Why a Post-Medical School Residency is Not Always Guaranteed

by Lauren DiProspero, former admissions officer at Columbia University To become a doctor, you must graduate from medical school. To practice medicine, you must be licensed. To become licensed, you must complete a residency program. Given this requirement, I am sure that many people assume that residency is simply the next step in a medical student’s journey, and maybe they even assume residency is a guarantee. That is, unfortunately, not the case. In February, the New York Times published an article about the impact of medical schools graduating more students and residency programs not increasing their spots accordingly. The result has been that about 10,000 medical school graduates are chronically unmatched with residency programs. If you are curious how the residency match process works, I encourage you to watch this video from The National Resident Matching Program. It is even more shocking because we will soon be facing a shortage of doctors: “Last year, the Association of American Medical Colleges released a study that found that the country would face a shortage of 54,100 to 139,000 physicians by 2033, a prospect made all the more alarming as hospitals confront the possibility of fighting future crises similar to the Covid-19 pandemic. Yet each year thousands of graduates emerge from medical schools with a virtually useless M.D. or D.O.; without residency experience, they do not qualify for licensure in any state.” There is no one reason why a student may find themselves unmatched. Some of the reasons may be out of the student’s control, especially given the way the matching system works. Prospective medical school students can, however, take steps to reduce the likelihood of being unmatched. Here are a few things to consider before you apply to medical school or accept an offer of admission. Choosing Your Medical School List In a previous post, I shared tips on building your medical school list, including the importance of looking at the residency match rate and board passage rate. You may be nodding your head in agreement but thinking: what is a match rate? It is the percentage of graduating students who are matched with a residency program. Some programs have a near 100% match rate while others program’s match rates may be significantly lower. As an applicant, you don’t yet know how competitive you will be for a given residency program or specialty—but you want to be sure that your medical school, in general, demonstrates a successful match rate/process. Additionally, for many residency programs, attendance at a Liaison Committee on Medical Education (LCME) accredited school is essential. Make sure the medical schools on your list have this accreditation. There are two populations of students who will face more challenges in the match process. Those who attend medical schools abroad, including Caribbean medical schools, will find that some residency programs prioritize students from mainland medical schools. If you are thinking about attending medical school outside of the US, I encourage you to consider if that truly makes sense considering the match rates. Instead, are you able to spend time making yourself more competitive for medical school? Or would it make sense to consider a different career in allied health? These sorts of questions and deep reflection are key to avoiding a situation where you may go unmatched and find yourself in debt. The second population who will face challenges with the US residency match process is international students—both students studying internationally who want to come to the US for medical school, as well as international students who are attending US undergraduate colleges. These students will find that not all residency programs are willing to sponsor visas. Advising and Curriculum As you learn about the medical schools on your list, as an applicant or as an admitted student, it is good to learn more about who is advising on the match process. A dedicated advisor at your medical school will prepare you for matching into your specialty of choice, as well as steer you towards a less competitive specialty if you are not competitive, or discuss other options, like completing a research or gap year before match, to make you a stronger applicant. Additionally, look to see if the medical school is undergoing a curriculum restructure. Where are they in that process and what is the impact on your medical school class? Will you be graded and evaluated under two different policies? Ideally residency programs will be informed of all changes and they can take these into account when evaluating applicants. But not all programs do a good job of conveying this information or setting students up to speak about it in their interviews. And sometimes a different grading system can lead to lower grades and evaluations. If you are admitted to medical school, ask how they plan to address these changes in your residency application. What about BS/MD programs? Many prospective pre-med high school students are interested in BS/MD programs. We have previously written about the pros and cons and what is needed to be a successful applicant. But that is only a small part of the decision and research processes. It isn’t just about finding a program and college that fits your education goals. You are choosing where you will attend medical school, which will in turn have an effect on where you match for residency. Take the time to research the same areas suggested above. There are also a very small number of BS/MD programs that do not require students take the MCAT. While a BS/MD program that doesn’t require the MCAT may seem like a good idea now, you may not be setting yourself up to become the successful, practiced test taker you need to be in order to succeed in the medical field for decades to come.