-1 slots for AMGs are over because there are fewer post-graduate positions out there. First of all, you need to find out what the irregular behavior is on your USMLE transcript. That is a huge problem. If you know what the behavior is, you can address it. The next thing that you should do is look for a research residency so that you have something to do for next year. These can be found at the NIH website (and similar websites) but get busy right now. You don’t have the luxury of mourning the loss of the career that you think you ought to have. You also need to go to your medical school and spend some time with your Dean of Student Affairs/Dean of Education so that you can find any options that they may have for helping you. They might not be able to place you in a residency but they do know about remediation which you are in dire need of. You need to learn how to take licensure exams (because you have so many failures) and you need to learn about medicine scholarship so that you can actually practice.

      After that, look into the possibility of getting a Masters in Public Health (MPH) which can go along with a Preventive Medicine residency the next year (not a bad gig in today’s world of health care policy changes). You are far from throwing in the towel so start moving forward. Your US citizenship (if you are a US citizen) is your best asset right now. Also, sign up for “Find a Resident” because that site will list positions where visa problems, health problems or logistics prevent a program from filling a slot. Be prepared to move at the last minute. Finally, if you find a preliminary position, get into it and work like you have never worked before to make the best impression possible. You have to do well on your in service exam without question because of your USMLE problems. If you get into a research year at NIH, look into taking the ABIM exam (study MKSAP 17 like your life depended on it because it does) and get some good evaluations from NIH. Get your name on a publication or two because that will make you more employable. Expect to spend the next year (if you are able to get a prelim med position) with nothing except excellent medicine work on your schedule (no vacations, no bars, no good times) because you have to prove that you won’t be a liability to a future residency program. Find a mentor in medicine and let them mold you into a good resident. If you are failing licensure exam, you need some remediation. With remediation, FM and Preventive Med are going to be your best specialty aim because IM and Neuro will likely be out of reach as will Psych and Path. You just don’t have the academics for those specialties but FM can be a great choice for you and can lead you to a good career. Make no mistake, you are going to be a long shot but you need solid academics and some solid remediation over the next year. Start working on doing your damage control and moving forward. Good luck.

      Comment by drnjbmd | 18 March, 2015 | Reply

      • drnjbmd,

        Thanks for your suggestions, I strongly appreciate it. I am US citizen but that is not helping. as for my irregular behavior on my transcript I addressed it on my personal statement and discussed about it if i were asked for it. I believe family medicine is more competitive than psych as my failures in cs is killing me. I applied to 90+ family medicine end up with no single IV, I applied 80+ for psych and end up with 5 ivs. friends told me to try to take step 3 and passed it this way I can assure the program director that I won’t need time off from training to take step3 during residency and might also reassure the PD that I can take in service test. what do you think about step 3 vs research. I looked up for NIH research fellowship but I think is more competitive than my credentials. I worked as clinical research coordinator for 1 year at neurology and that did not help either. if I start studying for step 3 now that will take me probably 6 months to be ready for it. however if a preliminary is not available for me now or off cycle. what about biostatistics. I’m register as Biostat graduate student with no credit yet, because I did not want to pile up more loans, MPH will cost me about 80,000 $ including living expenses. I understand I will have to keep looking forward for some opportunities for prelim positions. in meantime what about shadowing some physicians in my school hospitals? Is step 3 a Plus for my application next year, not really for extending interview but for ranking purpose?

