Unsolicited advice from unmatched residency applicants [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“When you enter medical school, you put your trust into an unspoken promise: Work hard, pass all your classes, and you’ll come out as a doctor after four years. While mostly true, this perception doesn’t take into account the residency application process and the possibility of graduating without a position as a physician-in-training. This thought didn’t cross my mind until I decided to apply for otolaryngology, one of the most competitive specialties. I went into the application season hoping for the best, knowing that the number of applicants was higher than ever. On the Monday of Match Week, I opened my email from the NRMP to be met with the words, ‘We’re sorry, you did not match into a residency position.'”

Katherine Yu and Shaan Somani are clinical research fellows.

They share their stories and discuss the KevinMD article, “Unsolicited advice from unmatched residency applicants.”

Did you enjoy today’s episode?

Please click here to leave a review for The Podcast by KevinMD. Subscribe on your favorite podcast app to get notified when a new episode comes out!

Do you know someone who might enjoy this episode? Share this episode to anyone who wants to hear health care stories filled with information, insight, and inspiration.

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Katherine Yu and Shaan Somani. They’re clinical research fellows, and they co-wrote the KevinMD article “Unsolicited advice from unmatched residency applicants: Hope for the best, plan for the worst.” Katherine and Shaan, welcome to the show.

Katherine Yu: Thank you for having me.

Shaan Somani: Thank you so much for having us.

Kevin Pho: So we’ll get into your article in a little bit. I’m going to ask each of you to share your stories and journeys to where you are today. Katherine, why did you go first?

Katherine Yu: Sure. So I was born and raised in Houston, Texas, and for me, from a pretty early age, I knew I wanted to do medicine. So I went through the traditional route. I went to college at Rice and then went to med school at UT Houston. During med school, late into my third year, I decided to pursue otolaryngology as the specialty of choice.

So last year I applied for residency, and then, unfortunately, things didn’t go as planned, and I ended up this March being unmatched. After considering my options, I decided to pursue a clinical research fellowship at the University of Kansas in Kansas City with their otolaryngology department, and this is where I’ve been for the past few months. So that’s a little bit about my background.

Kevin Pho: And Katherine, are you planning to match again in otolaryngology?

Katherine Yu: Yes, I am applying again this cycle, and so right now we’re in the midst of interviews.

Kevin Pho: All right. And in general, how difficult is it to get into an otolaryngology residency?

Katherine Yu: Yeah, so a lot of surgical subspecialties are pretty competitive, and otolaryngology is the same. In the past few years, it has been increasingly competitive. I would say last year about 600 people applied, and there are only about 450 spots, correct me if I’m wrong, Shaan. So the match percent, or match rate, last year was about 67 to 70 percent.

Kevin Pho: And Shaan, can you share your story and journey to where you are today?

Shaan Somani: So I was originally born in Indiana and then raised for part of my life between Indiana and California. I was part of the combined medical program at Northwestern, so I did both undergrad there for three years and then four years at the medical school in Chicago. I knew pretty early on in medical school that I had an interest in otolaryngology, but similar to Katherine, last year I applied and didn’t match.

So I was really fortunate in that my school allowed me to delay graduation without having to pay tuition, and so during this time I’ve been working as a clinical research fellow at the University of Kansas, which was the inspiration for the two of us to write this article.

Kevin Pho: Wonderful. I went through a combined program myself, at Boston University. So tell me about your experience going through a combined program versus a traditional one.

Shaan Somani: I absolutely loved it. I think that there are a lot of benefits to it, especially from the student perspective. Personally, I was able to go through the process with a lot less stress. The GPA requirements and the MCAT requirements were so much less than those of a traditional pre-med student. But there were also a lot of benefits in terms of personal growth. I was able to explore certain passions and pursue certain individual interests that I don’t think I necessarily would have if I had to spend all that time really preparing myself to look incredible on paper simply for the purpose of applying to medical school. And it also gave me a really tight-knit community, many of whom I consider my best friends and still keep in touch with.

Kevin Pho: All right, so let’s talk about the KevinMD article that both of you co-wrote, titled “Unsolicited advice from unmatched residency applicants: Hope for the best, plan for the worst.” Katherine, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you and Shaan decided to write it?

