7% of Med Students Don't Match. Do These Things Instead. #478

You didn't match. Now what?

Every year, roughly 7% of U.S. medical students don't match into residency. If you're one of them, you're not alone—and this isn't the end.

Reddit Question We're Answering: "M4 here. Didn't match into the only specialty I cared about. No backup plan. Would it be insane to just get off the hamster wheel? Years of sacrifice, crushing debt, and the light at the end of the tunnel isn't real. These two degrees feel useless now. Is there any coming back from this?"

In this episode, we break down exactly what to do when you don't match, how to navigate SOAP, and when to consider pivoting versus pushing through. 

What we cover:

→ How to navigate SOAP strategically (don't waste your 45 tokens) 

→ Why preliminary programs aren't stepping stones—they're your proving ground 

→ The one exam that makes the difference between 1 interview and 14 interviews 

→ Renee's story: Switching specialties days before the Match deadline 

→ When to pivot versus when to push through 

🎧 PODCAST EXCLUSIVE BONUS SEGMENT (25 minutes):

"The Surgery Resident Dismissed Because He Couldn't Pass Step 3"

In this podcast-only bonus segment, Nii tells the story of a co-resident who was one of the best technical surgeons he'd ever worked with. But he couldn't pass USMLE Step 3.

This 25-minute segment is exclusively available on the podcast version of this episode.

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Transcript

A Reddit Post Hits Hard

SPEAKER_02 0:00

So I need to read something off of Reddit. It's from a fourth year medical student who just didn't match. So this question reads currently an M4, about to graduate, didn't match into the only specialty I actually cared about. No backup. Would it be insane to just get off the hamster wheel and move on with my life? After years of sacrifice, killing myself in med school, crushing debt, the light at the end of the tunnel isn't real. These two degrees are essentially useless now. I'm struggling to even find a research year position. Is there any coming back from this? Or should I just accept this path isn't for me? So this is a tough question. This is a multifaceted question. And I'll be honest with you, back in 2006, I almost asked the same thing actually. What? Not all that, but yeah, those portions. Okay. I don't remember that, but okay. I don't tell you everything that's in my mind. Really? All right, everybody. Welcome to another episode of Docs Outside the Box. I'm Dr. Nee, joined by Dr. Renee. We are two first generation doctors. I'm from Ghana, or I'm Ghanaian American, excuse me. Dr. Renee is Asian. Haiti, she's from Haiti. Um, so today we're gonna be talking about career crisis, right? Um, to many people who are outside of medicine, they may not understand the whole concept of not matching, applying, you know, finishing medical school and then applying to a program and how that could be such a big deal. They may not understand that. But to us, to those who just went through this process about two weeks ago, because that's when this episode is coming out, um, this is a big deal. Not matching, right? Feeling like, yo, I want to get into the party and you kind of on the outside, I want to get in. And this is probably the moment that a lot of folks who haven't matched, they question everything. Was it worth it? What should I do? What's the next steps? Um, and a lot of people, it's not just I didn't match, it's a dream that might have to be deferred. So um I've been there, I've matched, but I've been in different situations where I'm like, man, I don't know how this is gonna work out. Um, so different situation for me, Dr. Renee. What about you? Have you been there?

SPEAKER_00 2:10

Uh I matched, fortunately. Um so it it I did not necessarily experience that, but I have worked with lots and lots of students um who just fortunately did not match. Yes. I have a couple of students um now that I'm working with who have not matched.

SPEAKER_02 2:29

We're talking about the 2026 match.

SPEAKER_00 2:31

So literally Yeah, the 2026 match. But I've had students who haven't matched, you know, in previous years. You know, I've been working with students for over 25 years, um, trying to help them get into medical school, um, which then evolved into helping people get into residency. Um, and then subsequently, what do you do when you don't match? So yeah.

SPEAKER_02 2:52

That's what this episode is about. What we're breaking down today is what to do if you actually don't match. And I think from the question that we heard, there's a little bit of an exit. Now, look, there's an existential crisis going on.

SPEAKER_03 3:05

Right.

SPEAKER_02 3:06

So the the second part what I want to discuss is, you know, when is it worth pushing through, right? When is it worth going and doing other things to get to your dream? Or is it worth it to just be like, I'm done with medicine, I'm out, you know, I'm gonna do something else, a different career. And um, we'll throw in a little bit also about how we went through some of these processes, even though we both matched.

SPEAKER_03 3:32

All right.

Why Not Matching Hurts

SPEAKER_02 3:32

All right, let's jump right into it. Um, so basically, this person who writes is writing the question, they didn't match. They feel like the degrees are useless. Um, at this point, they're having a difficult time finding a research position. Um, what should they do? Um, so I took a long time to kind of research this because um this is still, you know, obviously the match has been going on for decades. The whole process of trying to get into a program if you don't match is another thing that's been going on for decades. But recently, what, over the last five or six years, the soap process is a new process that they created to help students who didn't match get into programs. So um, I know you've recently um you've recently helped students who've gone through this process. So without talking about the soap first, right? Can you talk about what that feeling is like of not matching? What are the students telling you when they don't match?

SPEAKER_00 4:31

So oftentimes I know, especially with when students who I work with don't match, I know that they don't match because they don't send me any texts, they don't call me, they are silent. They are silent. And I will tell you nine times out of ten, every every now and then somebody will just forget to text me. But nine times out of ten, if I don't hear from a student, I know that they didn't match. And so you can imagine when I finally do text them, call them, that that conversation is extremely, extremely uncomfortable for them to have because they don't they don't like that they didn't match, right? And they don't want to have to say it out loud.

SPEAKER_02 5:22

So they're So Do you have to ask them, did you match, or are they just pick up and be like, yo, I didn't match?

SPEAKER_00 5:28

Usually, so usually I will say, if any of my students are out there, you know, usually I will text, what's the word? That's what I will text them. What's the word? Not did you match? Because I know that can be trigger triggering. I just say, What's the word? And then they'll either call me or they'll text me. So one this year forgot to text me. I text her, what's the word? And she did match. But there was another who I didn't hear from, and eventually he texted, I didn't match. Um, but it took a while. It took a while, it took about a day or two.

SPEAKER_02 6:06

Do you ever have to like kind of walk them off the proverbial, you know, cliff? Absolutely. I'm sure they're feeling devastated. I'm sure you're just saying. What do you tell them?

SPEAKER_00 6:16

It well, it depends on their situation. Um, you know, I've had students in the past who didn't match. And so I say, okay, well, you know, let's go through the soap process. Um, so going through the soap process, one of the first things we talk about, especially if especially if they're in kind of like uh, I don't want to say limbo, because it's not limbo, but it's especially if they are um not completely turned off by another specialty, right? If there's a specialty that I know, like, let's say, for example, I had one who um this is actually a few years ago now, she just graduated from residency last year, but she wanted to do to do internal medicine. And so I asked her, is there a world where you could do family medicine? Because that might actually open up, you know, your opportunities to be able to match either internal med or family medicine. And she was like, Yeah, I'm kind of open to it. She was like, I really didn't necessarily want to work with kids if I didn't have to. And we kind of went through, okay, well, let's imagine three years from now you graduated from a family medicine residency. Maybe your practice doesn't see kids, you know, so you you're not obligated to see kids just because you do family medicine. So you do know of the kids. Right, exactly. I think it's in I think it's important for people to kind of see beyond what they know right now and to understand that what they think is going to happen in their lives is likely going to change extremely drastically, but they can't see that right now.

Match Stats And Self Worth

SPEAKER_02 8:01

Okay. So I I I get what you're saying. So let's let's start like systematically, right? So let's let's talk about the statistics first, right? So the statistics, at least from 2025. I don't know if 2026 numbers are out yet, or I didn't feel like looking 2026, 2026 numbers up.

SPEAKER_00 8:17

Well, yeah, number the numbers for 2026 are out.

