Already Completed a Prelim Year: How to Use SOAP for Categorical

It’s Monday of Match Week. You’ve already done a full prelim year (or you’re about to finish it). You logged in expecting either a categorical match or at least a PGY‑2 spot. Instead, the screen hits you:

“You are NOT matched to any position.”

And now everyone is yelling “You can SOAP into categorical. You’ll be fine. Just SOAP.”

Here’s the real situation: SOAP is not designed for people in your exact lane, but you can absolutely use it. You just have to be strategic and brutally realistic in about 48 hours.

I’m going to walk you through exactly how to handle this as someone who’s already completed (or nearly completed) a prelim year and wants a categorical spot.

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1. Reality Check: What You’re Up Against

First, get clear on what SOAP is and what it is not.

SOAP gives you access to unfilled positions after the main Match. Those positions are:

• Mostly categorical IM, FM, psych, peds, prelims, and some transitional
• A smattering of categorical surgery, OB, EM, etc. (but not many)
• Often in less desirable locations or newer/less-known programs

You’ve got one big advantage and one big disadvantage.

Advantage:
You already survived intern year. You know how to write notes, admit patients, call consults, manage cross-cover. Programs love someone who can hit the ground running.

Disadvantage:
You’re in a weird in-between category. You’re technically PGY‑2 level in terms of training, but you’re applying to mostly PGY‑1 categorical spots through SOAP. Many programs will wonder:

• “Is this person going to be bored repeating intern year?”
• “Are they weak academically and that’s why they only got a prelim?”
• “Are there visa or professionalism issues we’re stepping into?”

Your job in SOAP is to flip the narrative quickly:

“I did a prelim year, proved I can perform, and now I’m fully committed to your specialty and your program long term.”

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2. Clarify Your Ask: What Are You Actually Trying to Get?

You have three realistic paths:

1. Categorical PGY‑1 spot in your target specialty
   Example: Did prelim IM, now want categorical IM or psych.

2. Categorical spot in a different, more attainable specialty
   Example: Did prelim surgery, now going for categorical IM/FM/psych.

3. Another prelim year (last resort / bridge)
   Example: Take another prelim IM year while you re‑apply for categorical later or try to convert internally.

Let me be blunt:
If you insist on SOAPing into categorical general surgery, ortho, derm, plastics, ENT, or similarly competitive specialties after a prelim year, your odds are microscopic. Not zero. But close.

If your primary goal is to have a stable categorical residency and finish training, then target specialties that actually have unfilled categorical spots in SOAP most years:

Specialty	Categorical Spots in SOAP (Typical)	Relative Attainability
Internal Medicine	Many	Higher
Family Medicine	Many	Higher
Psychiatry	Moderate	Moderate-High
Pediatrics	Moderate	Moderate
General Surgery	Few	Low

You have to decide right now:
Are you chasing a specific specialty at all costs, or are you chasing a career as a boarded physician with the training you already have?

There’s no “right” answer. But pick one. Your SOAP list has to reflect that choice.

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3. Prep Before the List Drops (Or As Soon As You Can)

If it’s already Monday morning and you just found out you didn’t match, you have only a few hours until the SOAP-eligible program list appears. Use every minute.

Step 1: Inventory what you have

• Updated CV with your prelim year clearly listed, duties, and any praise/awards
• Personal statement draft(s) – one for your target specialty, maybe a second for backup specialty
• At least one strong letter from your prelim PD or APD
  If you don’t have that, email or text them immediately:
  “I didn’t match into a categorical position. I’ll be entering SOAP and would be grateful for a brief letter focusing on my performance this year. I’m targeting categorical IM/FM/psych/etc.”

Step 2: Talk to your prelim PD / chief / trusted attending

This is not optional. Do not ghost them and try to SOAP in the dark.

What you say:

• “I didn’t match into categorical.”
• “I’m going to SOAP. My priorities: [specific specialty, geographic flexibility level].”
• “Would you be comfortable supporting me if programs call?”