Katherine Yu: So since we both came from a relatively unique experience of not matching, and we spent a lot of the last few months reflecting on our own experiences going through the process, we thought we had some pointers that we wanted to give medical students who might be doing the same thing this cycle, and also in the future, from our experience. We wanted to really emphasize to the readers, whether they’re students or faculty members, the importance of really planning out what you want to do and having conversations early on in the process, really considering your odds, and just different other life lessons or pointers that we wanted to really convey, since, you know, it is really stressful, this application process, and unfortunately there is a chance of not matching.

I think last year the match rate for otolaryngology and a lot of surgical subspecialties was in the 70s. And then I think a lot of the voices of people who are unmatched are unheard, because if you look at the national match rate, it’s at 97. So that’s why we thought it was important to really be open about what we went through, and to hopefully help people who may, unfortunately, end up going through the same.

Shaan Somani: Just to quickly tag on to what Katherine had mentioned, you know, I think that the goal of our article really was that we wanted to target it towards those applicants to specialties that are inherently considered very competitive, so, you know, these surgical specialties or certain other specialties where the match rate tends to be in the 70 percent range. But that being said, there’s always a chance of not matching, and I think that it’s prudent to have backup plans, or to be cognitively aware that this could occur, just so that, if you were to receive that news, you’re in the position where you at least know what the next steps are. And this is something that’s really true for any applicant to residency, and that’s something we hope to convey.

Kevin Pho: Katherine, for those who aren’t familiar with applying to an otolaryngology residency, describe what that process entails and how many programs you apply to.

Katherine Yu: Sure. Well, I knew it was very competitive, and I think all the candidates who apply to the specialty kind of self-select, because you know that it is competitive. So your board scores have to be extremely high, and then also you have to have good clinical grades and also be very well-rounded, with both extracurriculars and research and scholarly activities. For me, I decided relatively late, but I knew I was a decent applicant, and I still applied to almost all the programs, which is about 100.

Kevin Pho: And Katherine, how many programs did you interview at?

Katherine Yu: I interviewed in, like, the mid-teens last year, which is about average, I would say. I’m not sure; they don’t really release the numbers for interviews that applicants normally get. But I was predicted, based off of the national match data about two years ago, to have like a 90-something percent chance of matching, and then, unfortunately, it did not happen.

Kevin Pho: And Shaan, I know that it was certainly a very difficult experience for both of you, but take us through that week when you found out the news that you didn’t match. What was it like?

Shaan Somani: Yeah, truthfully, I look back and I think that was, without question, probably the most stressful week of my life. You see the email where it says very clearly, from the NRMP, “We’re sorry, you did not match into a residency position,” and my heart just sank. Our medical school had a policy where we were immediately supposed to go to their office, and it was like a war room, where we were brainstorming with our mentors. People were coming in, they were giving their advice and emotional support. I was having calls with all of my mentors within the field as well as my family, and it was a large period of just feeling as though I was, to some degree, racing against the clock, trying to hope that I could find some sort of position or plan for the upcoming year.

I already came into it with the idea of what I thought my backup plan would be, but I was really surprised that when I was in that moment itself, my entire idea of my backup plan had changed. Once it became a reality, I came to recognize that my original backup plan was to just abandon otolaryngology and to completely pursue another specialty. But the more I reflected on it, the more I felt that I wanted to give it another go, that I’m very motivated and I’m driven towards this specific field, and so I would do whatever it took in order to make that a reality. And I consider myself incredibly fortunate to have secured this fellowship here at the University of Kansas.

Kevin Pho: So Shaan, take us into that war room, as you call it. What are the options, in general, that are available to those who don’t match?

Shaan Somani: Yeah, so I think that the options available to you differ depending on when you really start having this discussion or thought, which is part of the reason why we wrote this article, because we really hope that by giving this information, some applicants will start having these conversations with their mentors as early as December or January, rather than March, when they find out the news.

Ultimately, if you only find out in March, your options are really to pursue a research program or a research year, or you could do a transitional or prelim year, or perhaps another alternative, which is significantly less rare: Some people perhaps spend their year volunteering or do something completely outside of medicine.

My personal opinion is that if you’re going to be prelimming, or going into a prelim spot or a transitional spot that’s completely separate from your original plan or your original residency choice, then it really behooves you to think about this as early as August and September, before you even apply, because you could always have these prelim spots and interview at them through the normal process, and then just simply put them towards the end of your rank list. At least then you’re a lot more in control of the situation, rather than having to scramble at the last minute.

Kevin Pho: Well, Katherine, after you found out the news that you didn’t match, walk me through the options that were facing you, and why did you choose the option that you eventually did?