SPEAKER_02 8:20

And they're they're they're pretty clear. They're pretty similar. So okay. Yeah. All right. So for basically, if you are an allopathic student, MD, 93% of the folks who apply and try to get into the match, y'all gonna match, right? 92% of DO students, right, who go through the match, 92, did I say 92, or did I say numbers already? You said yeah, you said that. So 92 point, 92.6% of DO students will match, right? So that leaves somewhere in the range between six to seven percent, whether you're MD or DO, who are not going to match, right? And I know that a lot of them are like, yo, I'm the only person who didn't match. You ain't alone, right? There's actually the numbers are staggering of folks who have a match. So um the thing that I always tell people who don't match, right, is look and listen, like matching or not matching, that doesn't reflect your ability. That doesn't reflect your medical knowledge, right? I think that's one thing. They take a big, that's the big thing. It's like, well, maybe I'm not smart enough.

SPEAKER_00 9:23

It doesn't reflect also if you're going to be a good doctor.

SPEAKER_02 9:27

Like right. Yeah. Right. But try telling that to them. But you know, we're here to let you know, as folks on the other side, if you didn't match, that doesn't mean that you're not gonna be a good doctor. That doesn't mean that you don't know enough. It just means that possibly maybe the strategy needs to be fixed. And that's what we're gonna get into now. So I know you have some more statistics. Um, what are the statistics that you have on this year's match?

SPEAKER_00 9:53

Um, so they're not other statistics statistics, but they're more kind of, you know, other side of those same statistics. So here it's saying that about 48,000 um applic active applicants entered the match. Um, and about 38,000, 38,000 matched to a PGY one year, and about 3,500 more of those matched into a PGY two year. And so total basically, it looks like about maybe 6,500 or so um didn't necessarily match, you know, on the first on the first round. Um, so I I think that that's important, right? So just so that people kind of understand that you are not promised to match just because you went to medical school. And I think that that's really important. And when you talk about strategy, which we'll talk about, yeah, why are you laughing?

SPEAKER_02 10:55

No, I think that that is something. Well, first of all, I think you should be though. I think I know theoretic, for me, I'm gonna say theoretically, I think every person who goes to medical school should be matched to some type of program to train them afterwards. I think, unless they don't want to do that.

SPEAKER_00 11:09

Yeah, I I actually agree. You should be promised. Right. That's not what we're talking about. But but just to kind of talk very quickly about the fact that a strategy, right, is going to be important. But and we'll talk about this a little bit later, but where does that strategy come from? And I think that's that's gonna be key.

SPEAKER_02 11:30

Let's talk about let's talk about the strategy then, because I think once you don't match, that's when you need to start to strategize, right? And some people don't know what to do.

SPEAKER_00 11:38

No, that's actually too late. I actually think that that's too late.

SPEAKER_02 11:43

Well, let's but this is not about this is not about strategizing before the match. This is if you don't match, what's the next step?

SPEAKER_03 11:50

Okay.

SOAP Explained Without The Chaos

SPEAKER_02 11:51

So let's go to step two, right? So step one was um recognizing the statistics of who matched and who didn't match. Step two now is if you didn't match, if you still want to go through, right? That's the key thing. If you still want to go through and get training, you need to go through the soap process, which is the supplemental offer and acceptance program. And that is how programs they fill unfilled positions during that match week, right? So that already happened about a week ago, right? So um I'm very interested. Do you feel comfortable describing what the soap process is? Because it's it's it's pretty detailed. But do you you want to discuss it?

SPEAKER_00 12:31

Pretty detailed. I I so don't quote me, but what I understand happens is that let's say on Tuesday, you find out if you matched. You may not know where. If you did not match, you also find out on that day. Um the soap process then opens up, and apparently you're supposed to go on to this platform and it lets you know what is available based on the specialty that you're interested, or specialties that you're interested in, and you can start applying. When you start applying, you know, you might have to revamp your personal statement to fit that specific specialty. Um, I don't know if you need to get any other letters of recommendation per se. Um, but if you do, then you know, make sure that those are on hand. Um, and then so they open up the process kind of like um in phases, right? And so during those phases, you essentially will you will you will essentially interview in certain phases. So like phase one, you might get an interview. Um, but if you don't get it in phase one, you might get it in phase two. If you don't get it in phase two, you might get it in phase three. It's something like that. Again, don't quote me. I never went through soap myself. But do you but this is what I understand the students go through.

SPEAKER_02 14:01

Do you need to be submitting like a bunch of applications? Do you need to be doing a bunch of like, remember back in the day, people would be faxing like crazy? Remember? No, everything is on a fax machine.

SPEAKER_00 14:11

Yeah, that was the scramble. The scramble was literally, it was just a free-for-all, right? Like you could literally have somebody call someone for you and just be like, hey, I got this student, you know, that I want to be in your program. And if the program director and the person who was calling was tight, they'd be like, Yeah, you know, I'll let them in my program. Like that's what it was, right? It was a complete free-for-all. Now it is, it's not like that anymore. That's why I said you have to apply. You might have to revamp your personal statement. I don't know if you have to put in new letters of recommendation, but if you do, you should have those on hand. Um, so it's an it's another application process. It just happens within like a three-day period. And so that's why it opens up in phases in terms of the interviews. If you go to phase one, you don't get an interview. You hope you get one in phase two and phase three and so forth.

SPEAKER_01 15:09

And then at some point It's like a three-day pro it's like a three-day process.

SPEAKER_00 15:12

Yes, it's a three-day process. And then something happens where you I think the the acceptances are in phases as well. There, the acceptances are in phases as well. So you have, I think, um, two hours. You have about two hours to accept or decline the offer, right? So you, you know, the programs will put in the offer, you have to keep checking your email, checking your email, checking your email, and then you say yes, accept or decline. I would not recommend for someone to decline if you get an offer because you don't know if you're going to get an offer in the next phase. So, but that's usually how it will go. And then once the smoke settles, once the smoke settles, then match day, like the final match day, is usually on a Friday. Then everyone now knows where they are going, including the people who originally matched that Tuesday before.

Prelim And Transitional Year Reality

SPEAKER_02 16:11

And that's when you see all the Instagram and Twitter and threads videos and people dancing on the street. I gotcha. Okay. All right. So step three, once you are going through the soap process, you're probably going to be flooded with a whole bunch of prelim programs. So hopefully you're considering those. But that's what I was going to say as step three is consider preliminary programs, right? This is the opportunity, or actually, let me just describe a prelim program, it means that you are there for one year. You're not guaranteed that you're going to continue in that training program. So let's say you get into a preliminary program as a first-year in internal medicine. There's no guarantees that they're going to offer you a second-year position, third-year position, and so forth. I went through surgery. We had a combination of categoricals, which are you're guaranteed that you're going to be finishing that program year one all the way to year five. And then I also was in a pool of preliminary doctors also who were there for a year. And then maybe the program, if they had space, would bring them on as second-year prelimb students. Sometimes, depending on the funding of the program, they will bring them there and continue into third year, right? But those prelim positions, those prelim years, you got to look at it as yeah, this is an opportunity to audition, not just at the program that I'm at, but also to build the skills, audition so that if I can get a letter of recommendation to go to another program, the place that I'm at, they can let them know how good I am, how good I am at replacing potassium, and go to another program. So I would just say make sure you consider the prelim programs. Don't turn your deck your nose down on them. I know plenty of surgery attendings right now who were prelims. I'm sure you, Renee, you know plenty of OB attendings right now who are prelims at certain points, and then they got transitioned into a category, categorical position, maybe not at your program, but another program. But it's it's it's a great opportunity to get your skills sharp, um, to become a really great resident. Um, and obviously to get the recommendations you need for when you want to rematch, right? Um, and then you need allies, and that's the best way for them to see how you're working. That's my thoughts on that.

