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Join Amna Shabbir, an internal medicine physician, as we delve into the complex emotions surrounding Match Day outcomes. We explore strategies for navigating feelings of rejection, shame, and disappointment while emphasizing the importance of self-compassion and resilience. Amna shares valuable insights on reframing failure as a learning opportunity, cultivating positive self-talk, and maintaining a strong sense of identity amidst external validation.

Amna Shabbir is an internal medicine physician.

She discusses the KevinMD article, “To the physician who didn’t match: You are not forgotten.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Amna Shabbir. She’s a geriatrician and internal medicine physician. Today’s KevinMD article is “To the physician who didn’t match: You are not forgotten.” Amna, welcome back to the show.

Amna Shabbir: Thank you, Dr. Pho. I’m so happy to be here.

Kevin Pho: So go to KevinMD.com/podcast, she has been on in the past, so you can search her name to hear her story and prior episodes. Today let’s jump right into the KevinMD article, “To the physician who didn’t match: You are not forgotten.” For those who didn’t get a chance to read your article, what’s this one about?

Amna Shabbir: This one started when I was reading a lot of messages and posts that medical students and other physicians who were applying for the match of 2024 were writing everywhere. And there was such stress and anxiety and this anticipation, all wrapped up in one.

And I’m looking at these messages, asking myself, how can I contribute, what can I do? My initial reaction is, I just want to give a massive proverbial hug to everyone and validate their experiences. But what could I do in the space and time that I had available? I could write an article, and I could use the power of your platform.

And that’s exactly what I did. I wrote the article, I think it was one and a half hours, I sent it to you and you accepted it right away. And this was just my way of reaching out to all the applicants and talking about what match day does for us.

And I know that I focused on action, but there’s so much more that I want to talk about in terms of just the impact of match day in the larger trajectory, when we talk about physician well-being, when we talk about burnout, and we talk about all these things and we forget the psychological impact that match day has on all of us.

Kevin Pho: Yeah, absolutely. I go on my TikTok feed, I go on my Instagram feed, you have these huge match day parties. I remember my match day was, let me see, my match day was back in, I think, 2002, so that was like 22 years ago, and it’s nowhere near what it is today, what you’re seeing on social media.

So talk about the emotions that these fourth year medical students are feeling around match day, and especially for those who didn’t match, it must be really difficult for them, these conflicting emotions. But just in general, what are you seeing, what kind of emotions are these medical students feeling on match day?

Amna Shabbir: You have absolutely tapped into what the reality is. The reality is, it is an impactful day. And now there are parties, now social media is there, everything is in the spotlight. And so that feeling of being othered can be very prevalent. You’re missing out on the biggest party that could potentially be happening for the year.

And so the feelings of isolation, first of all the feeling of shame. All my friends are there, all my peers are there, colleagues are there, extended family, everyone knows I’m applying. And if I don’t match, what are the consequences?

And we talk about fourth year medical students. I also want to mention other physicians that are applying again this year, maybe they didn’t match last year. And then we have the whole bucket of couples match, then there’s that stress of, what if I’m not going to get into the specialty of my choosing? I tried a different approach in two different programs. And then there is that separate category of international medical graduates that are applying.

And all these are very high stakes situations, when you have invested financially, when you have invested mentally, psychologically, in all the different ways.

So some of the feelings that come up, one very realistic one is this feeling of being othered, and I am not part of the crowd. Another feeling is shame, oh my God, how did I not make it? Like, I worked hard but I just didn’t make the cut. The feeling of disappointment, the feeling of dejection, the feeling of sheer exhaustion. I tried so hard and it didn’t work out, or it didn’t work out yet again, or it didn’t work out the way I had hoped and planned.

And clearly, all of these individuals that are applying for the match are bright, resilient, hardworking humans that are focused. And so all of these emotions are feeding into each other.

I’m just blown away that we don’t talk about this more. We don’t talk about the trauma that a match day can leave on you, and as you think about your larger life.

Because when we talk about burnout and all the things that happen to physicians, if we zoom out, the people that go on to high achieving professions such as medicine, law, other professions, they self-selected themselves by being perfectionists for very long. They have worked hard through school, high school, college, and now they’re here.

And this match day is just a very, very important time in which we also have to acknowledge what happens, and then really, what do we do about it? What do we do about it if we’re going to miss the biggest party that’s happening? How are we going to comfort ourselves, and how are we then, after comforting ourselves, move forward with an approach that doesn’t involve further traumatizing ourselves, and really continuing to become the best doctors that we can?

Kevin Pho: In your article you introduced a concept of toxic positivity. So talk about that concept as it relates to the match day festivities.

Amna Shabbir: It’s the, it’s OK, you can do this next time, don’t worry, it’s an opportunity. And I know that I mention all of this as I go forward, when I give the solution.

If we refuse to acknowledge what’s happening in the present moment and just quickly jump to solutions, I feel that can be toxically positive. And anytime you resist what’s happening in the moment, and you force someone to be happy, that right there is toxic positivity. One has to come to those conclusions for themselves.

