S6E21: Beyond Match Day—Setbacks and the SOAP Process

Lina: How is the moving stuff going?

Dr. Whitesitt: Oh, my goodness. It is going. It's going. Everything is already in Las Vegas, so I'm essentially camping in my apartment right now. So I really feel your whole box of struggle.

Lina: Yes. I am currently living off of . . . basically on a mattress because all my stuff has also been shipped to Philly. I miss my bed, and I miss being a little bit more functional than where I am right now, so I get it. Just this weird transition period but . . .

Dr. Whitesitt: I'm running out of clean clothes.

Lina: We'll get there.

Dr. Whitesitt: It's so weird.

Lina: Yeah. So close though. Well, I guess we can start. Hello, everyone. Welcome back to "Bundle of Hers." Today you have me, Lina, hosting this episode and I have a very special guest. She's a friend of mine. She is also just graduated. Hi. Congrats, Doctor.

In today's episode, I really will just kind of let Kaitlyn share her story, but we wanted to share with y'all the struggles that come with feeling like a failure in medical school, in graduating, and kind of further on from that. But we'll kind of start off just . . . Kaitlyn, share your story.

Dr. Whitesitt: Okay. Hi, everybody. I guess I just first want to say thank you so much, Lina, for having me on the podcast. I have been a fan of "Bundle of Hers" since I first started listening in first or second year of medical school. You all have such unique perspectives and life stories and I feel like you're so brave to share those perspectives and talk about such important things in medicine, and I admire the work that you're doing. So it's really an honor to be on the podcast. I just really appreciate it.

Lina: Oh, it's an honor to have you. You also bring a great perspective and I am glad that we're sharing it with everyone today.

Dr. Whitesitt: Well, thank you for having me on. So I guess I can kind of start with my story. Is that kind of what we were thinking, right?

Lina: Mm-hmm.

Dr. Whitesitt: Yeah, I'll just kind of introduce myself again. I'm Kaitlyn. Like Lina said, we are friends, classmates, just-graduated fourth-years, which makes us doctors, which is a very weird thing to say out loud.

I am from a very rural area in north Idaho, like near the border of Canada. I didn't grow up with a ton of mentors in medicine because of that, and I think that potentially led to me having like a harder time getting into medical school at first. So it took me a few tries to get into medical school, and I did finally get accepted on my third try, which was very exciting and . . .

Lina: Third try for the win.

Dr. Whitesitt: Third time's a charm. So that was the start of my medical school career, was trying and trying and trying and feeling like you're just banging on a door to get in and then you finally get in.

And I kind of knew when I started medical school after having that time to reflect from going through that application process multiple times that I was potentially interested in OB-GYN, in obstetrics and gynecology.

So I did all of the things that you kind of do throughout medical school to prepare an application for residency, being involved in research and volunteer opportunities and leadership stuff, so working with underserved patient populations in the community through the Fourth Street gynecology clinic here, being a part of American Medical Women's Association, and Medical Students For Choice. And then I did some research in the obstetrics and gynecology realm looking at mental health and looking at different healthcare disparities within that, kind of within the women's health realm of things.

So I did all of those things, and then in third year, or I guess it was the beginning of fourth year, I did a couple different away rotations to bolster my application. Did well at those away rotations, got a letter from one leading up to ERAS application, got my ERAS application turned in, and then you get interviews. Now you're getting into the middle of fourth year.

So I would say I got probably an average amount of interviews for our OB cohort, just from what I had gathered from talking to people, with the caveat being I think OB-GYN has been a particularly competitive specialty, as you know, Lina, the last two years. And so I think that none of us really had enough interviews to feel "comfortable" with the match. With that caveat in mind, I feel like I had about an average amount of interviews.

Well, you do your interviews, you make your rank list, and then finally you get to match week at the end of your fourth year in March. And the Monday of match week, I got that dreaded email that said, "We are sorry. You didn't match to any program."

That comes with a lot of emotions. One of the hardest things about that week is that you really have to stuff those emotions down and you have no time to process them because you just have to produce to start going through what we call the SOAP, the supplemental offer application process, which is essentially where every program that doesn't match spots and has open spots sends out a list and then you choose which programs on the list to apply to.