SPEAKER_00 18:24

Yeah. Yeah. I think, you know, prelim positions, I think sometimes res or students who don't match kind of, you know, like, well, I don't, I don't want to do that. You know, that's like rotating, you know, third year all over again. And I'm like, well, it is not because now you are a resident. And then and trust me, you're gonna know the difference between third year of med school and the first year of residency as a prelim. Like these are not one in the same. Um, so I would definitely encourage anyone who doesn't match to think about doing what they call transitional years as well as prelim years.

SPEAKER_02 19:04

Yeah, I think the the mindset is, well, I'm not getting credit for this year. I'm not gonna grab, excuse me, I'm not getting credit. I'm putting it in quotations. I'm not getting credit for this. I'm not moving forward in this program. I'm probably here because, you know, I don't want to be at this program. I'm just using this for X, Y, and Z, or this year is not even gonna matter because what does specialty A have to do with the bearing of how I get into specialty B? There's all these different thoughts that they may have in their mind that may make them think that, yeah, this is gonna be just like third year of medical school. You know? Um, and to some extent, you know, at least at my program, and I know when I was doing fellowship, yeah, like the prelims, they don't get as much attention as the categoricals, right? That's just real talk, right? Because the, you know, the the attendings, the professors, the cases, those are preferentially going to go to the categoricals because they have an obligation to train them. So yeah. That's just something to talk about.

SPEAKER_00 20:10

Yeah, it is, but you know, the alternative to that is you don't match at all. Yes. And now you're not doing any training. Keep them checks coming. And it's not even, it's not even those checks, right? Like, yeah, you get paid. That's keep them checks coming. Right? You it's great, you get paid. But the reality is someone who has not been clinically training for a year is not an attractive person to get into a residency program the following year. Any breaks, that's the thing.

SPEAKER_02 20:43

Probably the worst thing you can do is worse than not matching, is not having any clinical experience for like a year.

SPEAKER_03 20:51

Yeah.

Step 3 And Staying Clinically Active

SPEAKER_02 20:52

You know. Well, let's keep it moving. This is step four, is actually for our allopathic brothers and sisters out there. Um, this doesn't apply to Comlex, I just, or to the uh osteopathic students. I just got I just got game on this. Is obviously, you know, if you didn't match, if you're trying to figure out what to do next, the other thing too is taking USMLE step three, right? And this is probably something that you want to do probably during your prelim year also, right? If you decide to match into something your pre-lim year, and you're like, okay, not only do I want to do the best that I can in this program, right? So I can get some allies, but when I it's time for me to rematch, I also want to rematch with my USMLE step three scores, right? Now, if you're an osteopathic medical student, if I'm saying this right, once they get into residency, they can take the the Comlex three, right?

SPEAKER_00 21:46

Yeah, once they're in a training program, they can. But let me ask you, why do you think it's important? Because I think people are going to ask, well, why do I need to take you step three? For what reason?

SPEAKER_02 21:58

I think that additional. Board examination, that ex uh uh taking that examination will show them how well you can handle standardized testing and see how well your scores will be and so forth. I just think that that is basically showing them the proof that I can take standardized tests and I can continue to do well, not only on a day-by-day basis, but also ultimately what they care about is can you pass the board examination when you graduate from this residency program?

SPEAKER_00 22:29

Yeah. Yeah, I think it's just another box for them to tick, right? They can tick that box and say, okay, here's one less thing that we have to worry about with this particular applicant, right? So if they accept you into the program and they maybe had some concerns as to whether or not you'd be able to complete step three, now they don't have to worry about it because you've already done it.

SPEAKER_02 22:58

I mean, I there's gotta be some statistics that show that like if you take step three, that you possibly may get more interviews. You don't think so?

SPEAKER_00 23:08

I I don't know. I mean, I'm sure, I'm sure somebody is looking into that.

SPEAKER_02 23:16

I'm I'm sure the ability to pass step three would show that respective program that you don't have a problem with licensing examinations. I think it makes you more competitive, in my opinion. That's what I would think. Um I did now one thing I did forget, and I was wondering how we got onto this number system, and I got, I felt like I skipped the number, but number one actually is let your medical school know that you didn't match. And I was thinking one thing, you were thinking another thing. But for some who don't match, who don't go through the soap process, you might be able to do an additional year at your school also. Right. You want to talk about that? Because I that was one thing I didn't think about that you mentioned before we came onto the show.

SPEAKER_00 24:02

Yeah, I mean, you can, you know, potentially stay an extra year, it will cost you, um, and potentially do a research project. But again, that has to be approved by your school, right? Um, so it it is something to think about, um, especially if you don't know that your chances of matching are high before the match actually happens. So it's it's something to think about.

SPEAKER_02 24:33

Well, I would say the fifth option that you can do, the fifth step is what I mentioned also finding clinical work or finding a research year, something that you can do to keep you going, right? So that you don't necessarily have a break in your CV, right? So whether you're scribing, working in clinical research, um, something that's going to either keep your skills current or move your skills forward so that when it's time to do the process of when you're ready to rematch, whether it's a year later or two years later, hey, this is what I did for the last year, this is what I did for the last two years and go from there.

SPEAKER_00 25:12

Yeah. There's also some states, not all, some states might allow you to do something they call in a like an assistant physician, not a physician assistant. An assistant physician, different different states might call it different things. Um, but an assistant physician is somebody who um is a medical graduate, hasn't completed a residency program, um, might be licensed, um, but can typically work in some sort of underserved area, right? Some urban or rural underserved area. So that's something that you might want to look into because some of these states have shortages and they need someone to work. So if, you know, if that's a possibility for you, if you're willing to do that, um, I think Missouri is a big is a big one in terms of states that that does it, which is ironic considering that osteopathic schools or the osteopathic rule is that you can't take your level three unless you're in a residency program. And that Missouri is like the home of osteopathy. Just putting that out there and be on me.

Rebuilding Your Application Strategy

SPEAKER_02 26:37

Go figure. I do want to talk about something that I think you will enjoy, right? Which is it not matching sometimes should trigger a systematic review of things, right? Oh, yes, absolutely. You talk about the re-strategization of things, and this is where I'm talking about now. You have to go through everything again, right? Like if you decide that you want to become a prelim, that's fine, right? Um, if you want to audition, but remember, you're gonna have to go through the match again, right? To get into a program. How do you make sure that the next time you do it, you do it the right way, right? So this is a time to go through everything. So I'm talking about personal statements, letters of recommendation. How did you interview? Was it did you didn't interview very well? What you can change versus what you can't. Your thoughts on your concise thoughts on that, Dr. Renee. But I know this is where you like to really shine. This is where I live. Yes. Especially personal statements.

SPEAKER_00 27:38

All of those things that you just mentioned, right, are going to be important. Um, because unlike, unlike when you're in undergrad, you can't go back and do a post back in medical school. So the grades you got are the grades that you got, the board scores that you got, are board scores that you got. So the only thing that you really have to work with are those things that you mentioned, which is, you know, did you interview well? What's your personal statement? What about your letters of recommendation? And really make sure that you're reassessing. Did you ask the right people for letters of recommendation? Um, can I tell a quick story? It's so quick. It's just a quick story. Can I tell them really quickly?

SPEAKER_02 28:18

Alfred, when you re-edit this, make sure you jump cut the story for her because she'd be taking long stories. You're like 10 minutes long.

SPEAKER_00 28:24

It's very, it's very, very short. But I was Go ahead, tell your story. I had a student that I was working with, this is years ago, um, and I had helped her to, you know, get into medical school. And now she was going into residency, and she asked me to write her a letter of recommendation. And so I did, and I wrote her this glowing letter because I had known her for so many years. And so a couple of of the letters that she, other letters that she had gotten, um, were a little bit lukewarm. And so I actually knew um the assistant program director at the program, at one of the programs at which she was applying. And she called me and was like, hey, I see you've been mentoring this student for quite some time and you wrote her such a glowing letter. She said, the other letters, they were good, but they were kind of lukewarm. And so she literally called me because we were friends, so that I could explain and potentially vouch for this student. So, you know, make sure that the letters of recommendation that you are getting are actually going to come from people who are going to take the time, people who actually know you, which means that when it's, you know, and this is retroactive now, when it's time to shine during your rotations, you gotta shine. Was that quick enough?