        Comment by SSS | 18 March, 2015

      • To SSS,
        Right now, you don’t have the luxury of either/or in terms of doing things. You are not successful this round of applications so your goal (and you only have one goal) is to make yourself more competitive for the next round. You don’t take “time off” to study for Step 3. If you take Step 3, you take it one time and pass it (your can’t have any more failures on any USMLE step therefore you have to address your USMLE test-taking problems before you take Step 3). Yes, your US citizenship is going to help you but not until you address your problems, i.e., the irregularities on your USMLE transcript and what you have done (objectively + no more failures) to remedy your test-taking problems, which you clearly have some issues. Without doing those things, anything clinical is going to be a reach. Doing a research PGY-1 year would give you access (limited but access) to clinicians + possibility of papers. If you enter a graduate program, you still have to do something to address your USMLE/test-taking problems. I would also suggest that you look into the Marshall Medical H.E.L.P. program (do an internet search) which is a great program for diagnostics (you need to have this done) and for finding some kind of a resource that will help you address your problems. As a medical student educator, I am surprised that your medical school didn’t provide some kind of resource/diagnostics when you started to have problems with USMLE Step I?? With that being said, having something on paper that states why you likely had problems and that you have address those problems would go a long way in terms of getting you into a clinical residency. Shadowing physicians is not going to do you much good unless those physicians are willing to work with you one-on-one + provide documentation of learning/progress, i.e., where you started; how you progressed and an objective assessment of your clinical abilities. Again, being the greatest clinician in the world is not going to help you much if your test-taking problems are not addressed objectively and solved. Every specialty has in service exams + specialty board exams + CME once you obtain an unrestricted license + maintenance of certification (MOC) exams if you are able to pass specialty boards. In short, those USMLE problems have to be addressed. If shadowing a physician can help you address your failures/problems with USMLE CS, then do so but you need to have documentation that you actually learned something solid rather than just shadowing i.e., letters from the people you shadowed. A combination of graduate work + clinical education + remediation and a clean pass on Step 3 with a good score would help you greatly but don’t even attempt to prepare for Step 3 without addressing your issues that caused problems with Steps 1 and 2 CK/CS. Good luck.

        Comment by drnjbmd | 19 March, 2015

  3. Hi,

    I am a IMG who wants to apply to Psychiatry. My question is related to applying to residency this year vs next year. I passed the Step 1 with a score of 229, but I failed my step 2 CS in the ICE (Integrated Clinical Encounter) part. I wonder how much it can impact my application. I did not take the step 2 CK, yet; but I expected to get at least a score of 230. Is it a big hit to fail the step 2 CS?.

    My credentials are: MSc in epidemiology. Graduation year: 2012. I had honors to participate in International Conferences in Mental Health and a Research Project under my supervision.

    In the case that I apply by next year (considering taking my time to take the step 2 CK and CS with good performance), Are there significant differences between applying this year vs next year?. Are there significant differences between a 2 years of graduation and 3 years of graduation?.

    I do not if I can apply this year with pending results of the step 2 cs retaken. Considering the provided information, What are my real chances to get into residency?

    Please, I need an advice.

    Thank you.

    Comment by rofranco | 27 April, 2014 | Reply

    • To Rofranco:
      Please read my reply to your question under Failing USMLE Step I and how to get beyond it. I will reprint it here:

      To Francisco:
      With fewer slots available and more American graduates, it’s going to be more difficult for you (and IMG) to get into any specialty with any failures of any steps of USMLE. You need to apply to enough programs (avoid high-powered university-based programs) that want IMGs with no failures on any of the USMLE steps. Many (but not all) programs will insist that there be no failures thus look closely at program websites before you apply. How can you overcome your failed attempt? You can make sure that you don’t have any more failures but again, as an IMG, you have made your quest more difficult. Much will depend on what programs you apply to and how many interviews you receive. If you do not receive enough interviews to rank at least 15 programs, then it’s going to be very difficult for you to match. The first thing that you may want to look at is last year’s match report for Psychiatry and the match rate (# IMGs/#AMGs) in each program. This will give you an idea of which programs are worth investigating online. Add this information to those that don’t mind a failure on USMLE and you will have your list of programs to apply to. Good luck.

      The year that you apply isn’t going to be a crucial as the programs that you apply to: Do some research and find all that don’t mind failures on USMLE for IMGs and whether or not you pass any remaining steps of USMLE as you can’t afford any more failures. Everyone has a high score in mind for each step but that doesn’t always work out and any failure for an IMG can put some programs out of reach. You also want to make sure that your are not too many years out from graduation as some programs want graduates who are no more than 3-5 years out from graduation. Can I give you a “real” number as to your “chances” to get into resident? No, I don’t have a crystal ball that predicts the future but you do have to do some research and you do have to make sure that you don’t fail any more steps of USMLE period. Many programs will use USMLE as the determining factor as to who they will rank or even invite for interview thus you need to be sure that your USMLE transcript is the best that it can be. Step I generally counts more than Step II (CK or CS) but again, some programs hold IMGs to the standard of NO failures at all. These are the programs that you want to avoid.