To paint a picture of where these emotions come from leading up to this, it's a ton of work. Your 20-plus years of educational experience plus other years of life experience all to reach this moment and then to kind of feel like, "Maybe now I actually won't get to do what I thought I was going to be able to do."

The SOAP process starts on Monday, and you are given this list and you have to choose which programs to apply to. I then had to choose 45 programs and create subsequently 45 personalized personal statements for these programs to send out. That's really the first 24 hours.

And then in the next two days, you field phone calls from places that have gotten your application. It's really scary, and thankfully you're primed a little bit by having already gone through interview season, but it's still a very kind of disconcerting thing to get a phone call from someone that'll just call you up and say, "Hey, this is so and so from such and such program. Why do you want to come to us?" or, "Why do you think you SOAPed?" or any question that they want out of the blue. And there's no time to prepare like the other interviews that you've done before.

I went through those two days, I got some phone calls, and then on Thursday you're offered . . . There are four different rounds where you're offered a position or not.

And then if you're offered multiple in one round, you can pick between those. But you can't go back. Each subsequent round, you can't go back to the offers prior to if you didn't like the offer your first round.

Lina: They're kind of putting you in a very tough spot, right? Basically months and months of preparation gets put down to a couple days, right? Or a couple hours even to send out that application. And also making that decision is also just to those couple hours. So yeah, wow, that's a lot.

Dr. Whitesitt: A very stressful process, and absolutely no time to kind of go through the feelings. So I think we as a cohort were advised to be prepared for the SOAP process just based on how competitive OB-GYN was this last year, but there's really no . . . I don't know. I think along the way, at least I feel like I got reassurance about my application and was told I would probably be fine. It's hard because there's really no way to prepare yourself for something like that even if you are prepped to be prepared. So there's a lot of shock in that initial email.

Lina: Yeah, of course. And I feel kind of where I was, you do all the things and . . . Like you mentioned, Kaitlyn, you do all the things, you prepare all the things, you make sure that you checked every box that you need to check, that you put yourself in a position like, "Oh, yeah, this can happen," but none of us really . . . It doesn't make sense, right? It doesn't make sense that this could happen because you did what was "required of you." You did what you needed to do.

And so I feel like in a sense, I was in the same place. I'm like, "Oh, yeah, there's a possibility." We're all told, "There's a possibility that you don't match." But we're all in the same place that it doesn't make sense why we wouldn't, right?

Dr. Whitesitt: Well, and that was exactly the thing. I think one of the biggest feelings that came up initially was disbelief, right? You're like, "How could I be a part of a system that . . ."

I mean, you give up so many things for it, like birthdays, holidays. You move far away from family. You go far away from your friends, your family. You just give up all these things, your time, blood, sweat, tears, everything, and then you're like, "How could I possibly be in a system that puts me in this situation where I've proven myself again and again to be competent and ready to do this and to show that I really care about this and have a passion for this, and then given a maybe, like, 'Well, maybe you'll match. Maybe we'll give you a job now after all that'?"

It's weird. There's really no other career that asks that of you.

Lina: Right? Yeah. And it feels a lot of times . . . At least I remember talking to people who are not in medicine, and it's like, "Well, I'm still not guaranteed a job after all of this." And the pure shock in people's faces is like, "What? Are you serious?"

I think it's important to recognize that this never comes from the failure of us or shortcomings on our part, right? This is a system thing. This is a failure of a system. This is a system where there are far too many applicants and not enough seats to take in those applicants, whether getting into medical school or getting into residency.

I mean, I applied to medical school three times as well, got in my third time. So at the time, same thing, I was being told, "Don't take it personally. It's a lottery system." But also, we kind of know that if you have more resources, more connections, you will be able to get past a lot of those lottery bridges or blocks or whatever, right?

You did even more of the work. You did even more of what was required. You're already in the system in medical school, so then to get into a place where they're like, "Oh, there are just not enough positions, so figure out what you want to do," whether that be SOAP, research, or something else, you are still halted from what you want to do, right? And so it's very hard.

I feel like I got to a place where even just getting into medical school, it was very hard for me not to take it personally and to feel like, "Oh, this was something that I did or something that I didn't do enough of."

And I remember the week leading up to match, or even just all the time that I was being told, "Oh, you still might not match," I was like, "I should have done something else or should have done more." It was very hard not to still take it personally.

