The Essential SOAP Preparation Guide for DO Graduates in Med-Peds

Understanding SOAP for the DO Medicine-Pediatrics Applicant

The week of the residency match can be stressful for any applicant, but it can be especially intense for a DO graduate interested in Medicine-Pediatrics (Med-Peds). If you do not initially match, the Supplemental Offer and Acceptance Program (SOAP) becomes your critical second chance.

As a DO graduate, you may have additional questions about how the osteopathic residency match landscape, the DO graduate residency pathway, and Med-Peds–specific factors intersect with SOAP. Knowing what is SOAP, how it works, and how to approach SOAP preparation strategically can make the difference between securing a position and ending the season without a spot.

This guide is designed specifically for:

• DO graduates targeting Med-Peds
• Applicants who want to be fully prepared before Match Week
• Those who want clear, step-by-step, actionable SOAP preparation strategies

We’ll walk through how SOAP works, how to get ready as a DO Med-Peds applicant, how to build your list, how to communicate with programs ethically and effectively, and how to keep future options open even if SOAP doesn’t lead to a Med-Peds position.

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1. What Is SOAP and How Does It Work for DO Med-Peds Applicants?

The Supplemental Offer and Acceptance Program (SOAP) is an organized, time-limited process through NRMP that helps unmatched or partially matched applicants connect with unfilled residency positions. For a DO graduate interested in Medicine-Pediatrics, understanding the structure and rules of SOAP is essential.

Who Is Eligible for SOAP?

You may participate in SOAP if:

• You are registered for the NRMP Main Residency Match, and
• You are unmatched or partially matched after the initial algorithm runs, and
• You are eligible for US residency training (meeting all NRMP and program requirements), and
• You are an MD or DO graduate (or equivalent international graduate) who has passed appropriate exams and has valid ECFMG certification (if applicable)

As a DO graduate:

• You must meet exam requirements for the programs you target (USMLE, COMLEX, or both, depending on program policies).
• Many programs in Internal Medicine, Pediatrics, and Medicine-Pediatrics accept DO graduates, but requirements vary.

Key SOAP Timeline and Phases

SOAP is time-compressed and structured. The exact times may change slightly each year, but the main phases remain:

1. Monday of Match Week – 11:00 AM ET

   • You learn your status: Matched, Partially Matched, or Unmatched.
   • If you are unmatched or partially matched, you may be SOAP-eligible.
   • The list of unfilled programs becomes available within ERAS (not public on NRMP).

2. Monday to Thursday – SOAP Window

   • You may submit applications through ERAS to unfilled programs (up to 45 programs total during SOAP).
   • Programs review applications and conduct phone or virtual interviews.
   • NRMP conducts up to four rounds of offers:
     • You either receive offers for positions or not in each round.
     • You can accept one offer at a time; once accepted, you are done with SOAP.

3. After SOAP Ends

   • Any remaining unfilled positions may be offered to applicants outside SOAP, but contacting programs before SOAP ends about these positions violates NRMP rules.

Why SOAP is Different from the Main Match

• Compressed timeline: Decisions must be made in hours, not weeks.
• Different programs may appear: Some Med-Peds programs may have unfilled spots, but there may be more unfilled positions in categorical Internal Medicine, Pediatrics, or other combined programs.
• Less emphasis on a tailored personal statement and more on a clear, concise snapshot of your candidacy.
• No direct cold-calling programs during SOAP: Contact is allowed only in response to program outreach, or if a program gives explicit instructions for communication.

For Med-Peds DO Applicants: Strategic Reality

Medicine-Pediatrics is a relatively small specialty, and many programs fill fully in the main match. In some years:

• Few or no Med-Peds residency spots are available during SOAP.
• However, there may be many unfilled categorical Internal Medicine and Pediatrics positions.

A realistic SOAP strategy for a DO Med-Peds applicant often includes:

• Monitoring the medicine pediatrics match landscape and Med-Peds fill rates historically.
• Preparing three tiers of targets:
  1. Med-Peds positions if available.
  2. Categorical Internal Medicine and Pediatrics (with potential for future Med-Peds–aligned careers, e.g., combined practice, hospitalist work with both adult and pediatric exposure).
  3. Transitional, prelim, or other categorical programs that still align with long-term goals.

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2. Pre–Match Week SOAP Preparation: What to Do Before You Need It

The best SOAP preparation starts months before Match Week. This is especially important for DO graduates in competitive or smaller fields like Med-Peds.