SPEAKER_02 29:45

That was good. Personal statements. What about personal statements? What do you have to quickly say about personal statements?

SPEAKER_00 29:51

So, personal statements, I think one, you gotta make sure that you actually are writing about the specialty. Like sometimes I get personal statements and I'm like, this is a great statement, but I don't even know what you want to go into. Like, this is kind of crazy. And I will tell you, I know exactly who does this. This there's a profile of a student who does this. The profile of a student who does that, uh, who does this, who writes a personal statement and writes nothing about a specialty or whatever, is a student who is applying to multiple residency programs. Yeah. To different specialties. So they might be applying family med, but they're also applying surgery. You know, and I'm like, But that doesn't happen.

SPEAKER_02 30:36

Stop first. That don't happen. Family medicine and surgery.

SPEAKER_00 30:39

I'm being, I'm, I'm, I'm paying the extreme.

SPEAKER_02 30:42

Maybe D R and I M or something like that.

SPEAKER_00 30:45

Whatever it is, Nate. Does it really matter for this example?

SPEAKER_02 30:48

Yeah, it does because family medicine and anyway. No, you you just no, that is not in the same damn line. Family medicine and surgery.

SPEAKER_00 30:57

You interviewed, I will just remind you, you interviewed somebody who was in a surgery residency and left to go to family medicine.

SPEAKER_01 31:04

Who are you talking about? I interviewed when was this? This was a couple of years ago.

SPEAKER_00 31:09

Yeah, it's different. But in the way, it's different.

SPEAKER_01 31:12

It's different than leaf.

SPEAKER_00 31:16

You missed the concise. Can we do this really concisely? And now you're spending your time on this. I could have told my story.

SPEAKER_01 31:21

Just keep it real. Represent surgery right, you know what I'm saying? Anywho, not everybody can do this. Not everybody can do this. Keep it moving.

SPEAKER_00 31:31

Okay, anyway. So, you know, make sure that your personal statement is actually reflecting the fact that you want to go into the specialty. Like, and I don't know because I've never, I didn't apply two different specialties. But if you need to write two personal statements if the system will allow, write two damn personal statements. Like, you know, you ain't too lazy. Okay, like, come on now. Write two personal statements if the system will allow. If not, then figure out how you're gonna navigate that because people want to know if you are interested in OB, like, trust me, OB wants to know that you're interested in women's health.

SPEAKER_02 32:08

Like, especially that I would I would say this: look, the board scores that you already took can't change those. Right. Things that you can change when it's time to rematch are definitely your personal statement, just according to what Dr. Renee is saying, your approach and your strategy, what programs you're looking to, what programs you're applying to, and so forth. Um, obviously, and the specialties, right? So, you know, if you are looking at internal medicine, maybe look at internal medicine in the Midwest, maybe look at it in, you know, in the West Coast. But I'll tell you right now, like, if you're looking to do something in New York City, or, you know, it's just like it's crazy. It's crazy, yo. Boy, bye. Because you compete in New York City, you're competing not just with everybody who wants to be in New York City and who crazily wants to spend money on$5,000, you know, single bedroom houses and stuff, right? You're also competing with a lot of IMGs who are out there too. So just you know, it's just the things you can change, I would definitely say is just that that's that systematized re-review of things that you already can control, which is your personal statement, the letters of recommendation, make sure you're asking people, yo, can you write me a strong letter of recommendation? Yes or no? That's it. Don't be writing me no lukewarm stuff.

unknown 33:18

Right?

SPEAKER_00 33:18

And then also and with that, also you can kind of sort of go through with that person so that you can see what do you think that they will be writing? Like you can actually talk to them and be like, uh, what do you think you would write about me? You know, like you gotta know.

SPEAKER_02 33:34

So let's keep that quick, but let's talk about that a little bit. How do you do that? Like, you know, because I think a lot of people don't know that you can do that. They may feel kind of weird. Well, we know, of course you can, right? Because Renee can't do that. Well, no, people don't know that you can. So then stop saying, of course you can and tell us how to do it. How do you do that? How do you have that conversation?

SPEAKER_00 33:53

So you essentially first, you don't come up to them and ask them for the letter first, right? That's that's the one thing. The first thing you ask them is, how do you think I'm doing? You know, what how do you think I'd be good at whatever specialty? You know, do you think I'd be good at OB? Well, yeah, I think you'd be great at OB because this, that, and the other. They're writing the letter for you right in front of you. It's funny because I have a student who just texted me, well, she's not a student anymore. She's a resident who just texted me and she asked for a letter of recommendation for, you know, some mission trip that she's gonna be going to. But the conversation went down the path of, yes, I think you're doing a great job, you know, as a PGY one. And so now it's like, ah, since you think I'm doing such a great job, I'm gonna ask you for a letter. That's what you do first. Like, you can't don't ask for the letter first. Ask them how they think you're doing, get the gist of what they think about you, then ask, you know, for the letter.

Switching Specialties Without Shame

SPEAKER_02 34:59

I like that. I like that. Hey, look, let's let's pivot a little bit because we both matched, right? So sharing a story about uh, like we can't share that. But I do think that our story is a little bit different, but it's still related, right? You switched specialties to apply for the match like at the last minute, right? Very last minute. Let's talk about what really happened, okay? So let's keep it quick because I got this in, I say we could do this in four steps, right? Let's talk about the switch. So you were always planning, you wanted to go into pediatrics, and most notably, you want to not only just do pediatrics, you want to do pediatric endocrinology, right? Correct. Let's talk about that. Let's talk about why you decided to change to Obi-Gyne.

SPEAKER_00 35:45

So, like you said, I always wanted to be in uh a PEDS doc since I was 10 years old. And um, as I grew into it, I added endocrinology. So by the time I get to got to medical school, I thought pediatric endocrinology, just because I loved biochemistry. No, because I loved biochemistry and I loved, you know, just kind of all of the, you know, molecular mechanics and stuff like that. Um, we did our pediatric rotation together, remember, at children's mercy in Kansas City.

SPEAKER_03 36:21

Yeah, you flunked it.

SPEAKER_00 36:23

I didn't flunk it, uh, but I was not good at it.

SPEAKER_02 36:29

I knew from the get-go I didn't like that. I was like, I don't like this. I don't like this at all.

SPEAKER_00 36:33

I was not good at it. I was, um, yeah, I just I found the medicine boring of pediatrics. And I've said this before in the show, but I found pediatrics boring. And that's not to say that's not a slight against pediatricians. So don't come after me and writing stuff and texting us. I don't even want to hear it. I'm not gonna read it. Okay. So I'm just saying I Renee, Renee, antagonism doesn't fit you.

SPEAKER_02 37:01

It fits me well. So just keep it moving. You're trying to keep going.

SPEAKER_00 37:06

I I really just sucked at it. I just sucked. Um, and so I didn't want to do OB. I that was like off my list, absolutely off my list. And it was the last rotation of my third year. And you know what's supposed to be happening during that time. During that time, you're supposed to be like starting to open up, you know, your application and starting submitting stuff or whatever. So by June is like, let's say June 1st, I'm like, I don't like pediatrics and I'm getting ready to go to OB. I don't know what I'm gonna do. And you were no help whatsoever at all. At all. Like, not at all. Like you just didn't even help me at all. But anyway, I see you quiet. I see you quiet.

SPEAKER_02 37:55

How did you know that OB? How did you know that OBAN was the right choice for you?

SPEAKER_00 37:58

I knew that OB was the right choice for me, probably like three days into my OB rotation. So, like if I started June 1st, I knew by June 3rd.

SPEAKER_01 38:08

Um by then the application process already started.

