Mastering SOAP: Essential Strategies for Unmatched Medical Graduates

The 10 Commandments of SOAP: Key Principles Every Unmatched Graduate Should Follow

Navigating the days after an unfavorable Match result can feel disorienting, emotional, and time-pressured. For unmatched graduates, the Supplemental Offer and Acceptance Program (SOAP) is not just a backup—it is a structured, high‑stakes opportunity to secure a residency position and re‑enter the pathway of clinical training.

To approach SOAP with clarity instead of panic, you need strategy, preparation, and discipline. These “10 Commandments of SOAP” translate that strategy into concrete, actionable principles that every unmatched graduate can follow to improve their chances of success and support long‑term career development in medicine.

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Commandment 1: Thou Shalt Be Deeply Prepared Before SOAP Week

In SOAP, the applicants who do best are rarely those who start planning on Monday morning of Match Week. Preparation begins weeks to months in advance.

Understand the SOAP Framework and Timeline

The first step is knowledge. You cannot be strategic if you don’t fully understand how SOAP works.

Key points to know:

• Eligibility: Only applicants who are:
  • Registered for NRMP
  • Fully unmatched or partially matched (e.g., matched to a prelim without a categorical spot)
  • And designated by NRMP as SOAP-eligible
    can participate in SOAP.
• ERAS and NRMP roles:
  • ERAS is the application platform (documents, program list, filters).
  • NRMP manages offers, rounds, and rules regarding communication and acceptance.
• Critical timeline elements (check NRMP/ERAS each year for exact dates and times):
  • Monday of Match Week: You learn if you’re matched/unmatched and SOAP eligibility.
  • Monday–Tuesday: Access list of unfilled programs; application window opens.
  • Wednesday–Thursday: Interview and program review period; SOAP offer rounds occur.
  • Thursday–Friday: Final offer rounds and conclusion of SOAP.

Create a personal timeline including:

• Deadlines to finalize your CV, personal statements, and LoRs.
• Dates to meet with advisors to review strategy.
• A template email for programs (ready before Monday).
• A plan for how you’ll spend each day of Match Week.

Get Documents and Application Materials Ready

Your application needs to be “SOAP‑ready” before Match Week:

• Updated CV:
  • Include any new rotations, research, posters, publications, quality improvement, or teaching since your initial ERAS submission.
  • Highlight leadership or responsibilities that show reliability and teamwork.
• Revised personal statements:
  • Prepare at least 2–3 versions:
    • One for your original specialty.
    • One for a backup specialty (e.g., internal medicine, family medicine, prelim surgery).
    • Optional: A generic professional PS that can be tailored quickly.
• Letters of recommendation (LoRs):
  • If possible, obtain one or two new letters—especially in your chosen backup specialty.
  • Ask letter writers to address your clinical performance, professionalism, and suitability for residency.
• USMLE/COMLEX and transcript:
  • Ensure all score reports and transcripts are present, uploaded, and error‑free.
  • Address any gaps or red flags in your personal statement or advisor letter.

Research Potential SOAP Programs Early

Even before the list of unfilled positions is released:

• Review historical SOAP data (NRMP reports, forums, your school’s advising data):
  • Which specialties frequently have unfilled positions?
  • Which regions/program types tend to participate in SOAP?
• Identify realistic backup specialties:
  • Internal Medicine, Family Medicine, Pediatrics, Psychiatry, Preliminary Medicine/Surgery, Transitional Year are common.
  • Base decisions on your profile, scores, and clinical experiences.
• Understand program profiles:
  • Academic vs. community programs.
  • Visa sponsorship policies (if applicable).
  • Preference for US MD/DO vs. IMGs.

Build a general shortlist of program types you’d target so that when the actual unfilled list appears, you can act quickly and strategically.

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Commandment 2: Thou Shalt Network Actively and Intentionally

In SOAP, time is short. Networking you’ve done months (or years) earlier can suddenly become invaluable.

Leverage Faculty, Advisors, and Mentors

• Meet with your Dean’s office, career advisor, or faculty mentor:
  • Honestly review your initial application.
  • Identify your realistic options and potential backup specialties.
  • Ask: “If I go unmatched, what SOAP strategy would you recommend?”
• Ask for advocacy:
  • Some advisors will email or call program directors where you are a strong fit.
  • Provide them with your updated CV and a short paragraph summarizing your strengths and interests so they can advocate effectively.

