How difficult is it to match after a substantial gap after graduating (say, 5 years or so)?
I graduated within the past few years from an MD school. Currently working in finance. Have great QoL and make good money, but am unfulfilled.
I have competitive board scores and no red flags from med school (i.e. no red flags prevented me from applying.) I did not submit ERAS my M4 year.
I assume the more competitive specialties will be off-limits, but could I match into something if I applied?
Two prerequisites you'll need are ensuring your Step exams don't expire and if they do, you'll need to retake 1/CK or take Step 3 before they do. Second, you'll need some recent clinical experience and the best way to do that is by contacting your medical school or finding a contact who will let you do a clinical observership.
I'll spend the rest of my post giving you application/interview advice. Just to preface this, I do think you can if you apply strategically. That said, you are fighting against the grain. The analogy I would use is a seasoned shopper at the mart being a PD. PDs/selection committees have tons of experience with which traditional applicants getting the job done in their program and graduating just like shoppers know which ingredients/brands make the dishes they prepare. Why would they deviate from that formula to choose some untested alternative brand? Unlike recruitment in business and sports, residencies don't inherently compete against each other so there's no pressure for them to change their practices, innovate, or take risks. The answer is either the supply of the brand they usually pick from is out or in short supply. You may very have acquired irreplaceable skills that will translate perfectly to medicine and you may truly exceptional physician but how exactly does the PD know that and also, does a benefit of recruiting an exceptional performer really outweigh the chance that that person may be a bad performer? Anyhow, that's what your fighting against.
What you have to do is tilt the process in your favor. You've already ID'ed #1.
1.) Don't apply to fields with a surplus of applicants who are all qualified.
2,) Figure out if doing this for the rest of your life is what you want. You already had a lack of fulfillment in your prior area. PDs will want to know what the reason for changing is. The best answers will be the simplest/tangible ones. Limit abstract ideas, concepts when stating this in essays/interviews.
3.) Tone down the things that make you different in your application. While it may appear to you to be your greatest strength, that's not always what PDs want. Find out ways to emphasize how you're equivalent to their other applicants. Emphasize how your board scores are safely above average (speaking of which, mind the expiration dates on some of these experience). When given the chance, talk about your clinical experiences even if they're not exactly the traditional rotations you are now far removed from them. If interviewers question your experience, remain composed. They invited you to an interview so they should have known before what they were dealing with.
4.) PDs have come to be leery of slow/difficult learners and thus use age or time out of medicine as surrogates of that. In your application, emphasize how you're an efficient and easy person to work with. Industry experience does have a good reputation and emphasize it to speak to how you get along amicably with everyone. Demonstrate that you're still someone that is reflective and takes feedback well because the unspoken assumption is that you may not be.
5.) Lead proactively with an overview of #1-4. All interviewers will ask you about the gap. You may as well speak about it off the bat, on your terms, and let them ask questions if needed. Then spend the rest of your interview highlighting what you want to highlight.
Best of luck! You should be able to find some spot if you apply broadly.
