Failure in medicine: my experience with the CaRMS match

Catherine Smith
University of Ottawa
Class of 2014

bert_phantana/iStock/ThinkStock

bert_phantana/iStock/ThinkStock

As a medical student, I have been fairly successful in my academic life. During my undergraduate years I was at the top of my class. I was accepted into medical school in 2010 and I did reasonably well on all of my tests and clinical rotations. None of my preceptors identified any red flags and the faculty never brought up any concerns regarding my work ethic. I don’t believe I am alone in this; the majority of my peers have had similarly smooth academic experiences. Therefore, the most difficult thing to hear is that we are lacking.

On March 5th, 2014, we received the results of our CaRMs match: the process that matches medical students to their desired residency. I had applied for Obstetrics and Gynecology and my partner to Pediatric Neurology. We were excited to start our new careers and had worked hard to become competitive candidates. We had the right electives, were actively involved in research, and had supportive mentors. However, when we opened the match results, I was floored.

“We regret to inform you that you did not match this year.”

My initial reaction was shock. There must have been a mistake. I thought I could hit refresh and then be magically matched; my computer almost melted from refreshing the CaRMs' page. My brain was blank. Numb. I experienced utter incomprehension.

My partner and I drove to meet with faculty and other unmatched candidates. It was somber. I was handed a list of available positions for the second round of CaRMs matching  – no OBGYN spots. I cried. We all cried for the paths we could not take and the imminent, difficult decisions that faced us. My career aspirations were gone so quickly and cruelly.

I had one week to apply, from scratch, to new specialities to which I had little affinity. I felt stripped of my autonomy to choose my career after years of hard work. I was resentful of how quickly I needed to change my dreams – the dreams that I had built over years of careful consideration. Mostly, there was a paralyzing sadness and embarrassment for what I perceived as a very public failure. My ego, after years of diligent development, was flattened. The illusion of academic invulnerability was shattered.

There was very little time to wallow in self-pity. I had taken time to grieve and had to become productive. “You’re still breathing, not bleeding, and your family still loves you,” my dad told me.

I know that he’s right. Whether or not I matched to a residency isn’t reflective of my worth as a human, my ability to be a productive member of society or, most importantly, my ability to be happy. Medicine can be all consuming. It becomes woven into every aspect of your life. A large part of my identity and sense of worth had become entangled with my career aspirations, and not matching to a residency was a moment in my life that forced me into the realization that I am more than just my career choice.

A crushed ego hurts. However, it was not evident to me until I didn’t match that it can also be healthy. As a medical student, you are taught to make decisions that can alter lives. This is a unique and terrifying power. We are taught to trust our decisions and commit to them. We have to be cognizant of a tendency towards egotism – not only for ourselves, but also for our patients. The medical community is one that expects both personal and communal excellence. This leads to a personal and societal intolerance of error and failure. To believe that I am infallible is a fallacy.

I have decided that the right choice for me is to take another year to explore my career options and aspirations. I hope to re-evaluate other areas of medicine, to maintain a healthy work-life balance and to approach this year with humility and gratitude. Here’s to a year of introspection and exploration of medicine, to an exciting year with my family and friends, and to remembering that what doesn’t kill you…

11 thoughts on “Failure in medicine: my experience with the CaRMS match

  1. Nina Nguyen

    Catherine,

    Thank you so much for sharing this difficult experience with us. Failure is a taboo subject in medical school, even though many of us will have to deal with hardships. Almost thirty upperclassmen at my school didn’t match, but yet nobody ever told us that getting unmatched, after so many years of hard work, could be a possibility. Instead, stories of failure are being brushed away, making us all think that it can only happen to everyone else but us. No, we’re not infallible — thanks for reminding us that we might not always be entirely in control of our destiny.

    Good luck on your next year,

    Nina

    Reply
    1. Anon

      Thank you for sharing the emotions and your experience for going unmatched.
      I am currently waiting patiently for CaRMS match results. One more week of torture. However the thought of going unmatched is really getting to me. Your article very accurately outlined all of the feelings I imagine myself as having if I go unmatched. There definitely needs to be more support and communication about this because it happens to many people.

      Thanks again!

      Reply
  2. mike evans

    Love this. Many threads here that are important (learning how to fail well, self-care, reflective learning, honesty, imperfection) that we could do much better in medicine. Catherine- i am 50 and a doctor.. had some failures and some successes but if i have had some success a major factor was because i took 5 years off before med school and flailed around.. We think of careers, especially medical ones, as linear, but for many the reward is in following your strike-outs, your base hits and your occasional home run.
    Interested to see how you feel about this over time.
    mike

    Reply
  3. Anon

    This happened to me years ago. It’s truly amazing how isolated you become when this happens.

    Talks with my school’s administration after I failed to match were tense, and devoid of good advice- take any spot in round 2 is what they told me, as if my career was something that could be thrown away. Yet I acquiesced and matched to a subpar program in a field I frankly did not care for one iota. I am convinced that their, and all medical schools’ ultimate goal is to make their match lists look good, even at the expense of their students’ careers.

