Match Day is often seen as a cinematic moment: MS4s who have put in so much work wait in suspense to see if their dreams will come true. They rip the envelope open, a name is read, and the applicants scream in joy because they’re headed to their top choice program. It’s the perfect happy ending, the satisfying conclusion to a story in which the protagonist worked so hard to achieve their dream.
At least, that’s the ideal scenario.The reality is that for a huge portion of medical students, that envelope contains a name that’s further down the list—maybe at #6, #10, or even lower. Or maybe they dual applied and the program they matched to wasn’t even their first choice specialty.
If you’re staring at a name that wasn’t in your top three, it’s okay to feel a sting. But this is the reality: no matter where you matched, it’s important to understand that this isn’t an ending, but a beginning. The Match algorithm is designed to find you a spot, but how you build your career is up to you!
Here’s why matching lower on your list could actually be the beginning of an amazing new adventure.
Why Lower Doesn’t Mean Lesser
It’s easy to feel like an outlier if you didn’t get your top choice, but rest assured—you’re not! A lot of people don’t land their “dream” residency and still have a bright future ahead of them. The data tells an encouraging story about their long-term success:
1. The happiness gap closes fast.
According to the NRMP (National Resident Matching Program) Applicant Surveys, while initial satisfaction is understandably highest for those who secure their #1 pick, that gap narrows significantly within the first year.
Surveys of residents in their PGY-2 and PGY-3 years show that the vast majority of trainees, regardless of where they matched, report higher levels of satisfaction with their training and feel well-prepared for their careers. Crucially, these surveys include those who matched into their top ranked programs, but also those that didn’t.
Statistically, about two-thirds of applicants match into one of their top three choices as the Match algorithm is designed to be favorable. This means that roughly a third of residents, literally thousands of doctors are starting exactly where you are.
2. All residency programs have a lot in common.
If the fleeting nature of the happiness gap isn’t enough to convince you, maybe the fact that all residency programs have a lot in common will. The US Graduate Medical Education (GME) system is one of the most strictly regulated in the world. And the ACGME (Accreditation Council for Graduate Medical Education) enforces rigorous standards for all residency programs under its purview.
So whether you’re at an ivory tower academic program or a top-ranked community hospital, the core curriculum, the residency milestone requirements, and the board-certification eligibility remain the same. You’re getting a similar education, often with better hands-on opportunities at programs that aren’t top-heavy with fellows.
3. The algorithm knows things you don’t!
Overall, I’d venture that when you rank programs, you’re ranking based on perception. Perception of yourself, of the program, the director, the residents, and the city. The Match algorithm, however, is a cold, mathematical program that matches you based on numbers and facts.
If you matched at #10, it means that the program saw something in your application that would make you thrive there. That could be a specific skill set, a personality trait, or a spark of potential that they wanted in their hallways for the next several years. Remember, the program didn’t settle for you. They chose you for a good reason!
4. You’ll meet amazing people.
You’re probably going to like your residency more than you thought because of the bonds you’ll form with your co-residents, who will become your new adopted family. You’ll bond over 2:00 a.m. admissions, the absurdity of hospital intake, and the shared trauma of residency. These relationships are forged by the work and hard times you endure together, not by the ranking of the program.
Keep in mind that when you start residency, your rank list is as good as a piece of paper in the trash. Your program doesn’t know you ranked them 12th, and they don’t care. To them, you’re their new colleague. Show up with that same energy.
A Few Encouraging Success Stories
To further illustrate why not matching at your top programs isn’t as bad as it seems, here’s some encouraging true stories of residents that matched into programs that weren’t their top choice.
From Disappointed to Running for Chief: Mariah’s Success Story
Mariah was a star med student. She had the Step scores, many research publications, and the Ivy League pedigree. She ranked a prestigious, renowned university program in Boston as her #1. When she opened her envelope, she didn’t see Boston. She saw her #8 choice: a midsized subsurgical community / academic hybrid in the Midwest. She later told me how she felt embarrassed to post it on her social media apps.