Dr. Whitesitt: Right. I think there's a lot of internalization kind of that failure feeling, even if it's not right, even if it's not real.

And I think during SOAP week, I feel like . . . So we all kind of came to the dean's office of Academic Affairs and I ended up sitting with a few other students who were SOAPing. I remember hearing them talk about other factors that they were considering in building their list to apply to, like partners who had to take licensing exams and could only do that in certain states, or kids with special needs who they were looking for a state that had resources for those kids that they could apply to.

And I remember just feeling two things. One, amidst all this despair, anguish, fear, disbelief, shock, all these negative feelings, also feeling incredibly lucky that I was as mobile as I was.

And then also this rage at the injustice of it, because I was like, "How could this system . . . I feel personally wronged, but now I'm angry for these classmates who are incredible people who have also put all this work and time in." You just feel this like how could we live in a system that puts us in this situation? And I think that's a question that I've asked myself and will continue to think about moving forward. It's like, "How do we fix this? Because this is such a problem."

Lina: Yeah, exactly. How can we be in a system that is not really setting us up for success? I mean, this happens every year and the numbers keep getting worse every year. I was just looking at numbers from this year, and 2,600 applicants did not match.

Dr. Whitesitt:Too many.

Lina:That's a very large number. That's a lot of people who . . . Like you mentioned, just a few of our classmates, but thinking just across the nation, the amount of people who have put their blood, sweat, tears, and everything in, at the end of the day they had amazing applications and there are not enough positions. Again, that's the system itself.

What was it like in the past 20 years or several decades? I don't know the number to be exact, but we've only been approved for an increase in residency spots once, I think. That was a crazy number like this, and that once was only for like 200 spots across the nation.

The people who are not matching are increasing every year. And OB-GYN specifically also, we were told from the beginning, "Oh, there's a 20% unmatch rate," and you're like, "That's still a large number." Again, putting in all the effort and all what we work on, and to get to a place where it's like, "That's just the way it is. Deal with it."

Dr. Whitesitt: Right. It's so wild. You mentioned this earlier, and I just think there are so many people in the community that really don't know about this. I remember having a similar conversation with my family and being like, "Well, I might not get this job at the end of the day." They'll be like, "Oh, you'll get to pick where you go, right?" And you just kind of are like, "No. Absolutely not," which is such a wild concept for most people I think applying to any sort of job.

And I also think it's something that I was peripherally aware of going into medical school, but that a lot of us didn't become aware of until later on. You get the rug pulled out from underneath you when you learn about this situation.

Lina: Yeah. Exactly. I mean, just kind of going off of SOAP, I think people can either find . . . Just an overview, people find either a transitional year position or a preliminary year position, right? It usually isn't in the specialty that applicants are originally going for.

I mean, you matched into a surgery prelim position, right? But you still kind of have to go through the process of the match again this year, and that's what a lot of people end up having to do who go unmatched their first time.

Other options I know are research years or some other clinical year. They tell you that there are multiple ways that you can go about this, but ultimately you're entering that system again. You're entering the cycle of match again. You become one of those non-traditional applicants, right? Which we started out as.

But I was just thinking of how much they tell you, "Oh, no, you're good. You have all these options. Don't worry." But we are already in a system that makes it seem like going the non-traditional route is bad, right? Like, "You're not successful. This isn't good enough. You didn't go the normal, the 'successful way.'" And so you're put in the spot where I'm like, "Oh, yeah, I have these options, but I'm still not good enough because I have these options."

Dr. Whitesitt: I feel like the non-traditional word is kind of a trigger word for me, and probably for you too, because I saw it in your eyes when you said non-traditional. There was this glint.

It does feel very triggering, because that's what you are when you have applied once to medical school and not gotten in, or taken a few years off, or whatever. And so I think there's this aspect of . . . not to be dramatic, but this re-traumatization of a past feeling of failure.

It does make your options moving forward feel like they're kind of tinged with this film of shame. It's really hard to sit and talk about, "Why did you SOAP?" I remember being asked that during SOAP week, and especially during that time when I hadn't had any time to process. It felt like an impossible question because it wasn't something that I had really been able to talk about that much. It really does make those options moving forward feel not as good.