SPEAKER_00 38:13

At least, at least, so at least I knew I was interested in OB. I didn't know if it was the right choice for me. I knew that I was interested and that I had changed my mind about it being kind of the last thing that I ever wanted to do. What I got stuck in was what we talk about on the on the podcast before is, you know, that idea of sunken costs, right? The idea that I had put so much thought into going into pediatrics. I had put so much thought into pediatric endocrinology. I had told so many people I wanted to be a pediatrician. You know, how could I possibly change my mind? This couldn't possibly be, right? Because I had said it for so long, it was meant to be. And um I ended up actually wasting, not I want to say wasting, I ended up taking a lot more time before I even applied to residency because I didn't want to apply OB and PEDs. I wanted to pick a path and go with it. And so I ended up doing um a couple more rotations, a couple of elective rotations, which at this point, now I'm in my fourth year. Like I'm well within my fourth year. Um, and so I didn't apply until like late October, maybe November. I don't remember exactly. So how but it was late.

SPEAKER_02 39:33

So when so when during that process, you're applying October, November. Because then not only do you apply, but then you have to start getting letters of, or excuse me, invitations for um interviews. Right? So that let's talk about that. Like, how is that like? Were you not getting interviews at all?

SPEAKER_00 39:53

Or no, I got like seven interviews. I actually stopped interviewing. Um, but I got I think I got like I want to say I got like seven interviews. Um and I didn't I didn't go on the last one. But I interviewed, I also you we gotta remember I interviewed late. Right. The the program I actually ended up going to, I think I interviewed in March. Not March. It couldn't have been March. It had to have been like late February. Because March is match, right? Oh, it could have been March. It could have been early March. I can't remember exactly, but I remember it being late. It was like, it was well like winter, I believe.

SPEAKER_02 40:34

Okay. When you did your match list, when you did your match list, were you confident or not confident?

SPEAKER_00 40:39

I was confident. I don't know if that was stupid of me, if I was just clueless. But I was confident in particular because there were a couple of programs that did show, you know, some just interest in me, just kind of um in the way that I interviewed. I thought I wanted to go back home to New York City. So I did apply to a program in Brooklyn. And at my interview, I quickly realized I did not want to go to that program. And it's fortunate.

SPEAKER_02 41:12

Why, why? Why did you want to why didn't you want to why did you know what did you see about that program that you didn't want to go there?

SPEAKER_00 41:17

I I just honestly, if I'm being really honest, it was the building itself, which is crazy because I'm I'm just hear me out, hear me out, hear me out.

SPEAKER_02 41:28

No, I don't want to hear you.

SPEAKER_00 41:29

I don't want to hear you, which is crazy because I had actually shadowed my surgeon in that building. Dr.

SPEAKER_03 41:36

Duncan.

SPEAKER_00 41:37

Yes. I had actually shadowed him in that building. So I was familiar with that hospital. But I think what happened was now because I had been out, went to, you know, so many different states and seen hospitals, seen how things were run. I had been at the VA in Leavenworth, which that building. Oh my God. You know, like so I I kind of understood just how the building would make me feel. But then there were also things about the program. But that was the thing that stuck out to me the most was God, if I had to come to this building every single day, I don't think I'm gonna make it because it's so depressing in here. Um so you know So on match day, how did you feel? I was scared. When you think I was scared, I was like, when you matched up your program.

SPEAKER_02 42:28

When you matched up your program, how did you would you what was the thoughts?

SPEAKER_00 42:31

I was relieved that I actually matched up my second choice. I actually matched up my second choice. Um, and so part of it is I wanted to, you know, go back to New York. So my first choice was actually um in New York um on Long Island. But I was really scared. I remember making that match list thinking, man, my second choice, that program really like the interview was so great. I interviewed with the chair. And um, I just remember thinking, man, this is so great. I feel like I'm gonna match here. And I'm like, but what if I mess it up and I put it second and then I it runs through the algorithm and I don't get in. You know? So I really did think about that. But I'll tell you about a few months later, um, when I was like at my wits' end and wanted to leave my program, it's that same chair who interviewed with me who convinced me to stay. And he he said that he wanted me in this program because when he interviewed with me, he really felt like I should be there. So my vibe was right.

SPEAKER_02 43:41

Okay, cool. Let's let's take a moment to look back real quick. Let's keep it simple and quick. So, are you glad now that you switched between pediatrics to older? Yeah.

SPEAKER_00 43:51

Let me tell you something. You do not want Dr. Renee, the pediatrician. Yeah, I've seen it. I'll give you some old Haitian Reb. Remedies, put that back to our kids, you know, I had to save the kids from you. Anyway, you don't know anything about kids either.

SPEAKER_02 44:08

So let me ask you, someone who is considering changing specialties, what would you say to them?

SPEAKER_00 44:12

If you're considering changing specialties?

SPEAKER_02 44:14

Yes.

SPEAKER_01 44:15

If you're considering changing specialties.

SPEAKER_00 44:16

I mean, if you're if you're if it comes to your mind, you probably should consider it. If it if it actually is a thought in your mind, you probably should consider it. I'm gonna tell you this. I understand that there are certain specialties that you would just never want to go into. But what I actually don't believe is that there is only one specialty that you would ever want to go into. I don't believe that, actually. I don't. No. You would have gone, you could have gone into orthopedics. Yeah, there you go. Yeah, you put your hand down. Look at you. He put his hands up, by the way, for those of you who are listening. I couldn't do orthopedics. Yes, you could have. Yes, you could have.

SPEAKER_02 45:02

You know, I wouldn't, I would not have liked orthopedics. You know me already. You know me very well. You know exactly I don't want I don't want the orthopedic surgeons to come after me because. Yeah, exactly. You just mean I would I would not want it. No.

SPEAKER_00 45:14

Yes, you would. You would have been, you would have been a a very good orthopedic surgeon.

SPEAKER_02 45:18

Okay, who knows how to replace potentials. I would have been good at everything. Anything I've done, the only thing I would not have been good at is pediatrics. I can tell you that right now. I would have sucked at pediatrics. I would not be good at that. But orthopedic surgery.

SPEAKER_00 45:32

The two people, two people who suck at pediatrics got children together. This is bad. Somebody call CPS. Somebody call CPS.

When To Push Through Or Walk Away

SPEAKER_02 45:41

Either way, I just the reason I wanted to share this is because look, like I I know this episode is specifically about people who didn't match, but every time, you know, there are times when people go through crisis. There are times when people go through stress and it's about their career. It may not necessarily be that I didn't match. It may necessarily be I don't like where I matched into now, right? I'm in my first year and I don't like where I'm here. Or I made the wrong mistake with the specialty that I matched into. Like we've seen that a lot. People do general surgery or some type of surgical field, and then they go maybe into anesthesiology. Or sometimes they go into ER, right? Or whatever it may be, right? Like there's so many different points along the ladder of reaching your career, the height of your career, that you could be like, yo, like I don't know if I'm this is the way I should be going. Should I still be going up or should I go to another ladder or should I get back down? So just something I just wanted to kind of go through. So let's let's focus right now on the last part of their question, which is when to push through, right? When to push through with continuing to become a doctor and when to walk away. Right. Um this one I struggle with, right? Um, because I there is no perfect answer. But I kind of was thinking about things and I was like, well, let me let me see if I got some guideposts. So I would say this you should push through if you didn't match and you feel disappointed. And particularly for this person who's like, man, I don't think I even want to be a doctor anymore. Like, like, I think for generic people who are listening and they're wondering, you know, should they consider another specialty or should they consider something else and they're having this existential crisis? Is the obstacle that you're facing, is it fixable? Right. So for example, like, is the obstacle that you you have bad board scores? Well, that's fixable, that's fixable, right? Like you can take step three. Um, you can learn how to take questions like I did, right? I can share that in another episode where I talk about how I only got the 10th percentile on my in-service examination for ab site. And then the next year I was up into the 70th percentile, all because one attending really helped me to understand how to take a test, how to answer questions, and so forth, right? So that's fixable. If you didn't match, that's fixable, right? You can do soap, you could do prelim programs, you could reapply. Um, if you are struggling in residency, right? Let's say you're you just feel like you're just it's not coming to you easily. Like mentors can help you. I had a mentor, you had a mentor. Um, sometimes you may have to repeat a year, possibly. I don't know if that necessarily means that you need to step out of medicine. Um, I would also say push through if you still want to be, like just you still want to be a doctor, right? Like you know that, okay, maybe this specialty is not for me, but I still enjoy taking care of people. I still enjoy being a doctor, right? I want to be X. I ended up being Y. I mean, we've heard so many stories of that. Like, even to this day, I have folks at my job currently, right now, when I'm doing locums, and they were, yeah, I was, you know, in emergency medicine. I just didn't like it and decided to switch to family, you know. So, you know, so I just think that as long as you feel like you can still be flexible, but the path, the destination is still medicine, I think that's a good sign that you push to. The other thing is if you have support, you have family that's there supporting you financially. There's some type of support that's there for you, whether that's continuing to um train, and obviously you can get a check from that, or you know, you still have an opportunity to get funding to finish your schooling or even your residency. That's something to consider also. Um, the other thing, too, is like when you talk to someone, they they talk to you talk to someone, they give you a certain perspective, you go back and you look and you realize that, yeah, like I think your struggle is temporary. It's not really fundamental, right? I know I'm talking kind of like ephemeral type stuff, but follow me, right? Um you know, for me, like I struggled with test taking, but I didn't struggle in the operating room. Do you see what I'm saying? So it's not really a fundamental issue, more so it's something that you can fix. But the true essence of what you're in residency for, I shined at, right? And once I'd learned how to take a test, that in combination with these hands that were given from above, I just don't understand. It's just, oh my God, so bad.