2.1. Honestly Assess Your Risk of Going Unmatched

As a DO Med-Peds applicant, risk is influenced by:

• Board scores (COMLEX and/or USMLE)
• Research and academic performance
• Number and type of programs you applied to
• Interview volume (how many interviews you received and where)
• Geographic restrictions (only applying in one area vs nationwide)
• Past attempts (reapplicants generally have a higher unmatched risk)

Red flags that you may be at higher risk:

• Fewer than ~10–12 interviews total (for a Med-Peds focused applicant).
• Multiple failed attempts on COMLEX or USMLE.
• Limited clinical experience in the U.S.
• Significant professionalism concerns.

If your risk feels moderate or high, you should plan for SOAP as though it will happen—even if you ultimately match.

2.2. Update and SOAP-Optimize Your Application Documents

Your ERAS application must be ready for rapid redeployment during SOAP:

1. Curriculum Vitae / ERAS Profile

   • Ensure all education, experiences, and publications are current.
   • Emphasize any dual-exposure roles: e.g., rotations with both adult and pediatric care, Med-Peds clinics, community-based experiences.
   • Highlight osteopathic strengths (whole-person care, OMT) when relevant, particularly for programs open to DO graduates.

2. Personal Statements For SOAP, prepare at least three versions:

   • A Med-Peds–specific statement.
   • An Internal Medicine–focused statement.
   • A Pediatrics–focused statement.

   Keep them:

   • Shorter and sharper than your primary application PS (1 page or slightly less).
   • Highly practical: emphasize reliability, teamwork, adaptability, and readiness to start July 1.
   • Flexible in tone, avoiding references that would exclude categorical positions (e.g., don’t write that you “only want Med-Peds and nothing else” in an IM or Peds statement).

3. Letters of Recommendation (LoRs)

   • Aim to have 3–4 solid letters that can apply to multiple settings:
     • At least one Internal Medicine letter.
     • At least one Pediatrics letter.
     • Ideally, a Med-Peds faculty letter if available.
   • Make sure letters are in ERAS and assigned correctly:
     • Use IM and Peds letters flexibly across categorical and Med-Peds applications.
   • For SOAP, you cannot easily obtain new letters, so pre-emptively getting strong generalist letters is key.

2.3. Research and Pre-Build a SOAP Program Strategy List

You cannot see the official list of unfilled programs before Match Week, but you can anticipate:

1. Identify Med-Peds Programs

   • Create a list of all Med-Peds programs nationwide.
   • Mark:
     • Programs that have historically accepted DOs.
     • Programs where your credentials reasonably match typical residents’ profiles.
   • Note: Many Med-Peds residencies fill entirely; your list is still useful if a few do not.

2. Identify Backup Categorical Options

   • Internal Medicine programs:
     • DO-friendly, community-based, and smaller academic programs may have higher odds of unfilled spots.
   • Pediatrics programs:
     • Children’s hospitals and community-based training sites sometimes have unfilled positions.
   • Consider programs that:
     • Accept DO graduates and COMLEX.
     • Are less geographically restricted.
     • Have a track record of training osteopathic physicians.

3. Create a Spreadsheet Include columns for:

   • Specialty (Med-Peds, IM, Peds, Transitional, etc.)
   • Program name and NRMP/ACGME code
   • DO-friendly (Y/N)
   • COMLEX vs USMLE requirements
   • Location and any personal ties
   • Preference level (e.g., Tier 1, 2, 3)
   • Notes on fit (e.g., heavy outpatient pediatrics, strong hospital medicine track, global health opportunities)

4. Rank Your Program Priorities Before the Stress Hits

   • Decide your philosophy:
     • Is your top priority to practice both adult and pediatric medicine?
       → You might prioritize Med-Peds (if available) and dual-exposure Peds or IM programs.
     • Is your top priority securing any ACGME position for this year?
       → You will cast a wider net with categorical IM and Peds, or even Transitional Year programs.

This advance work means that once the list of unfilled positions appears, you can quickly align available spots with your pre-planned spreadsheet and preferences.

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3. Match Week Execution: How to Navigate SOAP Step-by-Step

When Monday of Match Week arrives and you discover that you are eligible for SOAP, you must move efficiently and strategically.