Katherine Yu: Sure. So, similar to Shaan, it was definitely a shock. I knew there was always a possibility that I didn’t match, but I was very much hoping for the best. I was fortunate enough to have a really strong mentor, and so we actually had a conversation a few months prior to March about what I would want to do if I didn’t match. After talking with him and considering my options a few months ahead of finding out my result, I was pretty dedicated to continuing to pursue otolaryngology.

I thought about either doing a prelim, like Shaan said, or doing research. From my perspective, if there was an open spot for otolaryngology, I would go for it, but if not, I wanted to make my application stronger by doing research. I also thought that research would benefit me in the long term as well. I could pick up skills that would help me in my future career, especially if I’m interested in academia. So those are the reasons that led me to decide on a research fellowship.

So on that Monday, after I got the news, I immediately checked to see if there were any open spots, and then after that, it was a lot of looking around and seeing what options were available for research fellowships. And I was also very fortunate to be offered this position here at Kansas.

Kevin Pho: Both of you decided to continue to pursue otolaryngology. Now, Katherine, if you were to switch fields, what options were available to you?

Katherine Yu: If I were to switch fields, I think during that week, if I wanted to switch into another specialty and scramble, or SOAP, into another specialty, almost all of them were open. I think the only things were the more competitive things, like orthopedics or neurosurgery or plastic surgery. They didn’t have any open spots, but all the other subspecialties were available, and so those were things I could have stunned. But I wasn’t really interested, I would say, so that’s part of the reason why I decided not to do any of them. Since early on in med school, I already went through the thought process of what I wanted to do, and nothing that was available at the moment, no residency spots, really fit my vision of my future career.

Kevin Pho: So Katherine, you mentioned all the other residency slots were open, other than orthopedic surgery. So are we talking about things like family medicine, internal medicine, and pediatrics? What about general surgery?

Katherine Yu: Yes. I’m not too clear whether or not there were any general surgery spots, but there were preliminary positions in general surgery, and so those are one-year positions where you would be an intern, but you weren’t guaranteed to be able to continue residency at that program, and so you would have to reapply again. And that’s something I didn’t want to do. That’s definitely an option people frequently choose if they don’t match into a surgical specialty.

But I thought otolaryngology is also relatively unique in that, in your intern year, half of the time you’re with this field, but then the other half you’re off service or rotating through other specialties. And so I thought that it would benefit me more to do research rather than scrambling or SOAPing into prelim general surgery.

Kevin Pho: And Shaan, both of you talked about the importance of mentorship during this difficult time, so speak more to that. How do you find a good mentor, and what other types of support systems did you have during this period?

Shaan Somani: Yeah, honestly, I want to give a quick shout-out to my mentor, Dr. Monsooka, because truly, I don’t know if I could have handled that single week if not for him. He had my back through the entire process. He was the one who was helping me realize where I should apply for research programs and what opportunities were available.

In terms of how to find a mentor like that, I consider myself really lucky. I think that, to some extent, naturally, I sought out many different mentors throughout my time in medical school who were within the field, and I think it really came down to a personality fit. I found that he and I just really were the same. We’re cut from the same cloth. We really had the same sense of humor, and he also clearly really cared about my personal growth, and that’s something that is hard to necessarily always find in a mentor. There are a lot of mentors who are great at giving advice, but there are not many, in my experience, who are comfortable giving constructive feedback and willing to tell you to your face what you’re not good at, because that’s how you can improve. And I think that once you’re able to find that, it’s something that you should really hold on to, because that’s someone who cares about you to the extent that they’re willing to tell you this. And it’s never in a mean way; it’s always purely from a place of actual care.

In terms of other students, you know, I think that it’s about reaching out early on, trying to seek out different people, seeing where there’s that personality fit. And it’s tough. You might not always find it, but to a certain extent, you just have to make sure that you have those mentors available.

And then beyond that, I guess, to answer your second question, I really rely as well on my family, as well as on my friends. They were huge support networks. As soon as I found out that I didn’t match, I basically broadcast the news. I didn’t want to hide it. I wanted to make it very clear to people what was going on in my life, because that’s how I knew that they would be able to check in on me. And throughout that entire week, I had, every day, several people who were calling and texting just to make sure I was OK.

Kevin Pho: We’re talking to Katherine Yu and Shaan Somani. They are clinical research fellows, and they co-wrote the KevinMD article “Unsolicited advice from unmatched residency applicants: Hope for the best, plan for the worst.” Shaan, now that you’ve had some time to reflect on this experience, is there anything that you would have done differently?

