Will DiPasquale, University of Rochester Class of
I was enjoying the slow start to another day off in the spring of fourth year when my phone buzzed: “We are sorry, you did not match to any position.” I catapulted out of bed with a tight chest and a knotted stomach. I couldn’t believe it. Whether from blissful ignorance or sheer hubris, I had never truly considered the possibility of not matching. The initial shock quickly descended into despondence.
In the hours that followed, I was faced with very difficult decisions on how to proceed. As I write this, almost two months after getting the news, I continue to face the ongoing challenge of maintaining a positive and resilient attitude. One of the keys to wellness, for me, is talking openly about my life experiences, both positive and negative. The primary goal of this submission is to share with you about my experience so that we may, in some small way, cultivate a culture of shared wellness through open communication and solidarity. My hope is that the themes of this essay are valuable beyond the scope of The Match.
I Didn’t Match - Now What?
There are essentially three main paths available:
2. Don’t SOAP and graduate
3. Don’t SOAP and defer graduation
The goal is not to argue which of these options is superior as everyone’s circumstances are different. Nor is the goal to provide a comprehensive assessment of the merits and drawbacks of each option. The goal is simply to describe my experience and the thought process for the decision that I made.
As I described above, getting the news that I did not match was a complete shock to my system; I was in a complete mental and emotional fog in the days that followed. Still, mere hours after getting the news, I needed to decide whether to opt in or out of the SOAP. I had spent a couple hours sifting through the options available in the SOAP: transitional year spots, medicine prelim spots, surgical prelim spots, family medicine spots, and over five hundred Emergency Medicine spots. I seriously considered a medicine prelim or transitional year as it would allow me to graduate and temporarily begin working while I re-applied to Anesthesiology. SOAPing into another speciality would have required putting together a new application in less than a day (at least a new personal statement and new letters). I did not feel that I was in a healthy mindspace to be making such significant and lasting decisions.
I decided by Monday late afternoon that I would opt out of the SOAP. I felt some degree of peace in allowing myself the necessary time and space to properly recover from the disappointment of not matching before plotting my next move. Over the next week, I had to decide whether to graduate on time or delay graduation by one year. Graduating on time but without a residency position seemed like a risky proposition to me. Sure, I could re-apply in the next cycle as a graduate - but what would I do in that year? I considered pursuing non-clinical employment opportunities, but such an opportunity could have taken months to come to fruition, if at all. And further, I wasn’t willing to walk away from clinical medicine. So, I arrived, somewhat begrudgingly, at the decision to delay my graduation by one year. This provided me with the benefit of ongoing full-time student status; I could continue to engage in clinical rotations and research, strengthen my network within the department, pursue away rotations, and continue to utilize advising and other university resources. Fortunately, my school also discounts tuition for an unanticipated 5th year to about $10,000 for the year.
The Match is the door through which we must pass to get to the next chapter in our training. When that door doesn’t open - or perhaps it opens to an undesirable outcome - it’s a lonely feeling. What is envisioned to be a moment of celebration becomes a nidus for anxiety, self-doubt, and concern for the future. For weeks, I questioned in hindsight my every move in the application cycle - a sort of malicious root-cause analysis. My relationships with my classmates suffered; I avoided interaction out of embarrassment and a perceived mismatch between my emotions and theirs. I developed symptoms of depression. On top of this, I started a two week anesthesia rotation two weeks after match day. I felt like a human black cloud as I repeatedly shared my bad news with good hearted people who were taking an excited interest in my match results.
Staying Well in the Wake of Adversity
The work of staying well is the most difficult but most necessary challenge in the context of any adversity - personal or professional. My experience has taught me that three key themes of maintaining wellness are vulnerability, gratitude, and trust.
There were a lot of people that were looking forward to hearing my match results - friends, family members, neighbors, and even employees at a few of my regular spots. I started reaching out to my closest friends that night. I figured I’d have to tell them sooner or later. I held my phone with a pit in my stomach, and started dialing. I quickly realized these calls were quite therapeutic; my friends lifted my spirits with their positivity, their empathy, and their encouragement. Choosing to let my guard down and let my friends in proved to be immensely helpful in countering the initial pain. Still, it’s easier to share bad news with close friends than it is to share with professional colleagues in the hospital. But alas, I found myself continually uplifted by these conversations, too. One attending in anesthesiology shared with me their own series of setbacks in their professional journey (including multiple failed attempts at the LSAT followed up by not getting into medical school in their first application cycle!). Another colleague, a senior resident in vascular surgery, shared that it took them three tries to get into medical school. Only by opening oneself up to others can one discover solace in solidarity.
It’s human nature to project oneself into the future and eagerly anticipate its arrival. I think this contributed to the crushing nature of not matching; the next chapter in life that I had been envisioning for months did not come to fruition. As a result, I have been struggling with a sense of resentment for what I have in the wake of not getting what I want. To counter this, I have been trying to look at my life as it is with a perspective of gratitude. I have been taking inventory of the positive forces at play in my life with a particular focus on who was there for me at the lowest moment. Sometimes, though, it’s difficult or simply not possible to look at one’s own life with a sense of gratitude, especially during these moments of heightened stress. It’s essential to seek additional support in these instances in the form of professional mental health care.
I genuinely believe that life unfolds exactly as it is supposed to. In the moment, failures and rejections are unequivocally demoralizing. But I subscribe to the conventional wisdom that, “Everything happens for a reason.” I suspect that a fair number of people may roll their eyes at that sentiment, and that’s fair. Still, I can’t get behind a perspective that says, “This sucks and it will always suck.” Instead, I’m willing to bet on an outlook that says, “This sucks right now, but eventually it will suck less and, in fact, many positive things will likely come from and through this.”
In closing, the pursuit of a career in medicine guarantees the continual encountering of intense challenges. The innumerable board examinations, the fierce competition in securing one’s desired training, the missed time with family, the poor patient outcomes, to name only a few, all represent potential sources of isolation, demoralization and disorientation. In the seeking of support and solidarity in these difficult moments, one may be surprised to find that the grass is green, right where one is standing.