So you didn’t Match and have no options with the Scramble… now what?
First of all, you’re not the only one who didn’t match residency. That doesn’t make it hurt any less, but it does mean you’re not alone. If you’re like me and knew you had a low chance of matching, you may have already started preparing a backup plan. My school offered an option to stay on another year for half tuition to complete additional rotations at various programs. I know a few unmatched medical students who pursued that route. Personally, I wasn’t willing to spend more money for another partial chance, so I took my degree and created my own path.
I was fortunate to have a skill set and support from a local paramedic program that allowed me to challenge the paramedic exam and earn my license. Since I had applied to emergency medicine, I focused on EM programs I worked with. While some viewed it as “leaving” the academic setting, I believed it was the right choice for me at the time and I have no regrets.
Here’s a breakdown of what to do if you don’t match residency, including the options I considered and others I’ve seen unmatched physicians explore. Take time to reflect on your goals. You do have time, even if it doesn’t feel like it.
This is one of the more common paths for an unmatched medical student. It’s expensive, but it offers the chance to do multiple audition rotations and potentially match into a more competitive specialty. Financially, this might be tough depending on your loan situation. It could also delay your graduation, which some fear could be a red flag — though in my case, being a 5th-year graduate didn’t come up during interviews.
Ask your school if they offer tuition discounts or ways to assist with teaching. Helping with coursework can build your knowledge and show initiative on your CV.
One of my favorite phrases: “The worst they can say is no.”
Many unmatched medical students choose this, especially in combination with staying enrolled at their school. The downside? Most of these research positions are unpaid or poorly paid. If you have student loans due or limited financial support, this might not be realistic. However, if you have connections to research groups, they might be able to find funding.
Be cautious: I encountered a paid “placement” program that promised exposure at an academic institution but turned out to be a $25k fee for an unpaid research role — with no direct involvement in any residency programs. Be wary of scams during this vulnerable time. People prey on unmatched physicians with false hope.
This was the option I chose. While it didn’t directly help me match into emergency medicine, it built lasting relationships. I had clinical skills I could use, but not everyone does. Still, hospitals need help in many areas: EVS, patient care techs (PCTs), telemetry technicians, and more.
Though these roles may not be glamorous, they teach you the inner workings of a hospital. I gained tremendous respect for team members who work tirelessly with minimal recognition. It also kept me close to residency attendings and residents, letting me keep learning alongside them. I even attended didactics. It was humbling, educational, and meaningful.
Many people don’t realize that residency spots open up throughout the year. I monitored Residency Swap and the Facebook Physicians group. These are popular places where open PGY-1 positions get posted. But be quick and professional — once posted, programs get flooded with emails.
Include a cover letter tailored to the program, your test scores, transcript, resume, and updated contact information. And prepare for silence. I sent 10–15 emails; only a few responded, and most gave generic “we’ll get back to you” replies that never followed up.
There’s also a free Scramble guide on our website and a paid service called UnmatchedMD, which lists open positions and research opportunities. While I didn’t use it, it’s run by an MD and has solid reviews.
A unique option for those wondering what to do if you don’t match residency is to become an Assistant Physician — a special license available in select states. This role is not the same as a PA. You work under an attending physician’s license, practicing as an advanced provider.
I considered this route, but the hospital system I had access to wasn’t comfortable navigating the legal complexities. Still, this can be a great way to stay in clinical practice and gain experience while remaining competitive for the next Match.
Learn more at: assistantphysicianassociation.com
This isn’t often talked about, but it’s worth mentioning. Some unmatched physicians pursue unrelated jobs — and that’s okay. Residency programs want to see that you were active, productive, and growing. I knew someone who worked in finance for years before reapplying.
Use this time to pursue passions, whether that’s writing, art, engineering, or tech. It’s an opportunity to show well-roundedness and resilience as a reapplicant.
Now might be the time to pursue a Master of Public Health (MPH) or MBA. These degrees can enhance your resume and set you apart. Many med schools offer bridge programs, so inquire about options for graduates. This is a more expensive path, but it can be a good long-term investment.
If you’re passionate about global medicine, consider medical missions or service with the Peace Corps. These are often long-term commitments (two years or more), so make sure it’s a good fit for your goals. Alternatively, explore established international hospitals led by American physicians focused on sustainable care and training.
If you enjoy education, use your skills to teach. Tutoring for the MCAT, COMLEX, or USMLE is a great way to stay engaged. Multiple companies offer tutoring roles, and you can also reach out to universities and med schools to look for teaching assistant roles. This option keeps you connected to academic settings and can strengthen your application next cycle.
This may be controversial, but consider using the unmatched year for rest and renewal. Start a YouTube channel, train for a marathon, spend time with family — and mix in online classes or a board review course to stay current. Residency is exhausting, and this may be your only chance to fully recharge before it begins.
There are many paths for an unmatched medical student, and every journey is unique. Whether you’re exploring residency scramble alternatives, planning how to stay in the field after not matching, or even considering a year outside of medicine, know that you’re not alone.
In 2024, 80.2% of PGY-1 applicants matched. That means 19.8% — or 1 in 5 — didn’t match residency, which included 8,869 applicants from all backgrounds. It’s not uncommon.
Take heart. You will still become an amazing physician. Stay connected, stay curious, and most of all, stay kind to yourself.