      Comment by drnjbmd | 27 April, 2014 | Reply

  4. IMGs should be barred from practicing medicine in America. Their training is not up to the standard of American medical schools. If an IMG wants to be a doctor in America, they are free to compete for medical school spots in the US like everyone else.

    Comment by Brian Cox | 24 January, 2014 | Reply

    • To Brian Cox:
      I would disagree with you on the institution of a ban on IMGs practicing in this country as IMGs currently make up a significant portion of practicing physicians in the United States. IMGs being barred from practicing in the United States is not the answer. Should an International Medical graduate be given preference over an American citizen graduate of an American Medical School in filling a residency slot that is paid for by American taxpayers? No, they should have to meet additional requirements (and this is largely the case) and they should be selected behind American citizen graduates of American medical schools which is what is essentially happening now. At one point in this country’s history, there were not enough physicians go around but that has changed. With the training of more mid-level practitioners (physician extenders), the situation has changed but still, more physicians are needed in primary care. The additional needed physicians are being supplied by the increased number of American graduates of American medical school with increased incentives for entry into primary care. This has meant that there are fewer slots for IMGs and even FMGs (Americans who went offshore to attend medical school because they couldn’t get into medical school in the US) but there are some slots and IMGs should be able to enter these few slots if they are available. Last year, the NRMP (National Residency Matching Program) instituted an “all in” policy which stated that all PYG-1 positions had to be offered in the Match or none. This essentially eliminated the practice of some programs pre-matching IMGs without going through the Match. Federal entitlement programs, which pay for Graduate Medical Education training has essentially stopped funding these programs that only take IMGs thus most programs elected to open to AMGs and stop hiring outside the Match. It’s tough for AMGs to go to other countries for training and it has been tough for IMGs to come to this country for training. Unless training programs are no longer paid for by American taxpayers, then IMGs can’t be treated preferentially in filling these training programs. This isn’t a bar from training but it is a significant impediment for an IMG.the bottom line is that AMGs will come first and what is left over can go to FMGs/IMGs. There are no automatic entry for IMGs in residency training programs now but this isn’t (and should not be) interpreted as a ban.

      Comment by drnjbmd | 25 January, 2014 | Reply

  5. Hi , I am an IMG who graduated in 2009, I finished USMLE with score of 222/219/pass all first attempt , I had 4 months of USCE hands on with americlerk and I got 4 LOR ,I also did some volunteer job in USA in some clinic , I don’t have a green card so I need a job visa , I applied this year for 120 IM ,30 FM positions ,and I couldn’t secure a single interview ,can you please what is your interpretation on that ?

    Comment by Amal | 19 December, 2013 | Reply

    • To Amal:
      My interpretation is that you have applied in a year where American Medical graduates are at an all time high and American residency programs are going to take American graduates before IMGs. American residency positions are funded by Medicare/Medicaid funds which are paid for by Americans and will take American medical graduates first. American graduates are going to get first shot at those programs and IMGs will have what may be left over. The programs that you applied to didn’t need to interview you because they have enough Americans who that are likely to rank. There isn’t going to be much left over in the S.O.A.P for IMGs or even for American grads who didn’t match. In past years, IMGs could find slots because they could count on slots being open. American medical schools increased their class size (projected physician shortage) thus there are fewer slots available for IMGs. I certainly, as a graduate of an American medical school and a citizen of the United States, would not expect to come to your country and be selected over you in terms of residency slots that were paid for by your country. The United States is no longer looking for IMGs to take residency positions in primary care because there are plenty of American grads who want those slots. This is simply supply and demand. Even having a green card isn’t going to put you ahead of a citizen in terms of getting a residency slot.

      Comment by drnjbmd | 20 December, 2013 | Reply

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