SPEAKER_00 50:12

I would right you can see my face right now. Oh my god.

SPEAKER_02 50:17

Anyone who's seen me in the OR, they know this is just like it's a beautiful mind, it's a beautiful hand. But anyway, listen. Um it's different, it's different than I hate doing this every day. Now, I think contrary, you should walk away if you're like, yo, medicine is destroying your health, right? Like mentally, you're being broken down by medicine. Physically, it's breaking you down, right? Like you go, you talk to people, you find mentors, you have family, friends, like it's just not getting better. Or you realize, like, yo, life is just more important than my career, right? We've seen that before. Actually, excuse me, we've seen that recently, right? Um you're doing this for you're doing this for somebody else. Parents are put pressing you, pushing you. You got doctor parents, or maybe you have parents who may be immigrants, or maybe you just have parents who just in general are just pushing. They're like, yo, you're gonna do this. Everybody in your family is expecting you to do this, and this is what you're gonna do, right? And you just don't want to do that. We've seen that happen in our first year of medical school. One person, what they their father or their was it, their family. You knew that person more than me.

SPEAKER_00 51:22

Yeah, yeah, yeah. His father, um, you know, Midwest, homegrown. Um, and his father, I think, I want to say his father might have been an alum of at our school. I'm not sure. Um, but yeah, after the first year, he was like, you know what? I'm out. We had another one. We had another one who was in our school. Um, he was like, nah, I'm gonna go to jump school. I didn't even know what that was.

SPEAKER_02 51:47

Yeah, the parachute was in the middle of the military. He's in the military. Yeah.

SPEAKER_00 51:51

Yeah, he decided he just wanted to go to military and jump out of planes. I was like, wait, what? Yeah, first year. Yeah, first year. Yeah. I mean, if you don't switch, I guess that's when to do it.

SPEAKER_02 52:06

I think the last thing that I would say is if you tried everything and it's still not working. You've tried getting help, you've tried stepping away, you've even tried matching multiple times, you've reapplied multiple times, you've tried different specialties, and you're still miserable, right? This is a feeling. You're still miserable. Um, sometimes the answer is, yeah, the path isn't for me. Sometimes, right? And I think that's okay. But that's a that is a that is a a decision that you're gonna come to that I'm gonna be very honest with you, like you'll never have the complete answer. You'll never know that 100% this is what you should do, in my opinion. You know, I don't know if you want to.

SPEAKER_00 52:45

No, you'll never, you'll never know. What what you will know is whether or not you're happy on the other side. And that's what you have to be comfortable with, right? You you can't live in the what if. You've got to just live in the, okay, I made this particular decision. Am I happy with it? If you're happy with your decision, there's no need to think about what if, right? Um but yeah, I I think that that's a very hard um decision to come to, to walk away from many, many people. But I also do think that sometimes people, and I'm gonna take this from this question, I think sometimes people get so disappointed that sometimes they are not necessarily thinking that just because the path isn't straight doesn't mean you're on the wrong path. It just means the path is not straight. No, you know, I often tell my students, my students, the students that I tend to work with are students who don't have a straight path. Like their paths, if I tell you stories, you'll be like, wait, what? Um and you know, you know many of these stories, me. But what I tell my students is, listen, I don't know why this is happening. And I don't know why this is the path that you're taking. But what I do know is that at the end of this, you're gonna have a story to tell. And for whatever reason, you've been chosen to be a storyteller because this story is going to help somebody else. And so that's what you have to at least feel comfortable in knowing that your story is going to be something that is going to inspire someone else, help someone else make another decision. You know, you you have to really understand at least that aspect of it. Because if you went straight through, nobody wants to hear that. You know, I went to high school, then I went to college, I went to med school, then I went to residency, and then I started practice. I'm like, ah, great for you. That's not a story, right?