3.1. Monday Morning: Confirm Status and Regroup

1. Log into NRMP at 11:00 AM ET to see:
   • Matched vs Unmatched/Partially Matched.
2. If SOAP-eligible, take 30–60 minutes to process emotionally.
   • Talk briefly with a trusted mentor, advisor, or Med-Peds faculty.
   • Avoid panic applications or defeatist thinking.

As a DO Med-Peds applicant, remind yourself:

• SOAP is a structured, legitimate route that many successful physicians have used.
• A non-traditional or SOAP-assisted route does not undermine your long-term Med-Peds–aligned career.

3.2. Identifying Available Programs and Matching to Your List

Once the list of unfilled positions is released in ERAS:

1. Filter for:
   • Internal Medicine-Pediatrics positions first.
   • Then Internal Medicine categorical.
   • Then Pediatrics categorical.
2. Cross-reference with your pre-built spreadsheet:
   • Highlight programs that are on your radar and currently have unfilled positions.
   • Star Med-Peds options (if any) as top priority.
3. Check program requirements quickly:
   • DO acceptance.
   • COMLEX vs USMLE requirements.
   • Visa needs (if applicable, for DO-IMGs or dual degree holders).

You can apply to up to 45 programs during SOAP, so choose wisely.

3.3. Prioritizing Applications: Med-Peds vs Categorical

For a DO graduate targeting Med-Peds, consider this tiered approach:

1. Tier 1: Med-Peds SOAP Positions (if present)

   • Apply to all Med-Peds positions that minimally fit your profile.
   • Use your Med-Peds–specific personal statement.
   • Highlight any Med-Peds rotations, combined clinics, or experiences caring for both adults and children.

2. Tier 2: Categorical Internal Medicine and Pediatrics

   • Next, identify:
     • DO-friendly IM and Peds programs.
     • Programs offering strong continuity clinics and broad exposure.
   • Decide on your distribution:
     • For example: 20 IM, 15 Peds, 10 Med-Peds (depending on availability and your goals).
   • Use specialty-specific personal statements.

3. Tier 3: Transitional Year or Other Specialties (if needed)

   • Consider these if:
     • Very few IM/Peds/Med-Peds spots remain OR
     • You have significant geographic constraints.
   • Understand the implications:
     • A transitional year can give you clinical experience and a new application cycle, but you’ll need to reapply for a categorical position later.

3.4. Completing and Submitting SOAP Applications in ERAS

• Ensure each program has:
  • Appropriate personal statement.
  • Appropriate letters of recommendation.
  • Correct document assignments (Med-Peds letters can often be used for IM and Peds).
• Avoid major last-minute edits to your main ERAS application:
  • Fix typos or obvious errors only.
  • Don’t introduce drastic changes that may confuse programs.

Timing matters:

• You do not gain an advantage by being the first to apply Monday.
• Do ensure all applications are submitted before programs start making interview decisions, typically later Monday or Tuesday.

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4. Communicating with Programs and Performing Well in SOAP Interviews

Communication during SOAP has specific rules and unique expectations. Programs are under time pressure just like you.

4.1. Understand SOAP Communication Rules

During SOAP:

• You may not initiate contact with programs about unfilled positions unless:
  • They have explicitly invited communication (e.g., via ERAS or posted contact instructions).
• Programs may contact you:
  • By email or phone for quick interviews.
  • To request additional information or clarify aspects of your application.
• After offers are released:
  • You may accept or reject offers through the NRMP system only.
  • You cannot “hold” multiple offers to decide later.

Stay current by reviewing NRMP’s official SOAP communication guidelines each year.

4.2. Preparing for Rapid-Fire SOAP Interviews

SOAP interviews are often:

• Short (10–20 minutes).
• Focused on:
  • Whether you can start on time and function well clinically.
  • Your genuine interest in the specialty and program.
  • Red flags or gaps in your application.

For a DO Med-Peds applicant, prepare concise responses to:

1. “Tell me about yourself and your interest in Med-Peds or this specialty.”

   • For Med-Peds:
     • Emphasize your desire to provide lifespan care, manage complex chronic conditions, and bridge transitions from pediatric to adult care.
   • For IM or Peds categorical:
     • Express genuine enthusiasm for that specialty alone—avoid sounding like it’s purely a backup.
     • Many DO graduates build outstanding careers in IM or Peds alone, even if they once considered Med-Peds.

2. “Why were you not successful in the main match?”

