In 2014, the NRMP reports that there were 295 residency positions; 94.6% of the available position were filled by US seniors, 0 osteopathic seniors matched, 7 foreign trained applicants matched and 0 spots were left unfilled.  Looking only at US seniors, 295 ranked ENT programs only, and 73 listed it as a first choice while ranking alternate specialties.  Of those that listed ENT as their only choice, only 243 successfully matched, leaving 52 unmatched US seniors.  If you find yourself in this position, you are not alone.  But now what?

Take a moment to catch your breath.  This does not mean you won’t find a career that makes you very happy, and it also does not mean that you will never match into ENT.  You have several choices ahead of you, including pursuing a different specialty.  However, if you chose to pursue ENT, below are some options and areas to consider:

SCRAMBLE
In 2014 there were 0 available unmatched ENT spots to scramble into.  In 2012 and 2013, there were two scramble spots.  So while it is possible to scramble into a spot, it is definitely not a reliable back up option.  On Monday of Match week, you will be contacted and told whether or not you matched.  You are not told where, only that you did/did not.  If you did not, then you may participate in the Scramble.  This system allows you to contact any program that did not fill their spots, perform a last minute interview, and hope that they accept you into their open spot.  You can also scramble into a preliminary or transitional year.

PRELIMINARY OR TRANSITIONAL YEAR
This allows you to work as a PGY-1 (intern) doing general surgery (prelim year) or rotate through several departments (transitional year).  You can also do a preliminary year in internal medicine, but this would likely not prepare you well for reapplying to ENT.  If you work hard, get good letters of recommendation, add a research project or two to your resume, it may be possible to match into a PGY-1 ENT position, or if you are lucky, a PGY-2 position that recently opened.        

RESEARCH YEAR
Many applicants chose to take this year to bone up their application.  The best way to do this is through meaningful research.  What makes research meaningful?  #1) You develop a relationship with a senior mentor who is well known in the Otolaryngology field and is willing to go to bat for you with phone calls and letters of recommendation. #2) You have a significant role in the research project, allowing you to speak knowledgeably and passionately about it in your cover letter and future interviews. #3) You are given the opportunity to network, either through the department you are working with or through regional, national, or international meetings. #4) You are able to publish or present your research which allows you to show future programs that you know how to see a project through its conclusion.   

ENT ROTATIONS
It is possible to do away ENT rotations or ENT rotations at your home institution as a prelim/transitional PGY-1.  This can be challenging because many of programs rely on their PGY-1s and therefore, loathe to see them leave for a month.  However, this is certainly possible with some planning.  All the rules for doing well on an away as a medical student are magnified: work HARD, look PROFESSIONAL, READ about your cases, know your ANATOMY, and be KIND and CURTEOUS to EVERYONE.  This is another way to get a good letter of recommendation, a phone call, or an invitation to interview. 

 REAPPLYING
To reapply successfully, something must be different, and your application has to be perfect.  Spend time making sure there are no errors, misspellings, etc.  You cannot change your prior board scores or grades, or the fact that you did not match.  What you can change are your research experiences, letters of recommendation, your maturity/demonstration of commitment to the field of ENT, and your interview skills.  

Even you don’t do a research year, you must do at least some research before you reapply.  During your interview, be sure you are well versed in all the nuances of your research and show that you took ownership of your project.  Look up the people you are interviewing with on PubMed and see if they have similar research.  Share your excitement about future applications.  

It is important to think very critically about who wrote your letters during your last application.  While it is often the younger faculty with whom you work the most closely, bond, and become friends, they are not the best people to write letters for you.  They are not well known and their word does not carry as much weight.  Programs are looking to people they trust to vouch for you.  

Revisit your personal statement (PS).  In fact, it will likely be best to rewrite it.  You must address the red flags. Be honest, direct, and passionate.    Don’t make excuses.  You want to convince the person reading your PS that you will work hard for them, will contribute to the program, will be a fantastic fit during residency, and will make an outstanding otolaryngologist.  Remember, the majority of PSs sound the same after reading through hundreds.  You want yours to stand out for the right reasons.  Now is not the time to take a risk on something “creative”.  This is the one and only chance for YOU to tell the programs who you are.  Make every word count!

Interviews matter.  While you may be very polite, interesting and genuine, you may not come across that way in an interview.  Buy or download frequently asked interview questions for residency.  Sit down and write out answers to as many as you can.  You will be surprised how many you will encounter and how you become better at answering the “typical” interview questions.  If you can, try to do several mock interviews. Look professional (dark suit).  Offer a firm handshake.  Read up on everyone you might encounter…staff, residents, etc.  Know about the program, and have questions that let people know you have done your homework.  Remember, the interviewer has the upper hand.  There are more applicants than there are spots, which means they get to be critical, not you.  You want your interviewer to leave the room with a “warm and fuzzy” feeling.  This is important to consider, because you are generally asked “what questions do you have” at the end of your interview…DON’T ask something that forces them to be critical of themselves, ENT or their institution.  Ask something that lets them brag or bond with you.  Save your tough questions for the residents (although residents have relationships with their staff, and will share stories during the interview process).  Attend the social events.  If you drink, have one drink, hold on to it all night as a social accessory, but don’t drink more than that.  

The bottom line is, matching into ENT can be a numbers game.  While programs will see a failed match as a red flag, your job is to prove to them why you are a fantastic applicant.  If you are passionate and hard working, you can tip the scales in your favor. The programs will want to know why you think you didn’t match, what you learned, what you did about it, and why you are better equipped now than any of the current applicants to succeed in their program.  GOOD LUCK!