You’ve finished the year strong, worked hard on your interviews, and now you finally have time to catch up with friends and partake in some well-deserved rest and recreation.  Unless, like many fourth year medical students, you find yourself worrying incessantly about whether or not the odds were in your favor this year.  No matter how much sleep you catch up on, the questions remains,


“What do I do if I don’t match into ortho?  Do I need a back-up plan?”   

First things first.  This is a very important question!  Take a deep breath and take a close look at the mixed emotions that this thought brings.  We are a group of type A goal setters, who, for most of our lives, have achieved nearly every goal we’ve set.  With uncertain odds, we may be facing an unexpected setback. The medical education and healthcare system views failure as an aberration rather than the norm, leaving many applicants at a loss when ideals meet the uncertainty of the real world.

In this competitive and unrelenting environment, the possibility of failing to attain one’s biggest life goal to date is terrifying.  Don’t let this paralyze you!  The orthopedic match process is a complicated and competitive system.  Every year, excellent candidates go unmatched… and still go on to have amazing careers.  Ryan Holiday puts it this way in his book on stoic philosophy:

“How we interpret the events in our lives, our perspective, is the framework for our forthcoming response—whether there will even be one or whether we’ll just lie there and take it. Where the head goes, the body follows. Perception precedes action. Right action follows the right perspective.”

from The Obstacle Is the Way: The Timeless Art of Turning Adversity to Advantage

So how do you get into the right head space? Know your options. Should you not match, there still steps to be taken that can continue your path into ortho through a different route.  For students who have dedicated their third and fourth years of medical school to matching into orthopedic surgery, there are four main options when building a contingency plan.




ONE – Scramble into an unfilled ortho program


If you go unmatched on match day, first check if there are any unfilled orthopedic programs on the postmatch website.  It happens!  In 2016, several osteopathic positions did not fill and were filled in a postmatch agreement.  And call in as many favors as you have to get that spot.  This is a long shot though so don’t let this be your only backup!  Read the options that follow so you can be ready to pivot if you don’t get one of these rare spots.


TWO – Scramble into an alternate specialty

We have very little time to explore specialties as medical students and it’s easy to get tunnel vision once you catch the ortho bug.  Take a step back and honestly review your clinical experience.  What aspects of the healthcare system do you like and dislike?  What have you learned about your professional work style?  What specialty matches you to your work style and maximizes what you like, and minimizes what you don’t like? Was there a specialty that interested you but you dismissed because your rotation experience was marred by unfriendly residents or unreasonable hours?  If not and you have some time (as this is being written, there is still 1 month until the AOA match and 2 months until the NMRP match), start from scratch!  

Use that white coat to chart new territory for yourself.  Many of you have mandatory rotations or easy electives left.  Don’t waste the valuable clinical exposure!  Ask all the specialists who’ll give you the time of day why they went into their field.  Wander into different areas of the hospital like the radiologist reading rooms or the cath lab.  Once you’ve picked a few possibilities, start hustling.  Talk to your dean or friends in other fields to see if they can introduce you to an attending you can shadow for a day or two.  If you don’t have vacation time, ask your current preceptor for a day off to shadow.  They know how important this is.

Once you’ve decided, start to research the programs and how to navigate the SOAP process or the AOA postmatch process, also known as the scramble.  Know how this system works.  

We’ll discuss these details and tips and tricks in an upcoming post.



If you still can’t picture yourself doing anything else and want to give it another shot, here are two options that will allow you to reapply.  Now, this is not a decision to be taken lightly.  It is very important to understand that these are not easy options.  There is a high likelihood that you will postpone your career as a physician and still not match into an orthopedic program.  Going unmatched does not reflect your value but the stigma is real.  Be prepared for most programs to flat out dismiss your application.  Remember that there are plenty of well-qualified traditional applicants each year and you will have to work hard to convince someone to take a chance on you.  With that said, if this is what you’re meant to do, here’s how to give yourself the best chance to match in the future.


THREE – Research Fellowship

Dive into the academic/research side of orthopedics and spend a year or two boosting your CV and developing relationships in the field.  You will be a full time employee (salaries vary) working on various publications for a particular principle investigator.  This is a little known option that can yield big results.  If your CV has some holes, this may be a good way to boost it.  Most importantly, it is a good way to build a relationship with an ortho mentor who will be willing to make phone calls for you when you reapply.  No previous experience necessary.  


Watch for an upcoming post all about where to find these fellowships, how to pick the right program, and what to expect.


FOUR – Transitional Year or Traditional Rotating Internship


The traditional rotating internship  (TRI for AOA) or transitional year (TY for ACGME) programs are in many ways similar to the fourth year of medical school.  You will spend time on different services throughout the hospital. This makes TRI’s and TY’s a great way to simultaneously explore other specialties while you reapply.  You will hone your clinical skills, improve your bedside manner, and begin to understand what kind of doctor you’ll be when everything’s said and done.  Several specialties like PMR, radiology, dermatology, and anesthesia actually require a separate intern year. If one of these strikes your fancy, you may end up applying and matching into a PGY2 position and start immediately after your intern year.  The MOST important thing to realize about TRI/TY’s is that they are not created equal.  Getting into the right program can mean the difference between having time to grow, explore, and apply, and being worked into the ground and never seeing the light of an orthopedic OR again.  Notice also that these are different than prelim years.  Avoid these. You will likely be too busy to complete a robust application.  

Get more details in the posts below:

If none of these look appealing, there’s ALWAYS one more option: Become the next Michael Crichton, who graduated from medical school and instead of becoming a physician, became “the man, the author, the filmmaker, the doctor, the teacher, the visionary, and more”.

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