Yes, I was really lucky I think during SOAP week to get a preliminary surgery position at this great little program in Las Vegas. I have a program director who is really supportive, and I think it's a place that I'm really going to grow and is either going to prepare me very well to be an OB-GYN, which is my hope in the future, or if that is not the path that ends up coming out in the wash for me, then it will prepare me well to continue on in surgery.

But I think moving forward, it doesn't feel . . . I don't know. It feels daunting, one, to have to go through that process again, but two, to have to answer that question again and again on the interview trail of why. "Why do you think you SOAPed?" Especially when you're given all this feedback and reassurance throughout the application cycle that they're like, "Actually, no, you have a really strong application. We think you're going to do just fine."

Lina: I think it's very unfair for them to expect you to answer that question. They're kind of putting the blame on you in a sense, like, "Oh, why do you think you SOAPed?" And I think that's a very unfair question to be asked.

Dr. Whitesitt: It feels unfair. I mean, it's expected I guess, just because we know how this works. But yeah, it doesn't feel good and I'm very worried about being able to talk about it and not feel super emotional about it.

I will say luckily I have been in touch with some people who have gone through this process before, and so this has been really key in dispelling some of the shame that felt about it, is really listening to other people talk about, which is another reason that I feel like this is an important topic to talk about.

But I have heard, at least in OB because of how competitive it's gotten, that this person who had SOAPed before had mentioned most programs at least don't look at it as a bad thing that you SOAPed because they are aware of the situation. So that really relieved me of some stress about that, even though I think it's still going to be really hard to answer that question.

I'm hoping that that's going to hold true for me in this next cycle, but it is hard, especially when . . . Yeah, I don't know. It's still an unknown. It's still out there. I still have to go through that process.

Lina: We're still trying to get out of kind of this failure mindset, and I felt like throughout all of fourth year and interview season, there were a lot of feelings of, "Maybe I'm not good enough because I did start out non-traditional, in a sense. I don't have maybe everything that needs for success."

In general, I just felt like I wasn't good enough, and I think that starts from kind of feeling from the beginning and how I started medical school. And then just always there's that aspect of non-traditional is bigger than just taking a different path in your years of applying or getting to medical school or gap years.

But it also goes beyond being part of the minority, being part of the minority population that is medical students or residents, and looking different, speaking different, having a different background, right? I am the first in all of my family and my parents' families to even be anywhere close to medicine, right?

All of those feelings I feel like were accentuated in fourth year and in my interview process, and also the question of "Why do you feel like you belong in our program?" or "Why do you feel like we should pick you?" I recognize how hard that was for me going through it again, and I recognize how daunting it is for yourself, Kaitlyn, thinking of going through it again.

And I think a lot of it is the community around me, a big part, and you mentioned a little bit about that. But they do help ground me and remind me of why I am doing this. And recognizing that a lot of this isn't us. A lot of it is the system around us and a lot of it is kind of, like I said, the failure of the system around us, right? It's remembering why I applied the first time and the second time, and why I chose to apply the third time to medical school.

I remembered the women in my communities. I remembered back home and my family. I remembered why I started this whole process. And I think I've said that in previous episodes, but sometimes in the hardest times going through medical school, it was kind of remembering why I started doing this, remembering that identity as wanting to be a doctor, wanting to be a provider. And even when I ultimately chose OB-GYN, it was wanting to be a women's provider, right?

It's hard to constantly remind yourself that, but it is something that you kind of feel like, "I need to ground myself and remind myself every day why I'm still doing this."

Dr. Whitesitt: What you're saying really feels like . . . It hits home. I guess you'd call it imposter syndrome kind of thing where you really feel like after having to try and try and try to get into medical school, you already kind of have this black mark on your shoulder where you're like, "Am I good enough?" There's a small question in the back of your head that's . . . It's like there's a set of rules that other people are maybe playing by and you're like, "Am I missing something?"

And so I really feel that where you're like, "I don't know how to tell you that I'm good enough for your program," especially when I think a lot of us have a lot of respect for each other and a lot of . . . Especially when there are so many qualified people, right? You're like, "I think I can do this, but also, why are you asking me to tell you why I am better than my classmates who are also awesome?"