Connect With Residents and Alumni

• Alumni networks:
  • Contact graduates from your school who matched into programs in your target specialties and regions.
  • Ask them about:
    • Program culture
    • What the PD values
    • Whether the program has historically taken SOAP applicants.
• Current residents:
  • If you had strong relationships during audition rotations or sub‑internships, reach out respectfully.
  • Ask if their program typically participates in SOAP and whether it may have unfilled spots.

Use Professional Social Media Strategically

• LinkedIn and X (Twitter):
  • Follow residency programs, PDs, and GME offices.
  • Many programs post about their SOAP participation, open positions, and preferences.
• Professional etiquette:
  • Do not “spam” PDs with DMs.
  • Instead, use social media to gather information, attend virtual events, and stay informed about programs’ needs and culture.

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Commandment 3: Thou Shalt Tailor Thy Applications to Each Program

During SOAP you can apply to a limited number of programs per round. That cap means quality and fit matter more than volume.

Customize Your Personal Statement and Experiences

For each program (or at least each specialty):

• Align with program mission and patient population:
  • Does the program serve underserved communities? Emphasize your commitment to service, language skills, or community work.
  • Is it academically heavy? Highlight research or scholarly interests.
• Reference specific program features (when allowed and appropriate):
  • Special tracks (global health, primary care, research).
  • Patient demographics or local pathology that interest you.
• Demonstrate genuine interest:
  • Avoid generically copying and pasting; even small tailoring can signal you did your homework.

Highlight Your Distinctive Strengths

Programs know SOAP applicants often have some setbacks in their applications. What they need to see is why you are still an excellent future resident:

• Clinical strengths: reliability, strong work ethic, procedural skills, team communication.
• Personal strengths: resilience, empathy, maturity, adaptability, leadership.
• Specific experiences:
  • Extra ICU or sub‑I rotations.
  • Longitudinal research projects.
  • Teaching experiences (TA, tutor, peer mentor).

Connecting these strengths directly to the program’s needs shows intentionality and professionalism.

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Commandment 4: Thou Shalt Be Strategic in Program Selection

SOAP rewards applicants who are realistic and flexible while still being thoughtful about fit.

Determine Your Specialty Priorities and Backup Options

Ask yourself:

• Am I willing to train in a different specialty (e.g., FM, IM, Psych) to stay in clinical training and keep doors open?
• Would a preliminary year or transitional year help strengthen my application for my preferred specialty next cycle?
• How flexible am I geographically?

For many unmatched graduates, success in SOAP comes from embracing a broader set of acceptable outcomes, such as:

• Matching into a community internal medicine program instead of an academic one.
• Accepting a preliminary year with a clear plan to reapply.
• Choosing a less competitive specialty that still aligns with your interests and long-term career development.

Assess Program Fit and Realistic Chances

When the list of unfilled programs is released:

• Filter quickly based on:
  • Specialty and program type (categorical vs preliminary).
  • Visa policy (if applicable).
  • Accreditation status and any major red flags.
• Be honest about competitiveness:
  • Board scores, attempts, and clinical experiences.
  • Whether the program has a history of taking IMGs, DOs, or applicants with prior attempts.

Prioritize:

• Programs where you have demonstrated connections (prior rotations, faculty advocates).
• Programs that historically value similar applicant profiles.
• Regions where you can realistically see yourself thriving (but don’t over-restrict; SOAP is not the time to be overly picky).

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Commandment 5: Thou Shalt Be Proactive (But Not Desperate)

SOAP moves fast. Being proactive means acting deliberately within the rules—without crossing ethical boundaries.

Take Initiative Within the Rules

• Prepare communication templates in advance:
  • A concise introduction email to program coordinators/PDs (if and when allowed).
  • A brief update with your CV and expression of interest.
• Respond quickly to interview requests:
  • Check your email, ERAS portal, and voicemail constantly during Match Week.
  • Have a professional voicemail greeting and ensure your phone is available.

Avoid Panic‑Driven Decisions

Proactivity is not the same as desperation:

• Don’t apply indiscriminately to every open spot if:
  • You’re not remotely interested in the specialty.
  • The program clearly does not fit your needs (e.g., severe location conflicts you truly cannot manage).
• Focus on maximizing your chances of being a good fit, rather than chasing a position at all costs. A poorly chosen program can lead to burnout, remediation, or later hardship.

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Commandment 6: Thou Shalt Communicate Clearly, Professionally, and Consistently

Every email, phone call, and interview interaction is a data point to programs about how you will behave as a resident.

