What to Do If You Don’t Match into Residency Program At All

Not matching is rough. First, we suggest that you take some time to dust yourself off and let the shock fade away.

And then? An unmatched med student can certainly feel adrift. What we have here is a step-by-step guide for US graduates who don’t have a residency program lined up, after Match Week and the supplemental offer and acceptance program have come to a close. Similarly, we will have an upcoming post specifically targeted to International Medical Graduates.

As a US Grad, remember that the odds are in your favor. More than 99 percent of U.S. medical school graduates do end up practicing medicine within six years of graduation, according to a study published in JAMA.

Find out why

First, diagnose why you did not match. Sometimes having another set of eyes on your application can be valuable—so turn to an advisor, mentor or trusted med school friend and ask them for their thoughts. Take a close look at your personal statement. Remember, your medical school really wants you to match. They are a tremendous asset in this. Make appointments to speak with relevant people there.

There are some common reasons that students don’t match. According to a survey by the AAMC, they included:

  • A poor score on the national board exam.
  • The student’s academic standing not being competitive enough.
  • Poor interviewing or interpersonal skills.

Next steps


If there is a glaring deficiency—say a poor national board exam—then that will be the focus going forward. Once you’ve identified the area to improve, the first step will be to boost that particular section.


The second step is to sign up to take USMLE Step 3. From personal experience, people who have matched do not have much time to study for Step 3. This should work in your favor because you do have time to study for it. So don’t despair – what I’m trying to say is this Step is different than the other ones. Passing Step 3 may be beneficial for multiple reasons.

  • It assures program directors you have the test-taking abilities.
  • It may overshadow any previous poor test scores.
  • If someone who did match cannot pass Step 3, then this may present a vacancy for you to fill.
  • It enables you to apply for H1b and J1 visas.

A solid, easy-to-read, and comprehensive book to use is Master the Boards USMLE Step 3. You can also take out your old Step exams and pinpoint the areas in which you had low scores. Attack those areas first. This helps to break down the test into manageable pieces.

If you are “all tested out,” and can’t really sit and study anymore, don’t despair. You can use something more engaging like Firecracker, or simply do some UWorld questions. Even an engaging podcast like The Curbsiders might add some knowledge when you don’t have the motivation for typical studying.


Third, take a year to stay clinically competent and seek out research opportunities. This may include working in a lab, being a scribe, or being an EMR trainer. Try to get a basic poster presentation completed and presented in a six-month to a one-year time frame. Offer to volunteer or teach to demonstrate your commitment.

Dr. Margarita Loeza, MD, who is a family medicine physician and chief medical information officer at Venice Family Clinic, has a handful of strategies for how to best spend your time post-match if you aren’t in residency. If you know the field you’d like to end up in, then reach out to the people who run the labs or conduct the research.

For this step, it would be prudent to put the other person’s interest first. For example, what is a problem they have that you can help out with? Of course, your problem is that you didn’t match. However, by delivering a solution to their problem you are much more likely to get an opportunity. So spend time listening. Then instead of ‘asking’ to join the team, frame it differently: how you can help ‘solve’ their problem.

Practicing with no residency?

If you wish to practice without doing residency realize that in some states this is possible. However, this program is in its infancy. Missouri, Kansas, and Arkansas permit unmatched medical school graduates to work in medically underserved areas without a residency.

Look into the data—and consider a specialty change

The NRMP has some incredibly useful information regarding the numbers of students that match into their preferred specialty. It has the average Step 1 score, Step 2 CK, number of publications, and more, all relating to the statistics around matching. For those who like to deal with numbers, this is as close as you’re likely to get to predicting chances of matching based on scores and other metrics.

Rather than get extremely granular, I liked to use it as a general guide. For example, I split it into five categories: very below average, below average, average, above average, and savant. My favorite charts were the ones below. That way I could break it down into 5 categories in my head instead of looking at the ‘average’ Step X score. They are called Chart AN-3 and Chart AN-4 for anesthesiology for example. Each speciality has them! It is useful when one asks “Am I objectively not competitive enough for X? What about this other one?”

Stay positive

Not matching is not the end of the world, and nor is it the end of the road for your medical career. There are options for you, from research fellowships to volunteering to dedicating yourself to studying for USMLE Step 3. Keep your eyes and mind open to any and all opportunities, and prepare yourself to try again at the next Match, if it comes to that.

Thalamus is a tool for managing your interview season, no matter whether it’s your first or second time! We aim to make the Match process easier and increase the chances of students and residency programs getting what they want from the whole endeavor. Find out how it works!