What you want from them:

• Clear sense of how they’ll describe you (strong, average, “fine but…”)
• Realistic guidance on where you should aim (they often know who went unfilled)
• Permission to list them as a contact for programs during SOAP

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4. Building Your SOAP Strategy: Breadth vs. Specificity

Once the unfilled positions list drops, the clock starts.

You can apply to up to 45 programs total in SOAP. Those go fast.

Here’s how to think:

1. Pick 1–2 primary specialties
   Usually:

   • Your original target (if at all realistic), plus
   • A more attainable one you’d accept long term

2. Decide your geographic flexibility
   If you say “I only want West Coast university programs,” accept that you might not match. If you can say, “I’ll go anywhere for categorical,” your odds jump.

3. Segment your 45 slots

Example breakdown for someone with a prelim IM year:

• 25–30: Categorical IM programs (broad geography, some community, some university)
• 10–15: FM, psych, peds categorical spots
• 0–5: A few prelim spots in strong programs as pure backup (if you’re willing to do another prelim with a serious plan)

If you did a prelim surgery:

• 0–5: Any realistic categorical surgery (maybe 1–2 per region)
• 25–30: Categorical IM/FM/psych (where your prelim surgery work actually looks solid)
• 5–10: Transitional/prelim medicine if you’re okay with that as a bridge

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5. How to Present Your Prelim Year in SOAP

Every program reading your SOAP application will ask themselves:

“Why did this person only have a prelim, and why are they here in SOAP now?”

You have to answer that before they ask. In your ERAS entries and especially your personal statement.

Write a targeted SOAP personal statement

This is not the time for a generic “I have always wanted to be a doctor” essay.

You need three things:

1. A concise origin story for your prelim status
   Examples:

   • “I initially matched to a preliminary internal medicine year while reapplying to categorical IM after a late decision to switch from radiology.”
   • “Due to a late specialty change and limited interviews, I matched into a prelim surgery year with the intention of reapplying categorical.”

2. A clear statement of what you want now

   • “I am now seeking a categorical internal medicine position where I can build on my intern year foundation and commit to a long-term home.”
   • “My experience this year confirmed that I want to train in psychiatry/family medicine/etc.”

3. Evidence that you are functional and low-drama
   Mention:

   • Strong multisource feedback
   • Comfort with cross-cover
   • Specific responsibilities (ICU nights, admissions volume, etc.)
   • Any concrete praise (“identified early as a resident we could rely on”)

Do not:

• Blame your current program
• Trash talk anyone
• Over-explain the failed match with a long sob story

Keep it simple, adult, and forward-looking.

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6. Program Targeting: Where Your Prelim Year Actually Helps

Your prelim year is most attractive to:

• Programs that are chronically short-staffed
• Community programs that need someone clinically ready
• Programs that lost a resident mid-year and are trying to avoid that again

Red flags for you (but also opportunities if you’re willing):

• High workload, low handholding environments
• Places with reputation for scut and chaos
• New programs still stabilizing

Why might you still consider them? Because you’re not starting from zero. You’re not an M4 any more. You can survive hard work if it leads to a categorical slot and a board certification.

Look for:

• IM/FM/psych/peds programs that explicitly mention:
  • “Will consider candidates with prior GME experience”
  • “Open to PGY‑1 repeats with prelim backgrounds”
• Surgery programs (rarely) that:
  • Have had prelims convert historically
  • Have unfilled PGY‑2 or PGY‑3 spots posted outside SOAP (keep an eye there too)

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7. Communication During SOAP: How to Stand Out Fast

SOAP has strict communication rules. You cannot cold-call everyone and spam. But once programs contact you, you need to be ready.

Here’s the script structure when they call or email:

1. Thank them & clarify level

   “Thank you so much for reaching out. I’m currently completing a preliminary [IM/surgery/etc.] year at [Hospital]. I’m very interested in your categorical [specialty] position.”

