By Jason Schairer, MD 

As physicians, we often have a drive to succeed that distinguishes us academically. It helps us navigate challenges in college, such as tough pre-med courses and exams like the MCAT. It allows us to work 80 hours a week caring for those most in need, and then spend the remaining hours that should be used sleeping to instead do research and committee work, and seek face time with program directors. This trait -- drive -- is often our greatest attribute, but it can also be a source of great stress when we don't live up to our own extremely high expectations.

When it comes to matching into residency and fellowship, our stress is at an all-time high. It's made worse by the fact that these are extremely visible processes. Most of our peers know which field holds our ambitions. But when we come up short on Match Day, it feels like the ultimate setback, and the disappointment in our hearts is only compounded by the fact that we have to share the news with well-intentioned friends who ask for our results.

In 2010, I was one of those residents who didn't match into fellowship. But I'm here to tell you, my career has seen a fair deal of success despite not matching my first time around. I have risen to positions of leadership in my institution, the fellowship program, and regional organized medicine. I have given lectures on the national and international stage. I have published important works. If you don't match, all hope is not lost.

It is going to be tough at first. On Match Day 2010, I opened the email and saw the red text. It seemed that everything I had worked for had fallen apart. The worst part was walking around the hospital the rest of the day, seeing the sad look in the eyes of people who suffered the same fate. It was extremely hard to finish that day of work.

When I arrived home, my two dogs rushed to greet me. They had few cares about the match and why I was sad. Their excitement and love helped pull me out of the morass. Later, my wife came home and comforted me. It reminded me that the people who truly cared about me didn't love me because I was a doctor. They cared about me as a person. I wasn't going to let this setback define me. It was a challenge to overcome.

From this experience, I learned there are a few steps you can take when you face a setback like not matching into your desired field. First, assess if you truly want to be a part of that field. It is OK to walk away if your heart was not in it or if you determine you'd find happiness in another specialty. Next, look for scramble spots that may be feasible. To be clear, many of these spots are already spoken for. And finally, reevaluate your candidacy. Critically examine the underlying reasons why you didn't achieve what you set out for and consider future remedies or ways to improve.

It may be hard to admit that we bear at least part of the responsibility for coming up short. We cannot blame a single person or program for not matching because perhaps if we had been more competitive, then we would have matched somewhere. It is through this honest introspection that we can hope to avoid the same fate next year. This assessment should be done ideally with your program director, or if possible, the fellowship program director. The goal is not to match into their program but to improve your candidacy. For GI fellowship specifically, which just recently had its 2021 Match Day, the time to reapply is coming rapidly, so this step should take place in the weeks immediately after match.

It's also helpful to take another look at your application. Some common areas of weak applications include: lack of research and publications, lack of distinguished clinical work, and a poor interview.

Research can be challenging if you're at an institution that does not have a strong research program in your desired field. But ideally, your projects should be short, worthy of publication, retrospective, and provide an opportunity for you to be first author. We can talk ad nauseam about "good studies," but a good prospective study can be challenging to complete in time for the next application period. It can help if you form an alliance with residents applying to the same field so that you can collaborate and get your name on other studies, but it's most meaningful if you are first author on some studies. Finally, it helps to identify staff who have success in publishing, as they can best guide you through that process. Published results increase your chance of matching.

If your clinical time has been productive but without recognition, it is fair to talk with your program director to determine what changes you need to make. Letters of recommendation can drastically move someone up the rank list. Approaching each rotation with a desire to distinguish yourself can help improve the quality of the letters.

The interview day can be quite stressful. Here are some tips to improve your interview day. First, learn about the program. Know who is there, what they do well, and how you can benefit their residency or fellowship. If they see you as someone who brings value to the program and makes their life easier it helps your chances of matching. Conversely, not knowing who you are interviewing with can hurt your chances. Second, be polite and kind to every person you meet. Rudeness when scheduling or boastfulness on tours gets back to the program director. Third, practice your answers to the common questions so they sound conversational. These questions include: Where do you see yourself in the future; why do you want to be a part of this field; why do you want to come here; what are your strengths; what are your weaknesses? Then review your CV and be prepared to discuss each of your projects.

Lastly, practice your interview with friends or in front of a camera. Do you like your posture? Do you seem easy to talk to? Do you seem confident but not arrogant? The interview is a completely subjective experience. With practice, we can convey that we are someone the interviewers would trust to see their patients.

Match Day can be a joyous or sad day. It is not going to define you either way. Your friends and family love you regardless or your results. The only thing we let down is our own extremely high expectations. Take this opportunity to grow, improve your candidacy, and in the end, find the field that will make you happy each day you go to work.

Best of luck,

-- Jason

Jason Schairer, MD, is a gastroenterologist who didn't match in 2010 and is doing just fine.