I think it's a funny question that, again, is one of those expected questions, but I've always thought of as kind of a weird question to be asking somebody. It really brings out this funny competitiveness aspect of the application process that I don't think should exist beyond . . . It shouldn't exist in the application process, but I think in medicine period, it's very team oriented, so it seems like a funny competitive juxtaposition to be placing us in.

Lina: Oh, yeah. Like, "Tell me why you're better."

Dr. Whitesitt: Yeah. I'm like, "I don't know. We're all different and great." But as far as what you're talking about, regrounding yourself and kind of figuring out, "How do I move through this? How do I keep going and how do I keep applying again and again and again?" being able to reflect on what those things are has been really important for me throughout this process.

Obviously, it feels impossible when you're in the situation. But I was so lucky because I feel like there were so many people that just came out of the woodwork to support me. They just showed up. People sent me gift baskets, care packages. People offered to bring by food. People offered to look things up for me and helped me . . . I crowdsourced information to personalize these applications, and people helped look those things up for me so I could put together the best application that I could going forward.

You and the rest of the OB cohort literally showed up at my house, at my door, to bring me a care package and to give me hugs, and it was so powerful to see that community come together in a time of need. I don't know. I just didn't realize how amazing that community would be in a time that I really needed it. I just had such overwhelming gratitude for the support that came out of everybody during that week.

It's been something that I reflected on a lot and thought about a lot after match week. That has kind of helped me move forward and helped me dispel a little bit of that shame and feeling of failure.

When you zoom way, way out, what really matters at the end of the day . . . If you're sitting on your deathbed, what is going to matter more than the relationships that you had with people or the way that you had positive interactions with people in your life?

And for me, medicine has been the conduit to have those relationships and to hopefully affect people's lives in positive ways, which is another reason why I continue to pursue it.

But if I have this beautiful, amazing community that I have played some role in creating, I must not be doing too many things wrong. I'm doing that right at least.

I don't know. It was just something that I really reflected on and it just really struck me as being this kind of profound piece of the whole process, and that has helped me feel better about a very challenging thing to happen.

Lina:The first thing that came in our mind and all of us . . . I remember a text from one of our friends in that OB cohort. It was like, "This system is so messed up," and it was never anything about you, right? As much as I remind myself that, I like to remind yourself that as well.

And I think, too, I wanted to do this episode and I wanted to share this with everyone else because I know a lot of our listeners are in a very similar process. And even if it's not necessarily matching or getting into medical school, but any type of hiccup or obstacle that you can find on the way to what we need to achieve, I think reminding ourselves of everything that we've talked about in this episode and kind of regrounding ourselves in our identities and the communities that are around us and the communities that we want to help, I think that goes a long way.

Kaitlyn, I don't think of you as like, "Oh, yeah, you need one more year and then you can be an OB-GYN provider." It's more of like, "The system is what it is right now, but you are an incredible OB-GYN provider already."

And this is to everyone in whatever specialty, capacity, or thing they're trying to achieve. You are already there, and you just kind of hold on to that identity and what that means to you.

Dr. Whitesitt: Thank you. That's really sweet. I was just thinking about what you were saying. Being able to fall back on your identities when you're going through a challenging period can be applied really to so many situations.

And I think because OB was so competitive this year, there are a lot of people who fell on their lists and are not at programs that they were super excited about.

I think what you were saying, it's like if I just zoom out and I remember that I still get to do those things that are my ultimate goals, which are what's important to me, i.e. community or serving women in this community, XYZ goals, I think for me it helps me feel reassured that I'm not a failure. I am moving in the right direction.

And I think a lot of people can apply that just to other challenges that they might be going through, regardless of if that's having to go through SOAP week, which I hope it's not.

Lina: Yeah. Exactly. Well, thank you, Kaitlyn, so much for joining me today and having this conversation with me and sharing kind of what you went through and where you're at right now. I think it's truly valuable to hear from you and to share this as well.

Thank you, everyone, for listening to us. Follow us wherever you podcast. Follow us on Instagram @bundleofhers. Share with us, if you do, stories of feeling inadequate or feeling like you have failed something in your path. We've got these cute little pins, "Power From Identity," that we would love to share with you as well in response.

All right. That is it. Bye-bye.

Dr. Whitesitt: Bye. Thank you.