We kept in touch and her first few months were a struggle. She missed the urban bustle and felt like her program didn’t meet her expectations like a top-tier academic program would’ve.
However, into her second year, she realized her residency came with a lot of benefits, including plenty of autonomy. Because her program didn’t have a dozen subspecialty fellows hovering over every interesting case, she became the primary on complex procedures by her second year. While her friends at more academic programs were watching from the corner of the room, Mariah was holding the scalpel. She also began to appreciate the culture rather than the competition. The prestige programs she interviewed at often felt like pressure cookers where residents competed for the favor of prolific researchers/publishers.
So yes, at the end of the day, Mariah didn’t match at her #1 choice. She later realized, however, that being at her #1 might have felt like being a cog in a massive academic machine. She enjoys her time at her #8 choice, where she feels treated like a colleague. She plans to run for chief in the coming year after her program has given her the hands-on confidence she possesses today.
Jon, Who Wanted SoCal but Found Himself in the Midwest
Jon, another student, eagerly awaited his Match results. He prioritized geography above everything, as he grew up in California and wanted to stay in the SoCal area so he could be with his partner, family, and friends. LA was his location of choice, so he ranked every SoCal program in his top five.
When Match Day arrived, he ended up at #12, a program in a midsized city in middle America he’d barely spent 24 hours in. He was upset not because it was a bad program, but because he would be away from his support system and everyone he loved.
As it turned out, moving out of California changed Jon’s life in ways he hadn’t anticipated. He noticed that he could actually live on a resident salary and not all of his paycheck had to go towards rent and gas. If he’d stayed in LA, his resident salary would have barely covered a 400-square-foot studio and a long commute from the city center. In his new program and city, he could afford to rent a luxury apartment or small house with a yard. His financial stress was reduced and he could actually save some of his paycheck.
And not all of the benefits were financial. In the years away from SoCal, Jon realized that he would have stayed the same person at his top choice, while matching at #12 forced him to become a doctor and gave him an identity outside of his hometown.
As these stories demonstrate, life is full of surprises. Don’t assume that because you didn’t match where you wanted to that you’ll never be happy. Doors close, but others open. And often new directions are filled with benefits we never could have imagined.
What You Can Do After Not Matching at Your Top Choice
If you’re having a hard time after seeing where you matched, there are things you can do in the short term that’ll help you get through the initial stages of disappointment.
I recommend the following:
1. Stay off social media.
Right now, your social feeds are likely curated galleries of people screaming, crying, and hugging their number one choice. It’s a highlight reel that makes you feel like the only person who didn’t get their dream spot. But you need to know the reality is that people rarely post “I matched at #9 and I’m currently staring at a wall.”
To help get you through that initial stage of disappointment, take a break from the socials and focus on spending time with your friends and family who came to celebrate your Match Day.
2. Focus on the positives.
Hey, you matched! Yes, it’s not your top choice but finding out at least one thing about your new location or program that’s objectively better than your #1 choice can help you feel much better.
Here are some areas you may find a win:
Cost of Living
Can you actually afford a two-bedroom apartment instead of a tiny studio?
The Commute
Is the parking free? Don’t underestimate how much free parking improves resident mental health. My parking in the busy Texas Medical Center was $12 a day, which adds up.
Moonlighting or Other Opportunities
Does this program allow you to make extra cash on the side? Or do they have other research or fellowship opportunities you’re looking for?
3. Reach out to a future co-resident.
The program doesn’t make the residency, the people do. Reach out to one person on your match list. Don’t talk about rankings. Just talk about finding a gym or the best local coffee. Once you start seeing your co-residents as friends rather than people who also ended up at your program, it starts feeling like a home rather than a consolation prize.
4. Send a letter to your new PD.
The first email to your program director (PD) is like the first handshake of your residency and it sets the tone for your entire professional reputation. Even if you’re still processing the result, this email should show your readiness to start.
Final Thoughts
The big takeaway is that you matched! Go celebrate and be happy because in a few months, you’ll start your PGY-1 year!
