The Match, The SOAP, & the reality of being an IMG

This past week was Match week, which for those of you readers unfamiliar with this term, it is the means by which MD graduates get "matched" into a residency placement.  For many people, Match week is the highlight of your 4 years of medical school, when you finally have a job post graduation and the reality that all of your hard work has in fact, paid off.

However, what many people don't understand is that there are far more MD candidates trying to "match" then there are spots in residencies.  Every year, there are thousands of applicants, many of them international medical graduates (IMG's) who don't receive a spot in a residency.  Therefore leaving them with the degree of MD but unable to be licensed and practice due to the inability to obtain a residency position.

The Facts:

• Josh is finished with all of the requirements to graduate from medical school at SGU and will receive his diploma in June.
• Josh passed all of his board exams, Step 1, Step 2 CS, and Step 2 CK with scores above the average for both IMG's and AMG's (American Medical Graduates)
• He had strong letters of recommendation
• He is in the 1st quartile (top 25%) of his graduating class academically for both the basic science years (first 2 years) and currently
• He applied to 100+ categorical surgery residency programs both community based and university based across the entire US
• Josh only received a few interviews to residency programs
• We found out Monday that Josh did NOT Match

While not Matching did not necessarily come as a complete shock because of so few interviews, we were still very disappointed.  It is extremely scary to know that you not only don't have a job after 4 years of medical school, but you also have no job with $200,000.00 worth of educational debt that will have to start paying back after you graduate.

The SOAP (Supplemental Offer and Acceptance Program):

• When you don't Match into a residency, you can enter the SOAP, a process by which you send out up to 45 more applications to residency programs that did not, for whatever reason, fill their positions during the Match.
• On Monday afternoon, Josh sent out the full 45 applications to programs for Surgery (both categorical and preliminary), Family Medicine, Emergency Medicine, and Internal Medicine.  At this point he was willing to do anything.  We thought FOR SURE he could SOAP into something based on his grades and Step scores.
• From Monday through Thursday, applications are reviewed by programs, phone interviews may happen, and every few hours, offers to those programs are made.
• There were approximately 900 positions in the SOAP.  There were over 1100 AMG's unmatched and over 8000 IMG's unmatched trying to obtain these spots.
• Josh got ZERO phone calls or emails the entire week.  NOT. EVEN. ONE.
• It is our belief that international graduates, regardless of citizenship were filtered out from the start, that Josh's application was not even looked at all week.

Our interpretation of the SOAP from an IMG standpoint was that it was like being stabbed with a knife and then having it twisted around inside of you in order to kill you slowly and painfully.....a slow, painful death.  There is nothing like sitting around all day for a week, waiting for a phone call, and one never coming.  The stress level in our apartment was sky high and yet we knew there was nothing to do but wait and hope and pray that something would work out.  Josh was a part of message boards online for people in the same position and we know that AMG's with significantly lower Step scores were getting multiple phone interviews as well as offers.  Never has the stigma of being an international graduate felt more damning.  Both Josh and I were so discouraged.

Post SOAP:

• On Thursday at 5:00pm EST, the SOAP ends, and unmatched applicants are then allowed to contact programs by phone or email that still have openings.
•  At this point, there were less than 50 spots across all specialties left after the SOAP and programs are not required to fill their positions.
• Josh began sending out what I call hail Mary emails to programs with unfilled spots hoping that someone might throw him a bone and at the very least email him back.
• He received many automated response emails saying either the positions had been filled or that they had decided not to fill their positions this year.
• By Friday morning, Josh was beginning to look into alternative options for the next year.  These included doing an MPH (Masters of Public Health), unpaid medical research, delaying graduation in order to do more hospital rotations, and jumping off a bridge....joking...kind of.

On Friday around noon, Josh received a call from the program director at the University of Massachusetts, one of the programs he had emailed the night before.  He conducted a 10 minute Face Time interview and offered Josh a general surgery residency position for this year on the spot.  Within minutes of getting off the phone, an email with the offer came through, Josh signed it, and that was that.  Relief immediately followed.

What we learned/Our advice:

• Apply on time.  Do not wait even a day to send out your applications. Being the first to get them in is likely key to getting multiple interviews.
• If you can, have all of your Step scores IN before applications are due.  You are best off if you have a COMPLETE application at the time of submitting it.
• Have realistic expectations.  If you are an international grad, it will likely hurt you.  Most IMG's go in to primary care (FM, Peds, IM, Psych).  If you do not want to go into one of these, consider apply to some anyway as a back up choice.
• Avoid the SOAP at all costs!  It is NOT set up to be in the interest of the applicant, especially IMG's.
• It is better to have a residency of any kind than not.  Trust me.

We feel very lucky.  Not only did Josh end up in his residency of choice, surgery, but amazingly he is also going to be at a university program at one of the top surgery programs in the United States.  It is nothing short of a miracle and we are definitely counting our blessings.

****EDIT: Here is a link to the follow up post regarding our match process.  Josh did, in fact, match into categorical surgery in the 2015 Match.  Read about it HERE.