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A Co Resident Gets Let Go

Step 3 Rules And Funding Caps

Pumping Gas With An MD

The Pivot That Saves A Life

Lessons And Reaching Out Early

Final Goodbye

SPEAKER_02 54:51

Like, that's just uh I'll I'll tell you right now, some of the best physicians, guys, some of the best physicians I know, some of people who are chairs at major academic centers, um, some people who are chairing, you know, departments right now, they have struggled and some of them didn't match, some of them went to school outside the United States, some of them changed specialties. I'm telling you right now, your path, just like Dr. Renee says, your path doesn't have to be linear. And just because it's linear, it's not linear doesn't mean that it can't lead to something amazing. Right. So I would I would leave it at that. Listen, if this episode helped you, share it with someone who needs to hear this, okay? Um, if you want more conversations just like this, um, where we talk about the real talk, the real struggles that first generation doctors go through, listen, I want you to subscribe to Docs Outside the Box. Listen, we are building a community of physicians who didn't have the book, the blueprint, like me and Renee did. So we're creating one together. So, guys, before we end this episode, I do want to tell one more story. Um, and this one is exclusive just for those who are listening to the podcast audio experience only. If you're watching on YouTube, you're not gonna hear this. So, this is just for you, uh, my loyal, trusted listeners from day one. And what you're about to hear is this is a story about a co-resident of mine. Actually, he was a resident that was he was a year above me, actually, right? Someone who I worked closely with. When I was an intern, he was a second year and show so forwards moving into residency. Excellent surgical capability. He made it all the way up to his fourth year in general surgery residency, and then boom, just like that, was asked to lead the program. The reason why I want to tell this story, the reason why it matters is it's a painful story, but it's really important because it teaches about the system, right? The medical system, the residency system. It also teaches about sunken costs and knowing when to pivot, right? We talked about in the previous, or excuse me, we talked about earlier that a lot of times the pathway in medicine is not linear. It's gonna take some turns. Sometimes you're gonna go backwards, sometimes you may have to get off the ladder, right? But it doesn't mean that that story isn't beautiful. So I want to take you back to when I was an intern and so forth through there. And I'm not gonna share his name just out of respect, but I'm gonna tell you right now, clinically, I could not have had a better second year as a resident when I was an intern. I was really, for me, nervous out of my element as a first year. Um I was in a new city, and there was just a lot of things about general surgery that I don't know, I just had a hard time grasping. And when I would take nightly call with this, with this resident, right? So within night call, there's always an intern who does all the scut work, sees all the consults, and then there's a second year in-house also who's running the intensive care unit, and then we'll listen to the consults from the first year, go and see the patient with the first year, and then the second year will then call the attending to say, hey, the attending is at home. Hey, this is the general surgery consult. I have um, this is what we want to do. This is, I think you need to come in for this, versus, no, you need to stay home. So, I mean, we had a very, like we worked very closely together. Um, when I would see him do procedures, a lot of times we would get consults from the ER, internal medicine, and other services to do central lines. We do bronchoscopies to get um, you know, uh to find out, you know, to do BALs and so forth. He he just was his hands were very good. He was very good with procedures and he made really important clinical decisions. Um he was a little bit about his background, he was the first generation doctor in his in his family. Very humble beginnings, the kind of story that makes you want to root for him. I'm telling you, when you met this dude, from the minute you met him to learning about him, to knowing about his history, there was nothing you can do but just root for him. And he fought to get here. There was, it was very clear about that. I found him to be very insightful, hardworking, the type of person who would bring their lunchbox to work. Um, he wasn't really interested in trying to impress people, um, but you couldn't help but after talking to him and being around him, just feel like, yo, this dude is confident, he knows what he's talking about, and he's very down-to-earth. And he worked and he helped a lot of people. Um, and when you asked him a question, however tough it is, you can tell he thought about it. You know? Um, the other things that I learned working with him on night shift and sometimes even on other rotations that we did together that he was in charge of is that he loved poetry. He wrote a lot of poetry in his free time. And anybody who knows, in surgery residency, particularly when I was training, it really wasn't that much time to really focus on your personal, some of the things that you want to do personally. Um, but he found time to do it and it mattered to him. And because of that, I thought that was dope. So, in general, um he was a very good resident, someone who for four years, three years, I thought was thriving very well. So, in our program, the issue that I was finding out was he had an issue where you had to take USMLE step three to complete residency training, right? Like you had to have had not only taken it, but you've had to have passed it to finish your residency training. So, just for those who are not so familiar with this, step one and step two of your USMLE or your ComLEX, you do in medical school. Step three, you do in residency. You can't graduate from your residency program. You can't become board certified without passing step three. Okay. His situation is most people take it early, right? Most people take their USMLE step three or their Comlex step three, either in their first year or their second year, like I took mine in my second year. They get it done and they move on. Obviously, they pass it. Um the problem is he took it multiple times, maybe at least three times or so, and couldn't pass it. And now he is in his third year, and the program is now realizing hey, dude hasn't taken or passed his USMLE three, we got a problem. I don't know if he struggled with step one or step two in medical school. Um, I don't know like the full story of standardized testing with this resident. Um, I don't know what his strategies, what his attempts were. Um, but what I do know is that our program basically gave him some time off to really study. So as a result, my program only had two categoricals per year. So because they gave him time to study, several months to study, he took a step away from clinical activities so that he can study. And then I, as well as my other co-resident, I might say same level, we would come up in level and assist the other resident who was, you know, now by himself, right? And so they gave him time to study. Um, he had opportunities to retake the test. And at the time when I was there, it appeared as though they wanted him to succeed, right? Like most programs do not want a categorical who's in their third year or even their fourth year to leave the program because it becomes very difficult to find someone to replace someone who wants to be at that specifically point of training, fourth year, and so forth. Most people who are at that point, they're they're already invested into their program, they're not leaving. But by my third year, he's now in his fourth year. You know, the conversations about him not passing the test were getting serious. Now, you all may be thinking, like, how is it that he's having these conversations with the residency program, but you're hearing about them? We had a very intimate program, only two categoricals a year, very small. Word got around fast, right? Um, so the urgency was coming up. Um, and also at the same time, um, the attendees are kind of prepping us that, hey, you know, you may need to take on co-chief activities as a third year, possibly as a fourth year. So just so you know. So we knew something was coming up. So um he took the test, I think, for the last time, and he didn't pass. And I remember talking to him about that, and there was this like question of what is he going to do because the program hadn't made its decision yet. Um, so basically, for me, you know, the way how I looked at it is I'm like, I'm teamed this guy, right? I'm like, yo, you spent four years in this program. Clinically, you're excellent. The attendings respect you, co-residents trust you, you're good at being a surgeon, but you can't take past this one test. And it's not even a test that determines if you can be board certified or not, right? It's just one of those hurdles that you have to cross. And that possibly might end your career. That's a lot. So the actual letting go process of how he got told he was gone, I have no clue how that occurred. But I do know the rumor mill was rampant. We all heard, you know, that he got let go and they couldn't keep him. Um, so everybody was whispering to each other, yo, they're letting him go, and so forth. At first, I didn't believe it. I was like, well, just like I mentioned for all the reasons before, you can't let this guy go. He's amazing. Um, but they did. They did. I can remember the mood among the entire residency was very somber. There I was shocked. I think a lot of my other co-residents and folks behind me, they were sad and shocked. Um, because this is someone that we worked with, someone that we trusted. And, you know, I think definitely for the lower levels, they knew that if they felt unsure about something, they knew that he was there and he could always help out. And now that was gone. The thing that I would remember thinking is that like if this could happen to him, it could happen to anybody, right? Um, not because we're bad surgeons or anything like that, but because there's rules that the system has. And sometimes if you can't meet those rules, no matter what, and even how good you are, how good you may be even before, you're out. That scared me, right? That's something that is that's really scary. Rules are rules. Um, but after he left, um, I kept in touch with him intermittently. And to be honest with you, I probably could have done a better job of keeping in touch with him. But I would check in, see how he was doing, vice versa. He would see how I was doing. Um, but what I learned in that process is that things were going to get worse for him before they got better. So, you know, obviously, we're talking several months, close to almost a year. Um, he started to make attempts to get back. Into the program, a couple of attempts to not only prove himself, but also see that if they would take him back. And the funny thing is, he actually eventually took step three and he passed it. Unfortunately, and this is very complex, they wanted him back. He passed step three. But because of funding and the amount of time that a resident is allowed, he had passed that point where basically there wasn't enough funding to let him finish out his fourth year and his fifth year. And I think in those situations, the program may have to come out of its own cash funds, or the medical school may have to come out of its own cash funds to fund his training, which, you know, at the time was, I don't know, 50, 60, 70, maybe even more. I don't know how much that's going to cost. Right. So programs are funded by Medicare, right? And the graduate medical education, right? And there's a cap. And programs, they just can't add residence whenever they want. It seems like from the inside they can, but they can't. The money has to be there. And for him, the money was gone. It was capped. So, you know, he's in this