Master Professional Written Communication

When allowed to contact programs:

• Use a clear subject line:
  “SOAP Applicant – [Name], [Specialty], [AAMC ID] – Expression of Interest”
• Keep the body concise:
  • Briefly state who you are, your connection (if any), and a specific reason for your interest.
  • Attach or reference your ERAS application and CV.
• Avoid pressure or “gamesmanship”:
  • Do not promise you will absolutely rank them #1, etc.
  • Do not send repeated emails if you get no response.

Communicate Confidently in Conversations

In phone calls or virtual/phone interviews:

• Speak clearly, at a moderate pace.
• Answer questions directly, then expand with 1–2 relevant examples.
• If you had a previous failure or gap:
  • Acknowledge it succinctly.
  • Focus on what you learned, how you grew, and why you are now better prepared.

Programs are assessing whether they can trust you with their patients and teams. Calm, respectful, and honest communication goes a long way.

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Commandment 7: Thou Shalt Maintain a Resilient and Professional Mindset

SOAP is psychologically intense. Emotions can run high—but your mindset will influence both your performance and how others perceive you.

Normalize and Process Your Emotions

Not matching is painful. It is also more common than you think, especially in competitive specialties and among IMGs. Allowing yourself to process:

• Talk with trusted friends, mentors, or mental health professionals.
• Acknowledge grief, disappointment, or shame—but don’t let them define your self-worth.
• Use practical coping strategies:
  • Sleep and nutrition as much as possible during the week.
  • Short walks, breathing exercises, or physical activity between interviews and offer rounds.

Present Yourself as a Future Colleague

Programs want residents who are:

• Stable under pressure.
• Able to handle setbacks with maturity.
• Team‑oriented and reliable, even when things aren’t going well.

Show this by:

• Being punctual for every interview and meeting.
• Expressing appreciation for the program’s time.
• Avoiding negative talk about prior programs, schools, or colleagues.

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Commandment 8: Thou Shalt Prepare Thoroughly for SOAP Interviews

Even in SOAP, interviews are often the deciding factor between two similar applicants.

Anticipate Common SOAP Interview Questions

Expect variants of:

• “Tell me about yourself.”
• “What do you think contributed to your not matching initially?”
• “Why are you interested in our program in particular?”
• “Why are you pivoting to [backup specialty]?”
• “How have you addressed any weaknesses or failures in your record?”
• “What are your long-term career goals, and how will our program help you get there?”

Practice concise answers that:

• Are honest but not self-destructive.
• Take responsibility without self‑blame.
• Emphasize growth, reflection, and specific steps you’ve taken to improve.

Conduct Mock Interviews and Technical Setup

• Schedule mock interviews:
  • With your school’s career office, mentors, or trusted peers.
  • Ask for targeted feedback on clarity, confidence, and professionalism.
• For virtual interviews:
  • Test your camera, microphone, and internet connection in advance.
  • Choose a neutral, quiet background with good lighting.
  • Dress in full professional attire—this affects both impression and mindset.

Bringing a printed or digital copy of your CV and a few key talking points can also help keep you focused during rapid‑fire SOAP interviews.

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Commandment 9: Thou Shalt Reflect, Learn, and Adjust—Regardless of Outcome

SOAP is not just a one‑time event; it’s part of your broader journey in medical education and career development.

Analyze What Happened and Why

Whether you secure a position or not:

• Review your entire application cycle:
  • Specialty choice and competitiveness.
  • Number and type of programs applied to.
  • Board scores, clinical experiences, LoRs, and red flags.
• Consider external factors:
  • Changes in specialty competitiveness.
  • Visa issues, geographic preferences, or timing of exams.

Work with an advisor to determine:

• What was within your control?
• What was not?
• What you can reasonably change for next time.

Create a Concrete Improvement Plan

If you do not match even after SOAP, or if you accept a prelim/transitional year:

• Consider ways to strengthen your application:
  • Additional clinical experience (sub‑I, externships, observerships).
  • Research or quality improvement with tangible outputs.
  • Targeted exam improvement or additional attempts if applicable.
• Explore alternative paths within medicine:
  • Primary care or hospitalist pathways after a core residency.
  • Public health, health policy, medical education, or research careers if clinical training remains elusive.

Reflection + action is far more powerful than reflection alone.

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Commandment 10: Thou Shalt Keep Thy Long‑Term Vision in Sight

In the chaos of SOAP, it’s easy to lose sight of why you pursued medicine in the first place.

Reconnect With Your Core Motivations

Regularly remind yourself:

• What aspects of patient care are most meaningful to you?
• What kind of physician—and person—do you want to be?
• How will today’s difficult steps move you closer to that person?

Journaling, mentorship conversations, or even briefly revisiting personal statements you wrote earlier in training can help you reconnect with your sense of purpose.

