Comment on “Medical Students Who Do Not Match to Psychiatry: What Should They Do, and What Should We Do?”

Abstract

To the Editor: We have read the article “Medical Students Who Do Not Match to Psychiatry: What Should They Do, and What ShouldWeDo?” byBalon et al. with pleasure [1]. The authors highlight the success of an increase in applications to psychiatry residency and the unintended consequences of that success [1]. More applications have led to an increase in the number of unmatched students, many of whom are otherwise qualified to be psychiatry residents. In their description of the dos and don’ts for unmatched students, the authors also provide different mechanisms that students have taken in the past to deal with their status as unmatched applicants. These range from strengthening their application to how one could move into a non-clinical role [1, 2]. The dos and don’ts are a real asset, because not much attention is paid in the literature to what unmatched students should do. Though this paper is written specifically for and about psychiatry, I (MM) found it informative, insightful, and applicable for my own journey into internal medicine. After finding myself unmatched, I was left feeling aimless as I was not certain what my next steps should be. Prior to the match, I was not prepared for the possibility of failure in matching. The match rate for the cycle that ended in March 2020 was 93.7% for US MD students [3]. While high, that percent belies the fact that 1200 US MD students did not find a placement [3], which is nothing to say of the hundreds more osteopathic students and international medical graduates who also did not place [3]. The authors are right to raise a very important issue: what—if anything—is owed to these unmatched students? What sort of guarantee about a medical career does entry into medical school provide? For most students, it is the appearance of a guaranteed, secure job, one that is hopefully fulfilling. Medical schools, unlike other professional schools, allow, in my (MM) opinion, the perception of guaranteed success. Much has been written about how entry into law and business schools does not promise a job on completion of their respective programs [4, 5]. The same cannot be said about medicine. Medical schools do not provide a full disclosure of the fact that students may not end up with a job after their education is complete. Websites tell stories about matched applicants, but the stories of unmatched students seldom receive attention. Percentages of unmatched applicants are often not mentioned or very difficult to find. Who are these unmatched students? One group is made of those considered to be competent and to have the skills but who otherwise fail to match due to poor strategic planning or attempting to match into a highly competitive specialty. The other group is made of those students who have “real” problems such as having taken the boards multiple times, having a history of unprofessionalism, or lacking self-awareness to determine if medicine is truly their calling. Are they to be promised a job after entering medical school and taking on hundreds of thousands of dollars of debt? Or do medical schools need to acknowledge that it is possible that otherwise qualified candidates may not be able to practice what they are taught? There are no easy answers. In order to resolve the dilemma of unmatched students, the medical community, medical schools, and society will need to answer what responsibilities and expectations they each have toward potential students. Do students need to know the possible chances of not matching and what that might mean? If it is decided that there is indeed a responsibility to guarantee positions for all students, structural reforms will need to be implemented, such as petitioning Congress to increase the funding for residency positions. Balon et al. * Mehreteab Y. Mengsteab [email protected]