situation where the the he finally passed the test, but this test, in essence, possibly could have could be endering his surgical career. He can't get back into any program now. Remember, it's not just the program where I trained at. Any other program that he wants to go to, in essence, has to come out of their own pocket to fund him. More than likely, they're going to all say no. So he's four years in the surgery residency. He has an MD degree. He finally passed a step three, but nowhere to go, at least in surgery. And I'm going to fast forward just for the sake of time. He struggled for a couple of years. I mean, he was doing non-clinical work. He was doing non-medical jobs and basically trying to figure out what to do with his MD degree that suddenly felt worthless to him after some of our discussions. And then I checked out with him again, you know, a couple of months later, and I found out that he was pumping gas. So has an MD, four years of surgery residency, one of the best technical surgical residents I've ever worked with. And now he's pumping gas. I remember I reached out to him again, and I had been struggling with having a really tough conversation with him because all he was talking about was he wants to get in, he wants to finish surgery. He wants to finish surgery. This is what he wants to do. And I remember I was going to call him, but I hesitated so many times because I wanted to have a very long, frank conversation. And I finally called him and I just said, dude, you have an MD and you're pumping gas, bro. Like, what are you doing? Like, for real, like, what are you doing? And I was a bit more diplomatic than that, but there was a point where I just said those words. And I want you all to remember, like, me and this resident, like, we're we're cool, but like, I don't know necessarily how this is gonna land, but it's bothering me so much that I'm like, I gotta let him know. You know, so we had the long talk. And I just told him, I was like, look, maybe surgery isn't in your future. And I know that this is hard to hear. And I know that you've struggled and you've sacrificed a lot. Um, but my man, you still got options. You still a doctor, and you can do different specialties that are going to bring you multiples of six figures, right? You don't have to pump gas. And this is, I used an example of a story that I always tell medical students and first-year residents is your medical degree is basically the keys to a Ferrari. You can either drive fast, you could drive slow, it don't matter. But that Ferrari, that Ferrari is gonna get you so many different advantages, so many people are gonna look at you, it's gonna get you into so many different places just because you have a Ferrari that you got to use it. So I mentioned that to him. I think his struggle was you could tell he was stuck, right? And he was stuck logistically because it was almost like, well, I can't move to any other program. I'm kind of locked in because I want to do general surgery. But there's also that emotional stuck that he had also. He had invested a lot, right? And don't forget also, like there's still student loans from college, from medical school. That's all accruing. I mean, I talked to you guys about me doing forbearance. I didn't ask him specifically, but I can imagine that I'm sure he had to take forbearance, you know, several times while he's pumping gas, right? And that debt is just accumulating interest. So I, you know, we we talk about the sunken cost fallacy. We mentioned that earlier in the episode, but I'm sure that's eating him alive, right? I spent years to become a surgeon. I can't just walk away, right? So when I was speaking to him, what I what I was trying to elicit from him was those four years are gone, whether you pivot or not, right? Because the question isn't like, how do I not waste those four years? The question is, what do I do with the rest of my life? Right? Like those four years are gone. They're not coming back, at least in surgery. What am I going to do with the rest of my life? Eventually, let's fast forward. He called me back and he decided that he pivoted to occupational and environmental medicine, which is obviously a completely different specialty, different patient population, different training, career trajectory is done. Um, but I'm gonna say that my man thrived in this. He's a practicing physician now, he's taking care of his family. Yo, and when you do occupational medicine, you have the ability to open up so many different clinics for so many different businesses. Like basically, this almost becomes like, you know, whenever you hear about workman's comp and so forth, like his office, his specialty is what deals with these types of situations or accidental exposures and so forth. So he's been able to set up clinics at various different companies and he's in charge of it. Long story short, my man is doing well. Financially, he's doing way better than me. And I couldn't even be prouder. As a matter of fact, I might have to ask him for some money. But I'm really proud that he is doing excellent right now. You know, he's using his MD degree, he's helping people, he's building a career, and it's not in surgery, not his first dream, but it's in medicine. So as I end this, I just want to talk about the lessons that I've learned. And hopefully you guys will pick up on this too. Lesson number one: medicine don't really care about you, as you've already learned about this, right? It is a system that will spit you up, it will chew you up if you don't meet the requirements. That's it. The rules are the rules. Doesn't matter how good you are, doesn't matter your potential, pass the test or you're out. Is it fair? I don't know. But it's the rules, right? And it doesn't like step three is not to measure if you're going to be a good surgeon. It's just what's needed to make sure that you can get licensed as a physician. That's the job. That's what comes along with it. You gotta pass that test. Was he unsafe? Nope. He was an excellent surgical resident. System doesn't bend. So that's lesson number one. Lesson number two what we want may not always be in our destiny. It's a hard lesson. And, you know, um anybody who has seen someone who's going into medical school, like you know, that person is never taught to give up. You fight for your dreams, you persist. You've seen it on Instagram and other social media where people will say, hey, like, I hit this pothole, I went this detour, but I still became a physician, I persisted. Right? But sometimes that dream ain't meant to be. Sometimes it just is not. And it's not because you're not good enough, not because you didn't work hard enough. Sometimes the door just closes. And you have to decide well, do I keep banging on that closed door that's right in front of me, or do I look for another door? That's the key. Lesson three. The sunk cost fallacy is real and it can be really expensive. So he spent years trying to get back into surgery, and that's years of lost income, that's years of interest accumulating on student loans, that's years of pumping gas when he could have been practicing medicine. Why? Mainly because he couldn't let go after all the four years that he had invested and he wanted to be a surgeon. That's tough. But there are times when you have to have a black and white discussion and just say, hey, look, those four years are gone. That's the past. That moment has come and gone. And the question that is facing you right now is how many more years are you going to waste chasing something that is not going to happen? All right, let's talk about lesson number four. The MD or DO degree is like having keys to a Ferrari. Mentioned earlier, this is a story. This is a, I don't know how to describe it. Is it a metaphor or what have you, but it's something that I tell medical students all the time. You can either drive fast, you could drive slow with your Fiora Ferrari. There is a potential that you can go into high gear, very high gear, right? A great career. And that's all based off of you. You drive that car. The question is, do you want the keys or no? He had the keys, but he was pumping gas. So it's not the keys' fault. It's not really his fault. Really, he was just really stuck. But once he decided to use the keys differently, everything changed, as you can see. This dude, he's in occupational environmental medicine. That ain't surgery, but it's still medicine. My man has got clinics all through the area that he's in. He's making very good money and he has an extremely worthy lifestyle for his children, for his family. It's a great career. It's a great life, and he's thriving. Lesson five. I wish I had reached out sooner. I wish, you know, I was keeping in touch intermittently. Um, but yeah, I was busy as a resident, but I just thought that talking to someone about being kicked out of a program is something that you don't want to keep repeating over and over and over again. So I gave him his space. And to be honest with you, I just I didn't know how to have that conversation with him. And I feel like I should have called more, I should have checked in more. Um, and to be honest with you, I really wish that I had had that frank conversation with him sooner, right? Because that conversation I'm having with him year three, I believe, if I remember, I wish I had pushed harder earlier. Maybe he would not have wasted a year. You know, I don't know. I never know. Maybe that's a sunken cost discussion also. But I think about that at times. So I will say this. Um, if you know someone who's stuck, whether they're stuck in a career that's not working for them, stuck chasing a dream that's killing them, maybe they are stuck in that sunken cost fallacy, and it's very apparent that they have that. Reach out. Have that hard conversation. It's hard for you, but it's even harder for them, but it's worth it. You can tell them my story, which is you have the options, you have the Ferrari, you just gotta use the keys. If you're the one who's stuck and you're listening to this, I know it's hard. I know it's really hard. There are so many times in my looking back that I'm like, man, what if I didn't match? Like, I'm gonna do an episode about the gamble that I made with choosing Morehouse number one, and then the other program as number two and so forth. And to be honest with you, you know, the decision I made to go to Morehouse was the best decision for me. I can't even remember the name of the program of the number two. But I wanted it to be number one because it was close to where I lived, but I really wasn't invested in that program. But when you have invested so much and you're stuck, it's tough. And walking away from that specific situation may look like failure, even though there's no options available for you. Right? But it's not failure if you pivot. And that's what it's called. If you pivot, that's fine. And sometimes the pivot is what saves your life. So, yeah, that's it. That's the story of my co-resident, um, the surgeon, the surgical resident who couldn't pass step three. He's not a surgeon, but he's a doctor and he is thriving and he's making more money than me. And probably you listening right now, he's doing good. Um, but what it taught me was, you know, I think about him every time and I talk to medical students or a resident who's struggling. I'm serious. Every time someone asks me, should I keep going or should I pivot, you know, I think about him. And a lot of times the answer isn't always like just give up. It's sometimes let's let go of what's not working and let's grab onto what is working. So if this story has resonated with you, if it um helps you make whatever decision that you need to make, I hope it does. Um if you're proverbially pumping gas with an MD or DO, call someone, reach out, reach out to us on Docs Outside the Box. Maybe we can help you. Remember, you have the keys, you have options. And I really appreciate y'all listening to this bonus segment. Uh, I'm gonna see you guys next week. And also let me know what you think about this bonus segment. Hit me up on fan mail or even by text and let me know your thoughts. All right. I'll catch you guys on the next episode. Peace.