So it’s really hard when everyone’s sharing, I matched here, I couple matched here, and then you’re like, it’s OK if you didn’t match, you’re really good, you can do it next time, it’s no big deal. Well, we know it’s a big deal. Let’s just stay in that space for a minute.

Kevin Pho: To your knowledge, from what you observe from medical schools, surely every medical school has students that don’t match. Do they do anything for these students? They must be aware of this situation.

Amna Shabbir: Yeah, so I have heard support in general, professors and some organizations also offering that, you know, here, these resources, you can call. I don’t want to quote this for everyone, but it’s not as mainstream or it’s not as talked about yet.

And also, anytime it’s institution led, often the medical students again feel labeled. OK, I didn’t match, and now I got the label of the unmatched physician, and now I’m being handed this handout and this number to call. And even from the most well-meaning place, sometimes it might not land that well.

The attempt I had, in terms of opening the conversation through articles, through sharing stories, and through talking, is just to normalize this experience. And while I was grateful to have matched the first time that I applied, many of my best friends didn’t. And I saw the impact, and I worked with them during medical school, and now they’re all phenomenal physicians.

The result of the match absolutely was not a reflection of the kind of humans they were, or the kind of physicians they were at that time, and continue to be, and they lived up to their amazing potential.

So in that moment, it’s just that you look around you, you feel like the world is over, and it’s not.

Kevin Pho: So let’s talk about the path forward. What are some paths or options, even solutions, that you alluded to? What are some paths forward?

Amna Shabbir: I tried to offer five points that I feel we need to talk about at this point. And I put the request over there to approach them with curiosity and open-mindedness when you are ready. So if you are feeling very raw right now, I don’t want you to feel that I am thrusting these on you. These are there as an option.

And I would start with the first point, which was, try on a neutral lens. In the heat of the moment, when all of this is happening, this is a huge event that happened in your life, and that feeling, OK, the world is over.

And I’ve felt that many times, when you’re walking in for that exam. And I’m sure, Dr. Pho, you might have felt this too. OK, USMLE Step 1, I don’t know what’s going to happen, this is it. And it’s not, because the sun comes out the next day, life keeps going on. So in a space of neutrality, what if you just looked at it as an event that happened, neither positive nor negative but just something that happened? That was recommendation number one.

The second recommendation was letting go of resistance. And I know I talk about it in the space of not matching, but you can pretty much apply it any which way. I’m also a physician coach, and I specifically love working with early career physicians, and this is something that we talk about a lot.

And the letting go of resistance is derived from Dr. Kristin Neff’s work surrounding self-compassion. She uses an equation, which she refers to in her book Self-Compassion, which is, suffering is equal to pain multiplied by resistance. In the book she offers that pain is going to come upon all of us, but the part of suffering is an option, because the more you resist the pain, the more it magnifies your suffering.

So as you look at the match results, they’re there, you don’t want to think about them, you don’t want to do anything about them, or you’re trying to tell yourself, I should have done better. Either way, you’re creating a lot of friction. If you can let go, or try to let go a little bit, about the resistance, and just stay with the pain of the result, that allows you the opportunity to hopefully move forward into what can be the next step.

The next is, I mentioned, you are not a failure and you are not broken. Because when we look at the results of the match, and in this way in medicine overall, it’s very hard to delineate our personality and our existence as physicians, and then just as human beings outside of medicine.

So the match results have come, and you didn’t match, or you didn’t get the program of your choice, or any of the other outcomes. And you start thinking that, I’m just not cut out for this, I’m just a bad person, or I am just not good enough, which is more common and more sneaky. And you start equating the match result with your lack of ability to achieve and move forward.

So what I offer is that you separate the result of the match. Because when that clock turned, and when the match announcement happened, wherever you were, in whatever setting you found out, you’re still the same human, you’re still the same compassionate human that you were just a couple of moments before you found out about your match results, and you are still the same amazing physician. This is not a reflection. There are algorithms involved, all these things that go at the back end, and then you start equating them to your own self-worth. So here I would recommend adding some objectivity to this moment.

My next point was, no failing, just learning. So the famous Thomas Edison quote comes to my mind: I have not failed, I have just found 10,000 ways that won’t work.

It’s the same way when we’re looking at, first of all, to come to point four, you would have hopefully tried on the first couple of points. You have tried to look at it through a neutral lens, you have tried to let go of some of the resistance surrounding the match results.

Now, as you’re trying to then separate yourself from the outcome of the match, you can look at it through the lens of objectivity. You can ask yourself, what was the learning experience here? What do I need to tweak in my resume? What do I need to do next? How can I pivot? How can I even, dare I say, leverage this moment in my life? So asking yourself, what is the opportunity over here?

And then finally, which is point number five, and I will always underscore point number five, which is, stop beating yourself up.

