Perspective on Not Matching Into Residency - A Look Back

When I found out I did not successfully match to integrated plastic surgery residency in 2011 it felt as though a door had been unexpectedly slammed in my face and I had been knocked to the ground. I ended up doing a transitional surgery year internship and then successfully matched to a plastic surgery integrated residency program the following year. After working for several years as a private practice plastic surgeon, I decided to transition my career to non-clinical pharmaceutical drug regulation at the Food and Drug Administration in 2020 where I remain.

With this blog post I am not aiming to repeat what is published on established resources for the acute steps you should take in the event of an unsuccessful match. Instead, I hope to share personal lessons learned over the past decade, and to provide reassurance that your chances for long term success or happiness remain unharmed despite the obstacle in your way.

Many online resources already exist to assist unmatched applicants in the acute phase of shock - with practical tools available to find positions, explore non-clinical career options, and strategize. There are various websites and discussion forums, Facebook groups, coaching services, and books - two of which I highly recommend – “Do You Feel Like You Wasted All That Training? Answers About Transitioning to Non-Clinical Careers for Physicians” by Michael J. McLaughlin MD, and “Becoming an Ex: The Process of Role Exit” by Helen Ebaugh.

At the time this singular event seemed like a catastrophe, and I felt shocked and disorientated. After working hard in college and medical school, this was the worse possible outcome of my sacrifices. While those around me celebrated on match day and at graduation, I recalibrated, and then in subsequent years I learned to reimage how to build sustainable happiness. Now, over a decade later, with time and perspective I realize that the once horrible experience ultimately allowed many opportunities to present themselves and doors to open that I had never previously imagined.

Here are my thoughts:

1) Know Yourself – You Are Not Just Your Profession / Your Specialty

One of the reasons not matching stung so much at the time was because my identity had been created entirely around medicine and my chosen specialty. Almost all my time over the past 8 years of undergrad pre-med studies and med school was spent building up this identity. In a single moment of discovering I did not match through an email, this all-encompassing identity felt as though it had crumbled.

However, over a decade after having gone unmatched, I learned with time that I am not just a physician or my specialty. I have learned the importance of cultivating other parts of my identity (as a son, brother, uncle, friend, partner, amateur tennis player, health and well-being enthusiast, RuPaul low-key super-fan, etc.). Though I ended up re-applying, matching, and completing my plastic surgery residency, I don’t introduce myself to strangers immediately as a plastic surgeon – it is not the core of who I am.  

Knowing yourself can help bring into focus what other parts of your identity are important to you, so that you can cultivate them and allow them to bring joy and stability to your life (a kind of stability that cannot be shaken by a single email informing you that you’ve gone unmatched).

2) Be Your Best, and Do Your Best

After not matching, I felt unmotivated and nihilistic: what was the point of striving to achieve if my efforts could end up in vain?

Part of why I felt unmotivated and nihilistic was because I was not my best self when I went unmatched: I was a stressed medical student in my 20s, eating poorly, barely exercising, conditioned by the stress of constant evaluations and tests. I had not developed the skills to be my best possible self. Therefore, when I went unmatched my fragile identity built entirely around medicine easily crumbled and led to feeling unmotivated.  

With time and practice, I learned to be my best possible self: eating well, exercising, cultivating interests outside of medicine, and nurturing relationships. If you have gone unmatched and feel unmotivated and nihilistic, know that’s OK – but it doesn’t have to be that way forever. Work on yourself, sculpt yourself into an identity that is the best possible version of yourself, and continue to strive to achieve. Although not matching may make you feel worthless, you have worth – and working on yourself will never be worthless or in vain. Your motivation will return over time once you water the right seeds. 

3) Push Yourself

After not matching, it did not only feel as though a door had slammed in my face – it felt as though that door had pushed me to the ground. I felt dejected, and as I described above, unmotivated.

When we are children, usually our parents push us. When we’re pre-med and in med-school it’s often our co-students and competitive environment which pushes us. But a decade after having gone unmatched I have learned that I have to push myself. Establishing daily goals, having a strategic vision for the future, and focusing on action over inaction is an individual responsibility. No one else is going to push you. 

For unmatched students, know that although the slammed door of not matching may have pushed you to the ground, it’s your responsibility to pick yourself back up and push yourself forward. There are resources to help you, but the intrinsic push has to come from within yourself. If you don’t feel this push now, cultivate it over time, and it will emerge.

I don’t claim to have figured out the secret sauce or formula to overcome the feelings of dejection that come with not matching or claim that I have a step-by-step blueprint to follow thereafter. Each of our situations is different and there is no single simple solution to a complex problem. Above are lessons that I have learned in my own journey and continue to practice daily. I encourage any unmatched students who want to reach out to contact me. An important part of my identity now is being supportive to other physicians, and I’m available to help anyone in a similar situation.

K Dev Verma M.D. was born and raised in Sydney, Australia, and migrated to the United States during high school. He attended Columbia University (Columbia College Class of 2007), and Harvard Medical School (Class of 2011). He went unmatched in integrated plastic surgery during his first application cycle and did a transitional surgery year at Beth Israel Deaconess Medical Center (2012). He then re-applied and successfully matched to a plastic surgery integrated residency program (Georgetown University Class of 2018), worked for several years as a private practice plastic surgeon, and transitioned his career to non-clinical pharmaceutical drug regulation at the Food and Drug Administration in 2020.