2. Address the prelim head-on

   “I initially matched into a prelim position due to [brief, neutral explanation], and this year has confirmed that I want to continue in [specialty]. I’m comfortable functioning at an intern level and would be glad to repeat PGY‑1 as part of a categorical track.”

3. Hit your strengths from this year

   Short, concrete examples:

   • “I’ve managed 8–10 patients on a busy teaching service, cross-covered up to 60 patients overnight, and have strong evaluations from my PD and ICU attendings.”
   • “My PD has offered to speak on my behalf; I’ve consistently been rated as reliable with excellent work ethic.”

4. Signal commitment and low-risk profile

   Programs are terrified you’ll leave again.

   • “I’m looking for a program where I can stay through graduation. I’m not reapplying to other specialties; I want to settle and grow with one team.”

If they offer a brief SOAP “interview” (phone/Zoom):

• Sit somewhere quiet.
• Dress at least business casual on Zoom.
• Have your story tight: 2–3 minutes max on “Why prelim? Why here now?”

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8. Dealing With the Emotional Side (While Still Being Ruthlessly Practical)

You’re probably exhausted. You finished night float last week, your co-interns are celebrating their PGY‑2 contracts, and you’re trying not to cry in the call room.

You don’t have time for a full breakdown this week. You can do that Saturday.

For now:

• Tell 1–2 people you trust exactly what’s happening.
• Avoid announcing it to the entire program yet. You don’t need everyone’s opinions.
• Sleep when you can. Eat something that’s not from the vending machine.

You have a short window to make rational decisions instead of emotional ones. Do not:

• Rage-apply to 45 random programs with no plan.
• Refuse to consider any specialty except your dream one if the numbers clearly say no.
• Ghost your prelim program because you feel ashamed. That will hurt you more than anything.

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9. If You Strike Out in SOAP: What Next?

Let’s be blunt: sometimes even with a prelim year, you don’t land a categorical in SOAP.

If that happens, you still have moves.

Option 1: Late-cycle open positions (outside SOAP)

After SOAP ends, programs sometimes:

• Lose someone in April–June
• Get extra funding
• Realize an incoming intern cannot start (visa, personal, etc.)

PDs email around. GME offices post late openings. You:

• Email programs in your target specialties with a tight, respectful note + CV
• Have your prelim PD send a short, direct email to a few PDs they know
• Watch the AMA/FREIDA postings and program websites

Option 2: Extend or repeat a prelim / non-categorical year strategically

Some prelim programs:

• Let strong prelims continue as “PGY‑2 prelims” or “hospitalists in training”
• Convert prelims to categorical when a spot opens

You do not bank on this. But you ask clearly:

“Is there any chance of conversion to categorical IM here in the next year or two if I continue to perform well?”

Get a straight answer. If they say “Never happens,” believe them. If they say “It has happened once or twice,” decide if that gamble is worth another year of your life.

Option 3: Step back, reframe, and reapply next cycle with a plan

Sometimes the best move is:

• Finish your prelim year strong
• Work as a hospitalist/clinical fellow/research fellow if allowed
• Fix whatever hurt you (Step 2 score, weak letters, no clear specialty commitment)
• Reapply early and broadly next year outside SOAP, where you can control the narrative much more

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10. Concrete Timeline: What Your Week Looks Like

Here’s how this typically shakes out, practically:

SOAP Week Timeline for Prelim Resident

Period	Event
Monday - 10	00 - Learn you did not match
Monday - 10	30 - Confirm SOAP eligibility and update ERAS
Monday - 12	00 - Call prelim PD and key attendings
Tuesday - 09	00 - Unfilled list released, build target list
Tuesday - 12	00 - Finalize personal statement and CV
Tuesday - 15	00 - Submit first wave of SOAP applications
Wed-Thu - 09	00 - Answer program contacts quickly
Wed-Thu - 12	00 - Do brief SOAP interviews
Wed-Thu - 16	00 - PDs talk to each other, reference checks
Thursday - 12	00 - SOAP offers rounds
Thursday - 15	00 - Accept best categorical offer

Have your phone charged, your email open, and your PD on speed dial. This week is sprinting, not jogging.