Celebrate Small but Meaningful Wins

Progress during SOAP and beyond can be subtle:

• Completing a stronger personal statement.
• Receiving detailed feedback from an advisor.
• Securing even one interview in a backup specialty.
• Handling a difficult interview question with honesty and poise.

Recognizing these steps keeps you motivated and underscores that your professional identity is built over years—not defined by a single Match result.

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Conclusion: Turning SOAP Into a Strategic Opportunity

For unmatched graduates, SOAP can feel like a compressed, high‑pressure marathon. But when you approach it with preparation, intentional networking, tailored applications, strategic program choice, proactive communication, and a resilient mindset, it becomes a powerful opportunity to redirect your trajectory—not the end of your medical aspirations.

These 10 Commandments of SOAP are not just tactics for one stressful week; they are principles of professional growth, reflection, and career development that will continue to serve you throughout residency and beyond.

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Frequently Asked Questions About SOAP and Unmatched Residency Applicants

Q1: What exactly is SOAP, and how is it different from the main Match?

SOAP (Supplemental Offer and Acceptance Program) is a structured process run by the NRMP during Match Week that helps unmatched or partially matched applicants connect with unfilled residency positions.

Key differences from the main Match:

• Timing: SOAP happens within Match Week; the main Match rank list is submitted weeks earlier.
• Mechanism: In the main Match, a single algorithm processes rank lists; in SOAP, offers are made in multiple rounds directly from programs to applicants.
• Scope: SOAP only involves programs with unfilled positions and applicants who are certified as SOAP‑eligible by NRMP.

You cannot participate in SOAP unless you are:

• Registered for the Match,
• Unmatched or partially matched, and
• Marked SOAP‑eligible in your NRMP account.

Q2: How can I best prepare for SOAP while I’m still waiting for Match results?

You should start SOAP preparation before Match Week, even if you’re hopeful you will match:

• Update your CV, personal statements, and ERAS application.
• Meet with advisors to discuss realistic backup specialties and strategies.
• Review NRMP and ERAS SOAP resources and deadlines.
• Build a general list of target program types and geographic regions.
• Prepare email templates and interview answers that can be tailored quickly.

Being prepared does not make you pessimistic—it makes you professional and ready for any outcome.

Q3: Can I contact residency programs directly during SOAP?

There are strict NRMP rules governing communication during SOAP:

• Before SOAP begins: You generally may not contact programs about unfilled spots because the list is not yet released.
• During SOAP:
  • Programs may contact you to request interviews or more information.
  • You must follow current NRMP rules about initiating contact; these can change slightly year to year, so always check the current SOAP communication guidelines.
• Best practice:
  • Use your school’s advisors or mentors to advocate on your behalf when appropriate.
  • Be professional and concise in all communications if and when direct contact is permissible.

Violating NRMP communication policies can jeopardize your eligibility, so always verify current rules.

Q4: What if I go unmatched even after SOAP? Is my medical career over?

No. Not matching—either in the main Match or SOAP—is a significant setback, but it is not the end of your medical career.

If you remain unmatched:

• Meet with advisors to perform a thorough post‑mortem on your application.
• Develop a 12–24 month plan to strengthen your candidacy:
  • Additional clinical experience or observerships.
  • Research, quality improvement, or public health work.
  • Exam improvement or addressing prior failures.
• Consider alternative or adjacent paths:
  • Reapplying to a different specialty.
  • Pursuing roles in clinical research, public health, health policy, or medical education if repeating the Match is not feasible.

Many physicians with excellent careers have taken non‑linear paths. What matters most is how you respond, learn, and adjust.

Q5: Is it a good idea to accept a preliminary or transitional year position through SOAP?

It can be, but it depends on your situation and goals:

Potential advantages:

• Keeps you in clinical training and actively building your skills.
• Allows you to obtain strong letters from US residency faculty.
• Demonstrates resilience, professionalism, and growth.

Considerations and cautions:

• A prelim year does not guarantee entry into a categorical spot.
• You’ll need a clear plan for how and when you’ll reapply during your prelim year.
• Be realistic about the workload; balancing residency duties with a reapplication can be challenging.

Discuss with advisors and, if possible, with residents who have taken this path to understand the pros and cons in the context of your specific profile and long‑term career development goals.

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For more on Residency, SOAP, and career planning in medical education, you may also find these resources helpful:

• “Maximizing Your ERAS Application: Essential Tips for Success”
• “Understanding the NRMP Match Process”
• “Exploring Fellowship Opportunities: A Pathway to Your First Job as a Physician”