Shaan Somani: I think, really looking back at last year, the biggest thing I wish I had done, you know, I really tried to prepare for virtual interviews, but it’s just different. It’s not quite the same as interviewing in person, and I’ve made much more of an effort this time around. I think, going through the interview process again, I feel that the conversations are a lot more natural, and I would say that people on both sides were a lot more engaged. But last year I think I struggled with that.

As much as possible, I would recommend just doing a lot of interview prep, not just with your friends or with your family, but with mentors, and really anyone who you could see providing some level of constructive feedback, and a lot of people will be able to pick up on different things. So interview prep was 100 percent the thing that I wish I had done a lot more of. Not to say that I didn’t, but I think I probably could have stood to benefit from just doing 10 times the amount.

Kevin Pho: And Katherine, is there anything that you would have done differently?

Katherine Yu: I think I was really fortunate in having a mentor who was there to advocate for me and also, all through the whole process, support me and prepare me for interviews. As for my decisions, I don’t think I regret anything I really decided to do. I’m really grateful to be doing research. I think I’ve grown a lot and learned a lot from these past few months. I think if I could change anything, I wish I had decided earlier on in my medical school career what I wanted to do, but that’s not something that was, I guess, within my control. So I honestly don’t think I have really any regrets.

And I think, going through the process this time around, I feel similarly to Shaan. I feel more relaxed and maybe less high-strung, since we’ve gone through it once. And so I think maybe, in some ways, during these interviews I can actually really demonstrate who I am better, and that’s possibly one way I struggled last year.

And so, yeah, I think overall it’s been a good experience for me. I think I learned a lot about my own personal resiliency and ability to adapt when things don’t go my way, since I think in medicine, compared to other career fields, there’s a very clear ABCD path that you do. And so I think, for the first time in my life, where things didn’t go as planned, I had to figure out and pivot and change my route. And so I think it’s a very valuable personal learning experience.

Kevin Pho: So Katherine, you said that you wish you had decided on otolaryngology earlier in your medical school career. Would you have done more research? What would you have done earlier on?

Katherine Yu: Yeah, I think so. I think I was fortunate enough to establish strong connections with faculty members in my home program’s department. I think if I had decided earlier on, I would have been able to do more research and had more exposure to the field, since, for both of us, unfortunately, COVID happened during our third year and part of our fourth year. And so I think I may have lost out on a lot of time being more invested in the specialty. So I think that’s one area.

But of course, a lot of medical students don’t decide later on, and they still turn out fine with whatever they decide on. And so it’s just a variety of factors that were outside my control. And I think, yeah, that’s pretty much what I’d have to say.

Kevin Pho: So my final question to each of you would be your one most actionable piece of advice to other unmatched applicants, and some take-home messages. So Shaan, why don’t we start with you?

Shaan Somani: I think that the biggest take-home message that Katherine and I would hope to take, or at the very least, that we certainly hope to convey through our article, is that not matching is not the end of the world. It is certainly a stressful experience, and it can feel devastating at the time, but it is a challenge, and like any challenge in life, it is an opportunity for growth. So take that, reflect, and think about how you want to spend the year ahead, and make the most of it to the best of your ability. You know, if that means pivoting to a different career path or sticking with your original goal, no matter what, this is an opportunity for you to put in the work and to shine.

Kevin Pho: And Katherine, what are some pieces of advice and take-home messages that you want to leave with the KevinMD audience?

Katherine Yu: I definitely agree with Shaan. I think that is something that we both really wanted to emphasize. I think, for a lot of the medical students who are applying, this may be their first experience with major failure, and I think, just the way that the education system is set up, it is hard on people who don’t match. And so I think we wanted to really encourage applicants who go through this that, yeah, it’s not the end, and there are so many things that are out there that you can continue to do. You can still pursue medicine, if that’s what you wanted to do, or you can pivot and do something else. So I think that’s my main piece of advice.

And I guess secondary is to really, really talk to your mentors. I think honesty both ways is something that’s really important. I think that that’s the only way that they can give you the advice with all the information that they have, and also you can really trust them to have all the information to really guide you the right way. And so I think that is maybe the secondary piece of advice I want to give.

Kevin Pho: Katherine, Shaan, thank you so much for sharing your stories, time, and insight, and thanks again for being on the show.

Katherine Yu: Thank you again.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes