Proudly unmatched

Proudly unmatched | Image Credit: © ronstik - © ronstik - stock.adobe.com.

I am coming up on the tenth anniversary of my medical school graduation. It was easily the worst year of my life, worse than my subsequent marital divorce—at least I saw that one coming. Going unmatched—I did not see that one coming. I can recall an inability to differentiate my tears from the water as I cried in the shower. Curled up in fetal position within my Boston apartment, I good-naturedly conducted telephone scramble interviews as the outside sleet more accurately reflected my inner turmoil. I had no desire to be in New York, Michigan, a preliminary, or surgical program, although UCLA was the most appealing location. More desperately, I wanted to avoid pursuing an unintended MPH or enduring a second grueling match season that seemingly would undo my journey in medicine.

Interestingly, I had excelled in my clerkships with honors outscoring high passes and passes combined. My Step scores were greater than average. I was heavily involved in teaching and mentorship, even developing a novel clerkship—Transgender Medicine—prior to its contemporary importance. It continues to be part of the curriculum with my objectives in place. My letters of recommendation were glowing. (My apologies to Drs. JA & JS; I read them several years later.) I will admit that I had minimal research exposure and publications. Nevertheless, it was not anticipated that I would go unmatched; it was a concealed placental abruption with the massive hemorrhage only evident as I transitioned from fourth year medical student to PGY1 resident. My new institution attendings shushed me from sharing “it” as if “it” were my personal failure. My co-residents were unaware “it” had even happened. Cooperatively, I hid “it” for years, only exposing “it” now.

I would like to share going unmatched not my personal failure. And should you go unmatched, it is not YOUR personal failure either. To my unmatched colleagues from prior cycles, in this cycle and the upcoming cycles, it is a flawed system (like marriage and divorce) with significant inequities, conscious and unconscious biases plus partialities- my own included. Ultimately, it is a computer algorithm with neither heartfelt human emotion nor more equitable alternatives (much like medical insurance and abortion laws). As I read through this year’s residency applications as part of my current institution’s selection committee, I was awed at your accomplishments that are well beyond my own at your academic age. There is no application that I reviewed that read FAILURE. You are elite of the elite. Prime of the prime. Top of the top. Be proud of your medicine journey regardless of your match assignment. And know this: it will work out the way it was meant to, and you will only know it 5, 10, 15 years later; a career down the hard-earned road. I should have been and now am proud of my unconventional route to, through and from residency.

Spoiler alert: I “successfully” scrambled picking up not only 1 but all the unfilled ob-gyn positions. (More sincere apologies to my unmatched classmates whose opportunities came to me and to the institutions I knew I would turn down.) And if I had a do-over, I would replicate it because it led me to a memorable New York year and a highly desired California residency that would not have been possible from my match season.

After completing my internship at SUNY Downstate, I transferred to and excelled at Kaiser Permanente San Francisco (KP SF). My program director’s graduation speech compared me to our gynecology oncologist. Thank you Drs. GJ and BP. I have significant gratitude to Dr. EM who left medicine for product innovation, equally opening our opportunities. One “successful” match (her) for 1 “unsuccessful” match (me). Crying in the shower. Fetal position in my apartment. Reluctantly enduring another East Coast winter. Strong emotions that are fragments of the joy I experienced with the birth of my mono/di twins as KP SF Chief Resident, graduating at the Presidio with my colleagues and family and now practicing in my childhood home, Cupertino, despite landing at Downstate. Now on the other side of the application process, I feel for you, your hopes, and your dreams. It will be undeniably remarkable like the multiparous stop & drop vaginal delivery or the primary arrest of descent cesarean section, either one delivering an incredible gift of life. Be proud.