Fifth Year of Med School for Those Who Don't Match

I have a question for those who are ‘in the know’ about med school, residency match, etc…Background: Student from our community finished med school requirements (Philadelphia–Jefferson?) and interviewed/applied for residency but did not match. Decided, at the med school advisor’s suggestion, to do a fifth year at med school and, although otherwise eligible for graduation, will not graduate. …No magic initials but will do another year of rotations, etc. and will apply for residency again next year. This, at a greatly reduced fee–something like $500. DS had a friend who didn’t match (this was a few years ago) but graduated, did research for a year and reapplied, with much better results… I’ve never heard of a “fifth year” program and wondered if anybody here could enlighten me…

There really isn’t any such thing a “fifth year” of med school for students who don’t match. The particular school has decided to allow this particular student to delay graduation and basically repeat 4th year. In other cases, the school may allow a student to remain and do a research year.

Med schools are under no obligation to allow a student to stay past their scheduled graduation date if the student has fulfilled all graduation requirements. A delayed graduation is only granted on an individual case-by case basis and it depends–at least partly-- on if the school administration has “faith” in the student and believes they have a good chance to match with an additional cycle. (Students who have spotty academic or disciplinary records–failed STEP exams, failed rotations, multiple failed didactic classes, ethics violations, or unprofessional behavior complaints – are much, much less likely to be allowed to delay graduation.)

Often in cases like you mention, the student “over-reached”–applied to specialties where their stats were borderline, or applied to residency programs that were too geographically restricted, or to program which were too competitive for their stats. ( For example, applied for ortho with below average stats and didn’t simultaneously apply in a less competitive specialty. Or only applied to Washington DC residency programs. Or applied only to top academic programs in their specialty when they only received Pass on the rotations in their specialty, or had only lukewarm specialty LORs. )

Usually these unmatched students are “counseled” about their expectations and encouraged to apply to broader range of lower ranked programs or to switch to less competitive specialties. (NOTE: some med schools do a better job of counseling and overseeing their 4th years’ residency application process than others. Ideally this “counseling” should happen before residency applications go out, rather than after a failed Match.)

Once a student has graduated from med school, they apply to residencies as an independent candidate–which is a huge red lag. The issue is that without malpractice insurance coverage --which terminates at graduation-- the student is closed out of all clinical contact with patients. PDs worry that clinical skills have begun to atrophy during that year away from patients and are afraid it will take too long for the candidate to “get up to speed” during intern year, and/or will require additional intense supervision–all of which are drag on the residency program. Most programs simply do not have the manpower/time/resources for that.

BTW, anytime a student doesn’t graduate on-time–that is, with the class they matriculated with-- this requires an explanation both from the student and from the Dean of the Medical school as part of the student’s MSPE when the student is applying fo residency. Typically any graduation delay is viewed as red flag–how serious of a red flag depends on the reason–a leave of absence to care for a dying parent, have a baby or undergo medical treatment is a minor red flag; whereas as failed clinical rotation, a failed Match, or failed STEP is a big red flag.

It’s definitely better for the student to do a 5th year vs graduate and doing something else for a year because applying to residency as “a US senior” is always best.

Why would a med school only collect $500 for the fifth year? Isn’t that costs the same as fourth year?

If it’s a “research year” (which is sometimes what they do) then tuition is much less.