    The isolation doesn’t stop there. If you match to an Ontario program, you are prohibited from transferring until PGY2. Yet everyone who matched in round 1 gets to transfer six months into PGY1 if they so choose. If that double-standard doesn’t indicate that second-round matchers are considered sub-par failures, then I don’t know what to tell you.

    Nearly a decade later, as an attending in the field I reluctantly completed, and still to this day don’t take pride in, I still feel a tremendous melancholy about opportunities lost, a tremendous envy for those who achieved what I couldn’t, and a tremendous anger at myself for not being proactive enough, aggressive enough, or enterprising enough.

    Re-training would feel like a surrender at this point. I have already done one residency that I hated, I do not want to pay (in lost income and to remove the return-of-service shackles) for the privilege of doing another. I expect to be leaving medicine altogether once I hoard enough retirement savings. To Hell with it.

    Reply
  4. fu

    your year off wont matter.
    apply to the usa and stay there. thats my plan. if america will give me an opportunity that canada denies me, my loyalites will go to the us.

    Reply
  5. Nadim Lalani

    Thanks for the honest post. Also can feel raw emotions that persist in other commenters. I feel for you all. This part of the Canadian Medical System is definitely imperfect. As a former Assistant Program Director for a really competitive specialty – we wished we could take most of our candidates as they are so accomplished. But many programs hands are tied with limited spots, decreasing spots and other pressures. Fact is that you can only control your end of it … the rest is up to the CARMs. And the system does infact match most CARMs applicants – I am not sure what the odds of favourable matching would have been for a couple match of O & G and Paeds Neuro? Maybe you just happened to be in a hyper-accomplished cohort and got out-competed? (akin to swimming your personal best in the Olympics, but being beaten by someone that swam a World Record time?) The US recently went to a CARMs style match because their previous system was not meeting programs AND applicants needs – so I wonder what a replacement of the CARMs system would look like? For those that do not match – if you tried your best – there should be ZERO sense of failure. I’d hire a professional coach and find a way to design a life and career that aligns with your values – you may be surprised at what you discover. What’s more – if you work on winning in your LIFE… the CARMs piece all of a sudden becomes less of an outcome and more of a byproduct that you can accept either way. Keep moving forward 🙂 Best NL

    Reply
    1. Noyb Noyb

      You can’t really say there should be zero sense of failure. Maybe I would have had a similar belief before, but then it happened to me. I thought I did everything I could, and everyone was “shocked”, but there it was.

      The fact is, when you lose a race or a swim meet, you know how you lost – someone else was faster, that’s pretty simple. There’s always a race next year, or in four if it’s the Olympics, so you can always train harder and go at it again. Carms is not so transparent, nor is it flexible, nor does it forgive. If you don’t match, you either take a second round spot which are invariably undesirable fields with weak political clout, in usually isolated locations, or you try again next year and fail because there is a stigma attached to you now. So I spent five years living in a place I didn’t want to be doing something I didn’t want to do. It sucked. It still sucks. It will never stop sucking.

      Reply
  6. Theresa

    You have LOTS o’ company. I also did not match many years ago. I took a spot at a university with unmatched spots in family medicine. After working in that field for a few years, I completed another residency. I’m quite happy that I got to do a few different things – I think it gives a broader perspective. You sound like you are treating this unexpected outcome as the opportunity it is. Way to go!

    Reply
  7. Anon

    Even if you do match to your desired specialty and desired program, it does not always turn out easily. I matched to my first choice, completed a competitive residency (while several coresidents left for other specialties), and completed fellowship training, only to find no jobs in my specialty in Canada. Tried hard to find anything, including working only 1 week every third month. We moved to the US and although I have a job that pays well, medicine here is becoming a losing game with administration. The EMR sucks a lot of time while my manager keeps telling me I have to make more money. I have often wished that I had not been so “lucky” as to match to my specialty of choice in CaRMS. If I had matched to family med (I backed up my competitive specialty application and applied/interviewed/ranked several family medicine programs), I would have had a more humane residency and could work almost anywhere. I would not have had to move away from my family and raise my children outside of my country. Sometimes bad luck has a way of working out best in the long run. If I had known then what I know now, I would have happily gone in to family med and would be working hard for patients at home in Canada. I hope that whatever you decide brings you satisfaction and happiness.

    Reply
  8. Bradley Greig

    Thank you, Dr. Smith.
    I know exactly how you feel. I did not match way back in the early 1990s. Several unpopular residency programs were lorded over my head with a very clear “take it or leave it” impression.
    It has been over twenty years and yet when I read your post all the feelings came right back (perhaps a form of PTSD).
    My lucky break was being accepted immediately to a program in the US that had actively sought us out. I had the best and most worthwhile experiences of my educational career there. I probably would have abandoned medicine without that time there.
    I have been practising in Canada since.
    Hang in there. IT’S NOT YOUR FAULT.
    What I have learned is that I don’t need a career to make me happy.

    John

    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *