Essential SOAP Preparation Guide for DO Graduates in Ophthalmology

Understanding SOAP for the DO Ophthalmology Applicant

For DO graduates interested in ophthalmology residency, preparation for the Supplemental Offer and Acceptance Program (SOAP) is as strategic as preparing for the main ophtho match itself. Even strong applicants can end up in SOAP due to the extreme competitiveness of ophthalmology, shifting program needs, or simple bad luck. Your success in SOAP residency opportunities will depend heavily on what you do before Match Week, not just during it.

This guide focuses on SOAP preparation specifically for a DO graduate pursuing ophthalmology, but much of the strategy applies broadly. You’ll learn what SOAP is, why ophthalmology applicants (especially DOs) need a robust backup plan, and how to build and execute a SOAP strategy that maximizes your chances of matching into a strong, fulfilling program—ophthalmology or otherwise.

Along the way, we’ll weave in key phrases like DO graduate residency, osteopathic residency match, SOAP residency, what is SOAP, and SOAP preparation so you can also better navigate online resources.

---

1. What Is SOAP and Why It Matters for DO Ophthalmology Applicants

1.1 What is SOAP?

The Supplemental Offer and Acceptance Program (SOAP) is the National Resident Matching Program’s (NRMP) structured process to fill unfilled residency positions after the initial main match list is processed. It’s not a free-for-all scramble like in the past; it’s regulated, timetable-driven, and electronic.

Core points:

• Eligibility:
  • You must be unmatched or partially matched after the initial match algorithm runs.
  • You must be registered for the NRMP Match and certified your rank list.
  • You need an ERAS application that can be sent to programs.
• Process:
  • Monday of Match Week: You learn if you matched (but not where). If you are unmatched/partially matched, you become SOAP-eligible.
  • A list of programs with unfilled positions is released.
  • Multiple SOAP rounds of applications and offers take place Monday–Thursday.
  • You can apply only through ERAS; direct program contact (outside allowed windows) is prohibited by NRMP rules.

SOAP residency positions are primarily categorical and preliminary PGY-1 roles in fields like internal medicine, family medicine, pediatrics, transitional year, and sometimes less competitive surgical or subspecialty pathways. Ophthalmology PGY-1 slots may appear occasionally, but PGY-2 ophthalmology openings through SOAP are rare.

1.2 Why DO Ophthalmology Applicants Are at Higher Risk for SOAP

Ophthalmology is one of the most competitive fields, and historically, DOs have faced additional barriers:

• Competitive metrics:
  • Ophthalmology applicants (MD and DO) frequently have very strong USMLE/COMLEX scores, research, and letters.
  • As a DO, you may face higher thresholds at some historically ACGME ophthalmology programs, even post-merger.
• Program bias/policies:
  • Some ophthalmology programs still do not consider DOs, or only rarely.
  • Others require USMLE scores in addition to COMLEX.
• Limited spots:
  • Ophthalmology residency positions are limited nationwide.
  • Small changes in the application pool can significantly swing match outcomes.

All of this means a DO graduate targeting an ophthalmology residency match should assume a non-trivial chance of going into SOAP, even with a reasonably strong profile. Proactive SOAP preparation is not pessimism; it’s strategic risk management.

1.3 Key Differences: Main Ophtho Match vs SOAP Phase

Ophthalmology has historically participated in a separate match (SF Match). Many applicants now navigate both:

• Ophthalmology match (through SF Match):
  • Usually occurs earlier than the NRMP main match.
  • Determines PGY-2 ophthalmology positions (many programs pair with a PGY-1 year; others require you to secure an intern year separately through NRMP).
• NRMP main match + SOAP:
  • Typically for your PGY-1 (intern) year or for non-ophthalmology categorical programs.
  • SOAP is the backup mechanism if you do not match into a PGY-1 or categorical position.

For a DO grad set on ophthalmology, you might end up in SOAP in several scenarios:

• You matched ophtho PGY-2 but failed to match PGY-1 in the main match.
• You didn’t match ophthalmology at all (SF Match) and are now looking for a SOAP residency alternative.
• You aimed for ophtho and a small set of prelim options and simply over-reached.

Whatever the path, anticipating SOAP and preparing early can preserve your career momentum and emotional stability when Match Week arrives.

---

2. Building a SOAP-Ready Strategy as a DO Ophthalmology Applicant

2.1 Clarify Your Hierarchy of Career Goals

Before you can prepare for SOAP effectively, you must understand your personal hierarchy of acceptable outcomes:

1. Top goal: Ophthalmology categorical training (PGY-2 ophtho + secure PGY-1 year).
2. Secondary goals (examples):
   • Any PGY-1 (prelim medicine, prelim surgery, transitional year) while planning a re-application to ophthalmology.
   • A categorical spot in another specialty you would find fulfilling (internal medicine, neurology, radiology, etc.).
3. Floor options: Positions you would take if needed to keep moving forward (e.g., community IM, FM), while exploring pathways back to ophthalmology or into a related field.

Write this down before Match Week. When the adrenaline of SOAP is high, you’ll be grateful for a clear, pre-committed decision framework.

2.2 Develop a Target List of SOAP-Appropriate Specialties and Programs

You cannot know exactly which programs will have unfilled seats, but you can identify categories of programs you’d aggressively pursue if you land in SOAP:

1. PGY-1 only (if you matched ophtho PGY-2):

   • Transitional year programs
   • Preliminary internal medicine
   • Preliminary surgery
   • Prelim positions at institutions with ophthalmology departments (potential networking)

2. Categorical non-ophthalmology options (if you did not match ophtho):

   • Internal medicine (particularly academic/community hybrid programs)
   • Family medicine (if acceptable to you)
   • Pediatrics or neurology in institutions with strong ophthalmology or neuro-ophthalmology connections
   • Less competitive surgical prelims where you can gain operative and ophthalmic exposure

For a DO graduate residency applicant, you should prioritize osteopathic-friendly institutions that have a history of taking DOs:

• Review past match lists from your medical school to identify DO-friendly programs.
• Use program websites and FREIDA filters indicating DO-friendly or “DO accepted.”
• Ask mentors or recent grads which programs are historically open to DOs.

Create a spreadsheet that includes:

• Program name, specialty, location
• DO friendliness (high/medium/low)
• Your level of interest (1–3)
• Any personal connections (alumni, rotations, faculty ties)

You’ll use this to quickly filter and select SOAP targets once the unfilled list is posted.

2.3 Decide on a Re-Application vs Alternate Specialty Path

If you don’t match ophthalmology, you have three realistic trajectories:

1. Re-apply to ophthalmology with a strong PGY-1 foundation
   • Choose a PGY-1 with heavy medicine/surgery exposure, research options, and ophthalmology contacts.
   • Plan research time in ophthalmology or vision science during or after intern year.
2. Transition into a related specialty with overlap
   • Internal medicine → potential cards, heme-onc, or rheum with ocular overlap.
   • Neurology → neuro-ophthalmology collaboration.
   • Radiology → neuroimaging/ophthalmic imaging.
3. Commit to a different long-term specialty
   • Some applicants find unexpected satisfaction in primary care or hospital medicine such that they choose not to re-apply ophtho.

Discuss this honestly with mentors before Match Week so your SOAP preparation is aligned with realistic long-term goals.

---

3. Pre–Match Week SOAP Preparation: Documents, Mindset, and Messaging

3.1 Keep a SOAP-Ready ERAS Application

Your ERAS application for the main match must be adaptable to SOAP residency needs. You won’t have much time during SOAP to make major edits, so prepare now:

• Personal statement(s):
  • Keep your ophthalmology personal statement as-is, but draft at least one additional generic statement for:
    • Internal medicine / transitional year
    • Or your chosen alternative field
  • Emphasize broadly applicable qualities: clinical reasoning, work ethic, teamwork, bedside manner.
• Experiences section:
  • Ensure descriptions are not overly narrow to ophthalmology. Frame skills in a way that generalizes (e.g., “multi-disciplinary care,” “procedural skills,” “evidence-based decision-making”).
• Letters of recommendation:
  • Have at least 1–2 non-ophthalmology letters (e.g., from internal medicine or surgery attendings) already uploaded to ERAS.
  • SOAP programs may prefer letters that show you can perform broadly as an intern.

3.2 Tailor a SOAP-Appropriate CV Narrative

SOAP programs are evaluating:

• Can this applicant hit the ground running as an intern?
• Are they safe, reliable, and teachable?
• Will they bring professionalism and humility after a possibly disappointing match outcome?

As a DO graduate, you also want to subtly highlight strengths of osteopathic training:

• Emphasis on holistic care and communication
• Broad clinical exposure and hands-on patient care
• Flexibility and adaptability in diverse clinical environments

Be ready with a concise 2–3 sentence elevator pitch you can use on calls or emails (when permitted):

“I’m a DO graduate with strong clinical evaluations across internal medicine and surgery, high board scores, and significant research experience in ophthalmology. While my long-term interest remains in visual and neurologic sciences, my immediate priority is to contribute as a reliable, hardworking intern who takes excellent care of patients and supports the team.”

3.3 Mental and Emotional Preparation

SOAP is emotionally charged, especially for applicants who aimed for competitive fields like ophthalmology. To function effectively, prepare your mindset:

• Normalize SOAP:
  • Many excellent applicants, including those who later become subspecialists, start their careers via SOAP.
• Prepare your support system:
  • Identify 1–2 trusted people you can talk to that week: mentor, advisor, close friend, or family member.
• Set expectations:
  • Decide in advance: “If I’m in SOAP, my goal is to secure the best available training, even if it’s not ophthalmology.”
  • Remind yourself that your identity and future are not defined by one match outcome.

Consider scheduling a pre–Match Week advising session with your dean’s office or ophthalmology mentor specifically about SOAP planning.

---

4. Step-by-Step Action Plan During Match Week SOAP

4.1 Monday Morning: You Learn You Are Unmatched or Partially Matched

On Monday of Match Week, NRMP informs you whether you:

• Matched (fully)
• Partially matched (e.g., only advanced position, only preliminary)
• Unmatched

If you’re SOAP-eligible, you’ll gain access to the List of Unfilled Programs.

Immediate steps:

1. Control your environment:

   • Find a quiet, private space.
   • Limit social media.
   • Have your advising contacts available.

2. Clarify your status:

   • If you matched an ophthalmology PGY-2 position but no PGY-1:
     • Your SOAP focus becomes preliminary or transitional year positions.
   • If you matched nothing:
     • You may aim for categorical non-ophtho and/or prelim spots depending on your long-term plan.

4.2 Reviewing the Unfilled List Strategically

When the list opens:

• Filter by:
  • Specialty (IM, TY, prelim surgery, FM, etc.)
  • Geography (be flexible; location is a secondary concern in SOAP)
  • Program type (academic, community)
  • DO friendliness (use your pre-made spreadsheet)

Quickly categorize programs:

• Tier 1: DO-friendly, acceptable specialty, reasonable geography, stable reputation.
• Tier 2: Acceptable specialty, more distant or less ideal location, or unknown DO-friendliness.
• Tier 3: Last-resort programs (geography/fit not ideal but still acceptable if no other options).

Remember NRMP rules about the maximum number of programs you can apply to in SOAP (historically 45, but always verify current rules each year).

4.3 Customizing Applications Under Time Pressure

You may not have the luxury to craft bespoke personal statements for each program, but you can:

• Use your generic IM/TY statement or your alternative specialty statement.
• Quickly modify a short paragraph at the top or bottom with:
  • Program name
  • Why the specialty and setting fit your goals
  • Any regional ties

Example SOAP paragraph for an internal medicine program:

“Although my original match plans centered on ophthalmology, I have consistently valued the internal medicine foundation that underpins high-quality patient care. Your program’s strong inpatient curriculum, diverse patient population, and emphasis on teaching hospitalist medicine align well with my long-term goals, whether I ultimately pursue subspecialty training or remain a general internist.”

4.4 Communication With Programs: What’s Allowed?

NRMP has strict rules about communication during SOAP:

• You may not reach out to programs unsolicited before they contact you (check yearly rules; they evolve).
• If programs contact you:
  • Respond promptly and professionally.
  • Be ready to discuss your interest, background, and SOAP situation openly but positively.

Sample answer to “Why are you in SOAP?”:

“I applied mainly to ophthalmology, which is extremely competitive, and I limited my non-ophthalmology choices to a small number of programs. While I didn’t match, my clinical performance and evaluations have been strong, and I’m excited about the opportunity to contribute as an intern in your program. I believe I can bring the same focus, work ethic, and teamwork that I applied to my ophthalmology pursuits.”

Avoid:

• Sounding bitter or blaming.
• Over-emphasizing that you’ll “just re-apply to ophtho and leave,” which may make programs wary of your commitment.

4.5 Managing Offer Rounds Wisely

SOAP happens in multiple offer rounds:

• Programs submit rank lists of SOAP-eligible applicants they would be willing to take.
• You receive offers at set times and must accept or reject within a short window.
• Once you accept a position, you’re out of SOAP.

Decision tips:

• Revisit your pre-defined hierarchy of acceptable outcomes.
• Don’t decline a solid offer on the hope of something better later unless:
  • You have clear evidence that better options will likely come.
  • Your advisors strongly agree it’s a reasonable risk.

In a very competitive year, taking a good but not perfect internal medicine, family medicine, or transitional year spot may be the difference between moving forward and not training at all.

---

5. Post-SOAP Pathways: Rebuilding and Re-Positioning for Ophthalmology

5.1 If You Secure a PGY-1 Only and Still Hold an Ophthalmology PGY-2 Spot

If you matched ophtho PGY-2 but needed SOAP for your PGY-1:

• Congratulations—your ophthalmology trajectory is intact.
• Use your PGY-1 to:
  • Build strong general medical skills.
  • Seek opportunities in ophthalmology consult services, if available.
  • Maintain contact with your future ophtho program and mentors.

5.2 If You SOAP Into Another Specialty but Still Want Ophthalmology

This is more complex but not impossible. You’ll likely face:

• Increased scrutiny when re-applying.
• Questions about your commitment and timing.

Your strategy:

1. Perform exceptionally in your SOAP residency:
   • Being a top resident is more important than chasing short-term ophtho research at the cost of performance.
2. Stay connected to ophthalmology:
   • Develop relationships with local ophthalmologists.
   • Seek elective time or scholarly projects with an ophtho flavor (e.g., diabetic retinopathy outcomes).
3. Engage mentors early:
   • Ask trusted faculty if a re-application is realistic based on your performance, metrics, and the current ophtho landscape.

5.3 If You SOAP Into Another Specialty and Choose Not to Re-Apply Ophtho

This is a legitimate and often healthy choice. Many physicians discover:

• A deep love for hospital medicine, primary care, pediatrics, anesthesia, or radiology.
• That the daily life in another field matches their personality and values better than they had predicted.

If you make this decision:

• Invest fully in your chosen specialty.
• Pursue subspecialties that might still overlap with visual or neurologic systems (e.g., neuro-ophthalmology collaborations from neurology or internal medicine).

5.4 If You Don’t Match in SOAP at All

Not matching in SOAP is devastating but not the end of your medical career. Your next steps may include:

• Research or clinical fellowship years:
  • Especially in ophthalmology or vision science if you plan to re-apply.
  • Work with academic mentors who can help reposition you.
• Additional degrees or training:
  • MPH, MS in clinical research, etc., when aligned with a clear strategy.
• Re-assessment of goals:
  • A frank discussion with advisors about the feasibility of another ophtho attempt vs pivoting to less competitive fields.

Regardless of the outcome, seek structured support—from your school, mentors, professional counseling resources, and peer networks.

---

6. Practical Tips and Common Pitfalls in SOAP Preparation for DO Ophtho Applicants

6.1 Actionable Preparation Checklist (Pre–Match Week)

• Clarify your career hierarchy (ophtho vs alternate paths).
• Create a SOAP target program spreadsheet including DO-friendly programs.
• Draft at least one non-ophtho personal statement (IM/TY or alternate specialty).
• Ensure you have 1–2 non-ophtho letters in ERAS.
• Practice a brief, positive explanation of why you’re in SOAP.
• Meet with an advisor or mentor to review your SOAP plan.
• Prepare mentally: schedule self-care and social support for Match Week.

6.2 Mistakes to Avoid

• Relying on ophtho only, with no backup:
  • Even excellent DO applicants can end up unmatched.
• Ignoring DO-friendliness in your SOAP plan:
  • Targeting programs with a strong history of taking DOs improves odds.
• Being overly rigid about geography:
  • If you’re in SOAP, prioritize training quality and opportunity over location.
• Sounding resentful or disengaged on calls:
  • Programs want resilient, professional trainees, not applicants stuck in disappointment.
• Turning down a solid offer based on wishful thinking:
  • Discuss decisions in real-time with mentors during SOAP rounds.

6.3 Leveraging Osteopathic Strengths During SOAP

As a DO graduate in SOAP:

• Highlight your training in Osteopathic Principles and Practice (OPP):
  • Emphasize patient-centered, holistic assessment and communication.
• Mention your broad clinical exposure:
  • Many DO curricula emphasize early and frequent patient care.
• Showcase adaptability:
  • Many DOs have rotated across varied community and academic environments—this is attractive to programs looking for flexible interns.

By leaning into these strengths, you position yourself as a valuable addition to any residency team, regardless of specialty.

---

FAQ: SOAP Preparation for DO Graduate in Ophthalmology

1. As a DO, how realistic is it to match ophthalmology after going through SOAP?

It’s challenging but not impossible. Your chances depend on:

• The strength of your original application (board scores, research, letters).
• How well you perform in whatever residency or PGY-1 you enter through SOAP.
• The mentorship and advocacy you secure in ophthalmology afterward.

Many programs prefer applicants who show resilience, maturity, and excellent performance as residents. If you remain committed, build a strong track record, and maintain ophtho involvement (research, electives, networking), a re-application can be viable.

2. Should I apply broadly to SOAP residency positions in any specialty, or only those that align with my long-term goals?

Balance breadth with realism:

• Include enough programs/specialties to maximize your chances of matching.
• Prioritize specialties you can genuinely see yourself practicing if a second ophtho attempt doesn’t work out.
• For many DO ophtho applicants, a broad mix of internal medicine, transitional year, and maybe family medicine or neurology provides both flexibility and reasonable satisfaction.

Avoid applying to specialties you are certain you wouldn’t want to train in; programs seek committed residents.

3. How do I explain being in SOAP to programs without hurting my chances?

Be candid, concise, and positive:

• Acknowledge that you targeted a highly competitive field (ophthalmology) and limited your non-ophtho applications.
• Emphasize your strong clinical performance, professionalism, and eagerness to contribute in their specialty.
• Avoid blaming others or sounding bitter; instead, frame SOAP as an opportunity to prove yourself.

Programs understand that many SOAP applicants aimed for competitive specialties. They care most about how you’ll perform for them now.

4. Is it better to SOAP into a transitional year or a categorical internal medicine program if I still want ophthalmology?

It depends on your long-term goals:

• Transitional year or prelim IM/surgery:
  • Good if you have a strong, realistic plan to re-apply ophthalmology soon.
  • Maximizes flexibility but carries risk if the next match also doesn’t work.
• Categorical internal medicine (or similar):
  • Offers a stable long-term path if re-applying ophtho is not successful.
  • You can still maintain some ophtho involvement while securing a full training pathway.

Discuss specifics with mentors; your exact board scores, research profile, and prior ophtho application strength will heavily influence this decision.

---

By taking SOAP preparation seriously as part of your ophthalmology residency strategy, you protect your future regardless of a single match outcome. Thoughtful planning, honest self-assessment, and proactive use of your strengths as a DO graduate can turn a stressful SOAP week into a pivotal step toward a meaningful, successful medical career—whether inside or adjacent to the field of ophthalmology.