   • Avoid blaming others.
   • Offer a brief, honest, and non-defensive explanation:
     • Limited number of interviews.
     • Late exam scores.
     • Overly narrow geographic or specialty focus.
   • Follow with what you’ve learned and how you’ve grown.

3. “Why our program?”

   • Show you’ve done some homework, even in SOAP:
     • Reference program strengths (community-based care, strong continuity clinic, teaching hospital, osteopathic recognition if present).
     • Connect with your interests (primary care, hospital medicine, underserved populations, global health).

4. “What are your strengths and weaknesses as a resident?”

   • Highlight:
     • Reliability, work ethic, adaptability.
     • Communication with patients of all ages and backgrounds.
   • For weaknesses:
     • Choose something real but improvable (e.g., perfectionism slowing you down early in training).
     • Describe concrete steps you’re taking to improve.

4.3. Presenting Your DO Background as a Strength

As a DO graduate pursuing a DO graduate residency position through SOAP:

• Emphasize:
  • Training in holistic, patient-centered care.
  • Skills in physical diagnosis and OMT (when appropriate to program culture).
  • Experience treating both adult and pediatric patients, if your rotations included that.

Be prepared to answer:

• “Did you take USMLE in addition to COMLEX?”
  • If yes, share scores as appropriate.
  • If no, confidently explain that you met your degree requirements with COMLEX and focused on being clinically excellent.

4.4. Managing Offers and Making Decisions Under Pressure

If you receive offers during SOAP rounds:

1. Know your pre-set priority list.

   • Med-Peds > IM/Peds categorical > Transitional Year (if this is your personal hierarchy).

2. Consider long-term implications:

   • A categorical IM or Peds position:
     • Provides board eligibility in a core specialty.
     • Often still allows caring for age ranges you enjoy (e.g., adolescents in Peds or young adults in IM).
   • A Med-Peds spot:
     • Directly aligns with your dual-specialty goal.
   • A Transitional Year:
     • Short-term training that requires re-matching into a categorical spot later.

3. Once you accept an offer:

   • You are bound to that position.
   • You exit the SOAP process.
   • You must withdraw from the Main Match if the offer comes before Match Day results are released.

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5. If You Don’t Land a Med-Peds Spot: Smart Next Steps for DO Graduates

Some DO Medicine-Pediatrics applicants will not secure a Med-Peds or even a categorical IM/Peds position in SOAP. This is difficult, but not the end of your path.

5.1. If You Match into Another Specialty via SOAP

If you accept:

• Categorical IM:

  • You can still craft a career resembling Med-Peds in many ways:
    • Young adult and complex chronic disease care.
    • Med-Peds-style hospitalist roles focused on transitions from pediatric to adult services.
  • Some residents complete IM and later pursue additional training in Pediatrics (though formal dual-boarded paths after residency are complicated and uncommon).

• Categorical Pediatrics:

  • You can focus on:
    • Adolescent medicine.
    • Care of children with chronic conditions transitioning to adult systems.
  • Collaboration with adult medicine colleagues can make your practice feel Med-Peds–adjacent.

• Transitional Year or Other Categorical Position:

  • Use the year to:
    • Strengthen your clinical skills.
    • Build relationships and mentors who can support a future reapplication.
    • Improve board scores (if you have eligibility to retest or take USMLE if previously absent).

5.2. If You Do Not Match Through SOAP at All

You still have options:

1. Post-SOAP Period

   • Some programs may have remaining unfilled positions.
   • At this point, communication outside SOAP is allowed.
   • Use professional, concise communication:
     • A one-page email with CV and a brief statement of interest.

2. Reapplying Next Cycle

   • Conduct a frank debrief with:
     • A Med-Peds or IM/Peds mentor.
     • Your school’s dean’s office or career advisor.
   • Strengthen your file:
     • Additional clinical experience (e.g., as a research assistant, clinical fellow, or observer).
     • Improved exam performance if still eligible.
     • New letters of recommendation from U.S. clinical supervisors.

3. Reassessing Goals

   • Explore:
     • Whether Med-Peds remains your non-negotiable goal.
     • Or whether a career in IM or Peds alone can satisfy your clinical interests.

Remember: many highly successful physicians had non-linear paths, SOAP participation, or gap years. The DO graduate residency journey can still lead you to meaningful, Med-Peds–aligned practice.

