What to Do if You Didn’t Get Selected for GME

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With the recent release of the 2022 graduate medical education (GME) results, I’d like to give tips for those who didn’t get selected. I’ve participated in eight of the last nine GME selection boards as a Detailer, Specialty Leader, and Deputy Chief of the Medical Corps, so I’ve seen it from all angles. Here we go…

Be Realistic

If you are personally interested in this post, I’m sorry but you need to be realistic about your chances of matching. You probably failed to match at least once. If you are applying to a competitive specialty and you’ve failed a board exam or had to repeat a year in medical school, you are probably not going to match in that specialty. There are some specialties where you can overcome a major blight on your record, but there are some where you can’t.

If this is applicable to you, the residency director or specialty leader for that specialty should be able to give you some idea of your future chances of matching. Will they be honest and direct with you? I’m not sure, but it can’t hurt to ask them for an honest assessment of your chances of matching.

Be Open to Other Options

If you are having trouble matching in the Navy for GME, you may have a better chance as a civilian or with a civilian deferment. By the time you pay back your commitment to the Navy or do an operational tour, you are a wiser, more mature applicant that some civilian residency programs might prefer over an inexperienced medical student. You’ll also find some fairly patriotic residency programs, usually with faculty who are prior military, that may take you despite your academic struggles. In addition, the bar is often lower at the GME selection board for those who are willing to consider a non-funded civilian deferment for training called RAD-to-NADDS.

Most applicants who want to train in a civilian institution want a full-time outservice (FTOS) training authorization. When you are FTOS, you are on active duty, you are paid your active duty salary (which is usually more than you’d make as a civilian resident or fellow), and your time counts toward your active duty retirement. The downside is that FTOS authorizations cost the Navy money and are therefore limited. This means they are more competitive to get.

The other type of civilian deferment is called “Release from Active Duty to Navy Active Duty Delay for Specialists” or RAD-to-NADDS. This is the one that is less popular and desirable than FTOS, but that means it can be easier to get in certain specialties. When you are in RAD-to-NADDS, you are not on active duty, you are making a civilian salary, and your time does not count towards your military retirement. Because you are not on active duty, this type of deferment is basically free for the Navy, so in certain specialties they can give out as many training slots as there are qualified applicants.

There are restrictions on RAD-to-NADDS. Most importantly, the Navy is not supposed to use it to train specialties in which it has unused training capacity in the Military Health System (MHS). For that reason, RAD-to-NADDS is only used for specialties where the training doesn’t exist in the MHS or it is full and there is no additional training capacity. For example, the Navy doesn’t use all of the training slots in Internal Medicine, so you probably couldn’t do RAD-to-NADDS in Internal Medicine. Because all the General Surgery residency slots are full in MHS training programs, you could do RAD-to-NADDS in General Surgery.

Past GME boards have been willing to give anyone who was willing to take a RAD-to-NADDS training goal in the undermanned specialties with no additional MHS training spots available (Emergency Medicine, Anesthesia, General Surgery, etc.).

If you are willing to consider RAD-to-NADDS, closely examine the GME note and by-site goals. You’ll see that some specialties are offering RAD-to-NADDS opportunities. If you are interested in one of these specialties, you’ll need to apply for civilian programs ahead of time, likely before the military GME results are released.

Make sure that the specialty leader is aware you will take a civilian deferment if one is offered to you, and make sure you apply to the civilian match. You don’t want to be given a RAD-to-NADDS spot and then tell the specialty leader you didn’t apply for civilian training spots.

Make Sure They Know Who You Are

Do everything you can to make sure the leaders in the specialty know who you are at your GME program of choice. This can usually be accomplished by rotating there as a student/intern, volunteering if you are a General Medical Officer (GMO), Flight Surgeon (FS), or Undersea Medical Officer (UMO), or attending journal clubs or academic conferences when you can make it. Over the years, we have had GMO/FS/UMOs that have volunteered to work in our Emergency Department during conferences or journal clubs. They often matched the following year. Many applicants do not go this extra mile, and those that do have a leg up in matching.

Avoid Red Flags

Some applicant red flags are obvious like failed board exams and repeated medical school rotations, but there isn’t much you can do about those anymore. One other under appreciated red flag is when someone has an operational tour where they are eligible for a warfare device and they don’t get it. Always get the warfare device if one is available during your operational tour.

The Career Intermission Program

I know of multiple physicians who used the Career Intermission Program (CIP) to temporarily leave the Navy, obtain the fellowship they wanted but couldn’t get in the Navy, and then came back on active duty. All the details are on this website. There is no guarantee that your request to use the CIP for GME will be approved, but you never know unless you ask.

Eventually, You Need to Get Board Certified in Something

If you want to match in the Dermatology residency in San Diego, I get it, but if you’ve tried a few times and haven’t matched, you may need to change your approach. Is there really only one specialty that will make you happy?

Eventually, you need to get board certified in something. If you can be happy doing a less competitive specialty, you should consider adjusting course and applying for them. What are the less competitive specialties? It depends on the year, but Family Medicine, Internal Medicine, Occupational Medicine, Pathology, Preventive Medicine, Psychiatry, and the Residency in Aerospace Medicine (RAM) come to mind. This list will also change over time. My own specialty, Emergency Medicine, was extremely competitive, but that has changed over the last two years for a variety of reasons.

2 thoughts on “What to Do if You Didn’t Get Selected for GME

    G.T. said:
    December 31, 2022 at 21:42

    I couldn’t agree more. I was a strong candidate (academically, but without much Navy street cred) and did not match for a competitive fellowship. I had an honest conversation with the SL & PD after the match, and they both told me I had a good chance of matching, and told me why I didn’t match (one spot and an overmatched person with more Navy street cred) and that that for me it would be all about timing. One of them actually called me to remind me to apply again mid next cycle. Needless to say, I applied and ma tched the next cycle. It’s all about being realistic, having an honest conversation with the SL, and then hope your timing matches training opportunities. I noticed this match was kind of rough for fleet returnees though….kind of unusual. Is this a message the Navy is sending?


      Joel Schofer, MD, MBA, CPE responded:
      January 1, 2023 at 06:33

      I wasn’t at the board this year, and I didn’t analyze it in detail, but the Navy is transitioning to straight-through training.


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