If I could tell myself one thing going back in time during all of medical education, it was this feeling that if I was extremely harsh on myself and perpetually self-flagellating and berating myself, somehow I’m going to have really good academic outcomes. And it’s just not true. And I could have avoided so much suffering if I was not doing that.

So a lot of times this is a feeling that we all have. Self-criticism is what we know as perfectionists. Self-criticism is going to yield your best results. The data suggests otherwise. Evidence suggests, and we’re all mostly physicians here thinking, when you’re afraid and you’re being self-critical, you’re tapping into fear responses, you’re jittery, you’re putting your amygdala in overdrive, you’re having a cortisol flood, and you’re asking yourself this question, am I good enough? And you’re then hoping that you’re going to outperform and fix this match day result from that space. That clearly is not going to happen.

Research also shows that people that are self-critical are actually less likely to take ownership of the results that they have in life, and they’re more likely to blame others.

So what I’m offering over here is, instead of self-criticism, pivoting towards self-compassion. And I know that when we go into self-compassion, some people find it very vague. What can I do at this point?

Well, I have a very simple recommendation, based off not my own work but a lot of other work that’s been done by the giants like Dr. Neff. How about talking to yourself about the match day results like you would talk to a friend? What if your unmatched friend came to you and talked to you? Would you be talking to them the way you are talking to yourself internally?

And the bottom line to this is, when you are practicing self-compassion, you’re actually less likely to procrastinate, you’re going to stay more in the space of taking action. Because where you are now, from not being matched to where you want to get, requires action, requires a lot of process that has to happen. And that can’t happen if you are not your own ally.

So can you try and become your own ally as you move forward? Because when you’re practicing self-compassion, the driving force is love. You’re going to have a surge of oxytocin, you’re going to think in creative, expansive ways, you will have intrinsic motivation to move forward. So research and evidence is all on the side of you not berating yourself and being kind to yourself.

Kevin Pho: You mentioned earlier, and you’re a coach, of course, for early career physicians, and you know physicians who didn’t match at first, and the vast majority of them today, they’re successful doctors. Is that right?

Amna Shabbir: Absolutely, that is right. And it’s a journey. I don’t want anyone who didn’t match to think that they need to work on their resilience skills or anything. You already are good, you are not broken. Now what we need to do is for you to not feel that way, to just look at facts. The facts are, you are smart. The facts are, you are exactly where you’re supposed to be. What can you now do to get from point A to point B?

And there is this concept of sharing vicarious experiences and learning through them. So as more people talk about their experiences of not matching. In fact, one other friend of mine shared, and she’s not just a successful physician but also a successful physician entrepreneur, didn’t match the first time, was embarrassed, and now is doing great.

So the possibilities are endless. As more people share their experiences of not matching and then doing great, that is actually psychologically wonderful for you. And as other people acknowledge the fact that by not matching you’re not less than, and you don’t feel othered, that is also wonderful for your healing and moving forward towards action.

Kevin Pho: Now, are you aware of any support groups for medical students who didn’t match? You’re a coach, obviously, and you’re providing a lot of fantastic advice here, but for those who may not see you or read you on your social media channels, what kind of support groups or options do these students have?

Amna Shabbir: Honestly, Dr. Pho, I am seeing a lot of support generating just on Facebook communities that are out there, mostly. And what I like is, there are a lot of tangible action steps that are being provided.

So a specific group is not coming to my mind just right off the cuff, but I will say that there are really good communities out there that you can just share with, that will help you start that process.

And then, what you look for you will find. You will find the community. If you are going to stay in that spiral of, I’m not good enough, and not sharing, you will continue to find evidence for that. But if you say, OK, this is what happened, what else can I do?

There are communities that are helping just international medical graduates that didn’t match. There are communities out there in terms of just discussing, OK, I didn’t match, what else can I do? And what I have seen is incredible generosity for physicians to come and just share, like, here’s what happened to me and here’s what you can do.

Kevin Pho: We’re talking to Amna Shabbir. She’s a geriatrician and internal medicine physician. Today’s KevinMD article is “To the physician who didn’t match: You are not forgotten.” Amna, as always, we’ll end with your take-home messages to the KevinMD audience.

Amna Shabbir: Today I want to leave with the two quotations I mentioned at the end of my article, because I feel that they were really powerful.

And the first one is by Sumner Redstone: success is not built on success, it’s built on failure, it’s built on frustration, sometimes it’s built on catastrophe.

And the second one is my all-time favorite, by Brené Brown, and it talks about worthiness and mattering and inherent worth, which I feel physicians struggle with a lot at all levels, and most humans as well.

[Amna Shabbir reads a short passage from Brené Brown on worthiness and belonging: the warning that if you walk through the world looking for evidence that you do not belong, you will find it, and the same for evidence that you are not enough; and the reminder that worth and belonging are not negotiated with other people but carried inside our own hearts.]

Kevin Pho: Amna, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Amna Shabbir: Thank you, Dr. Pho.