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6. Practical SOAP Preparation Checklist for DO Med-Peds Applicants

Use this as a quick, actionable reference:

6.1. Two–Six Months Before Match Week

• Honestly assess your match risk with an advisor or Med-Peds mentor.
• Update ERAS entries, verifying all experiences and dates.
• Secure 3–4 strong letters of recommendation:
  • At least 1 IM letter.
  • At least 1 Peds letter.
  • Med-Peds faculty letter if available.
• Write and upload:
  • Med-Peds–specific personal statement.
  • Internal Medicine–specific personal statement.
  • Pediatrics–specific personal statement.
• Build a SOAP planning spreadsheet:
  • Med-Peds programs (nationwide).
  • DO-friendly IM and Peds programs.
  • Notes on requirements and perceived fit.

6.2. One–Two Weeks Before Match Week

• Review NRMP’s up-to-date SOAP policies (offers, communications, eligibility).
• Decide your priority order among:
  • Med-Peds.
  • Internal Medicine.
  • Pediatrics.
  • Transitional or other specialties.
• Practice 10–15 minute “SOAP-style” interviews:
  • Explain unmatched status clearly and calmly.
  • Articulate why you fit Med-Peds, IM, and/or Peds programs.
• Prepare your physical and digital workspace:
  • Quiet area for phone and video calls.
  • Professional background for virtual interviews.

6.3. During Match Week SOAP

• On Monday at 11:00 AM ET:
  • Check match status.
  • Confirm SOAP eligibility.
• As soon as unfilled list is available:
  • Filter for Med-Peds, IM, and Peds.
  • Cross-check with your spreadsheet.
• Choose up to 45 programs:
  • Prioritize Med-Peds if present.
  • Then IM and Peds based on your preferences and risk tolerance.
• Submit targeted applications with correct PS and LoRs.
• Answer phone calls and emails promptly.
• Keep your phone fully charged and close by.
• Track offers each SOAP round and decide according to your pre-set hierarchy.

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FAQs: SOAP Preparation for DO Graduates in Medicine-Pediatrics

1. As a DO graduate, do I have a lower chance to match into Med-Peds, especially through SOAP?
Your chances depend more on your overall application strength, exam performance, and interview volume than on being a DO alone. Many Med-Peds programs are DO-friendly. However, Med-Peds is small and often fills in the main match, meaning there may be few or no Med-Peds SOAP positions in some years. That’s why a realistic SOAP strategy for a DO Med-Peds applicant includes categorical Internal Medicine and Pediatrics positions as strong alternatives.

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2. Should I still apply to Med-Peds programs in SOAP if they are very competitive and I had few or no interviews during the main cycle?
Yes—if Med-Peds positions appear on the unfilled list and you meet their basic criteria, it is reasonable to apply. The SOAP environment is different; some programs may have an unexpected unfilled spot and a smaller pool of immediate applicants. However, do not spend all 45 applications on Med-Peds alone. Balance your list with DO-friendly categorical IM and Pediatrics programs to maximize your chance of securing a residency position this cycle.

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3. How should I explain going unmatched in interviews without hurting my chances?
Be brief, factual, and non-defensive. For example:
“I focused heavily on Medicine-Pediatrics and applied somewhat narrowly. I received a limited number of interviews, and the specialty is small and competitive. I’ve reflected on this and am now casting a broader net, focusing on strong categorical Internal Medicine and Pediatrics programs where I can excel as a resident.”
Then pivot to your strengths, your readiness to start, and why you are genuinely interested in their program and specialty.

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4. If I end up matching into Internal Medicine or Pediatrics instead of Med-Peds, can I still work in a way that feels like Med-Peds?
Yes. Many IM and Peds physicians build practices that parallel Med-Peds values. For example:

• Internal Medicine: caring for young adults with childhood-onset chronic illness, hospitalist work with close pediatric collaboration, primary care with a focus on transition-age patients.
• Pediatrics: adolescent medicine, complex care clinics, children with special health care needs transitioning to adult systems.

While formal dual board certification (IM and Peds) is typically reserved for Med-Peds–trained physicians, you can still align your practice with the populations and continuity focus that drew you to Medicine-Pediatrics in the first place.

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By preparing thoroughly for SOAP—as a DO graduate and a Medicine-Pediatrics–focused applicant—you give yourself the best chance to secure a residency position that fits your skills, values, and long-term goals, whether that path ultimately runs through Med-Peds or through a closely related core specialty.