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11. Visual: Where Your Time Should Go During SOAP

Time Focus During SOAP Week After a Prelim Year

Category	Value
Application Targeting	40
Communication with PDs/Programs	30
Document Editing (PS/CV)	20
Emotional Spiral/Distraction	10

Your goal is to keep that “emotional spiral” slice as small as possible until offers are done.

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12. Tailoring By Specialty Background

If you did a prelim IM year

You’re actually in the best position.

Leverage:

• Directly target categorical IM in a wide range of locations.
• Secondary list: FM, psych, peds if you’re open.

Pitch:

• Experience with bread-and-butter IM: CHF, COPD, DKA, sepsis.
• Strong evals and interest in outpatient continuity clinic if going IM/FM.

If you did a prelim surgery year

Harder, but still workable.

Leverage:

• Your ability to manage sick inpatients, pre/post-op, ED evaluations.
• Target: categorical IM/FM/psych/peds, maybe EM if slots exist and you’re plausible.

Be honest:

• “I realized I want more longitudinal patient relationships / less OR, more medicine.”
• “I enjoy the critical thinking and continuity more than procedures alone.”

If you did a transitional year

You’re flexible.

Leverage:

• Broad exposure: IM, outpatient, electives.
• Tailor your story to whichever specialty you now want categorical in.

Do not:

• Sound like you still have no idea what you want.
• Programs hate the “I liked everything, so I’ll do anything” pitch.

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13. Quick Comparison: Prelim vs Categorical SOAP Targeting

Prelim Type	Strongest SOAP Categorical Targets	Backup Plan
Prelim IM	IM, FM, psych, peds	Another prelim IM, late-cycle IM
Prelim Surgery	IM, FM, psych	Another prelim surgery only if clear path
Transitional Year	Specialty you have most rotations/letters in	FM/IM, late-cycle spots

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14. Two Non‑Negotiables That Make or Break You

1. Your prelim PD’s involvement matters more than you think.
   A 2-minute honest phone call from your current PD to a SOAP PD can move you from “maybe” to “offer.”

2. Your willingness to be geographically and specialty flexible is directly proportional to your chance of landing categorical.
   If you limit both, you’re gambling. Hard.

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FAQ (Exactly 3 Questions)

1. Can I get credit for my prelim year and start as a PGY‑2 in a categorical program through SOAP?

Sometimes, but don’t assume it. Most SOAP categorical spots are PGY‑1. A few programs may consider advanced standing after you start, especially if your prelim year aligns closely with their curriculum, but you should mentally and practically plan to repeat PGY‑1.

2. Should I apply to both categorical and prelim spots in SOAP?

Yes, but with priorities. Focus most of your 45 applications on categorical positions you’d genuinely join. Use a smaller portion (maybe 5–10) on strong prelim programs only if you’re willing to repeat a prelim year as a bridge with a realistic path forward.

3. How do I explain failing to match twice (pre-med prelim match, now SOAP) without sounding like a disaster?

Keep it short and adult: explain structural reasons (late specialty change, limited interviews, geographic restriction), own any missteps (applied too narrowly, overestimated competitiveness), then pivot hard to what you’ve proven this year: you function well as a resident, your PD supports you, and you’re now applying broadly and realistically for a stable categorical home.

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Key points to walk away with:

1. Use your prelim year as an asset: show you’re already a functional intern and low-risk hire.
2. Be brutally honest and flexible about specialty and geography if your top choice is highly competitive.
3. In SOAP, speed and clarity matter: tight story, strong PD advocacy, and a targeted (not random) list of programs give you the best shot at a categorical spot.