Essential SOAP Preparation Guide for MD Graduates in Medicine-Psychiatry

Understanding SOAP for the Medicine-Psychiatry–Focused MD Graduate

As an MD graduate targeting med psych residency or other medicine psychiatry combined pathways, you’re already navigating one of the more nuanced corners of the Match. When things don’t go as planned on Monday of Match Week, the Supplemental Offer and Acceptance Program (SOAP) becomes your critical second chance.

Before you can excel at SOAP preparation, you must clearly understand: what is SOAP, how it works, and how it differs from the main allopathic medical school match process.

What Is SOAP?

SOAP (Supplemental Offer and Acceptance Program) is the structured process NRMP uses during Match Week to fill unfilled residency positions with unmatched or partially matched applicants.

Key features:

• Eligibility-based: Only NRMP-participating applicants who are eligible but unmatched / partially matched by Monday of Match Week can participate.
• Time-compressed: All major activity occurs between Monday and Thursday of Match Week.
• Multiple rounds of offers: Programs review SOAP applications and send offers through several rounds. You may receive, accept, or reject offers in each round.
• ERAS-powered: For most specialties (including med psych residency and categorical internal medicine or psychiatry), SOAP applications are submitted via ERAS.

For Medicine-Psychiatry–interested MD graduates, SOAP is often the bridge to:

• A traditional internal medicine position
• A categorical psychiatry spot with possibility of later transition
• A preliminary year leading to future medicine psychiatry combined pathways
• Occasionally, a true med psych residency position that went unfilled (less common but possible)

How SOAP Differs from the Regular Match

Compared to the main allopathic medical school match:

• No ranking by applicants during SOAP
  You apply; programs decide whom to offer; you only choose to accept or reject offers.
• Very limited customization
  Application materials (CV, PS, letters) must be ready before SOAP; you cannot rewrite everything mid-week.
• Speed and restrictions
  – No direct “cold calling” programs (communication rules are strict).
  – Programs may not solicit you outside official channels.
  – You must make decisions on offers within tight time windows.

For med psych–oriented MD graduates, this speed means you must decide in advance:

• If you’ll accept IM categorical if no medicine psychiatry combined spot appears
• If you’ll consider psychiatry categorical at a broader range of programs
• How you rank the value of preliminary medicine, transitional year, or psych-only options in terms of long-term med psych goals

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Strategic SOAP Preparation Timeline for Medicine-Psychiatry Applicants

SOAP success is largely determined before Match Week. Below is a realistic, actionable preparation plan tailored for MD graduates interested in medicine psychiatry combined or med psych residency–adjacent paths.

3–4 Months Before Match Week: Set Your Strategy

1. Clarify Your Priority Hierarchy

   Decide, in order of preference:

   • True med psych residency (5-year combined)
   • Categorical internal medicine at strong programs with consultation-liaison or psychosomatic medicine exposure
   • Categorical psychiatry with robust medical comorbidity training and integrated care
   • Preliminary medicine or transitional year that keeps med psych pathways open
   • Other back-up specialties (FM, neurology, etc., if consistent with your goals)

   Write this out as a 1-page “SOAP Decision Hierarchy” so that, when an offer appears during SOAP, you don’t decide under panic.

2. Review Your Application Performance

   Ask honestly:

   • Did you apply too narrowly to med psych residency or psychiatry/IM?
   • Were there red flags (exam failures, gaps, professionalism concerns)?
   • Were your USMLE/COMLEX scores or clinical grades borderline for your target programs?

   Meet with a faculty advisor from IM, Psychiatry, or Medicine-Psychiatry combined if available. Ask for:

   • A frank assessment of your competitiveness
   • Target ranges of programs to consider if SOAP becomes necessary

3. Identify Your SOAP-Ready Materials

   You’ll need:

   • Core CV updated and fully accurate
   • Multiple personal statements (PS):
     • One for internal medicine
     • One for psychiatry
     • One that specifically addresses medicine psychiatry combined interests (can sometimes be adapted to both IM and psych if carefully written)
   • Letters of recommendation:
     • At least two from IM faculty (ideally inpatient and outpatient)
     • At least one from psychiatry
     • A medicine-psychiatry mentor letter, if you have one, is a major plus

   During SOAP, you can’t chase down many brand-new letters. Have them uploaded into ERAS early, even if you hope not to use them.

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1–2 Months Before Match Week: Build Your SOAP Toolkit

This is where targeted SOAP preparation truly starts.

1. Draft Flexible, Modular Personal Statements

Because you’ll be applying across adjacent fields (IM, psych, medicine psychiatry combined), write interlocking versions of your PS rather than separate, contradictory narratives.

Core themes to highlight across all:

• Your commitment to integrated care and the bio-psycho-social model
• Experiences dealing with complex medical and psychiatric comorbidity
• Long-term goals such as:
  • Leadership in consultation-liaison psychiatry
  • Work in integrated primary care–behavioral health settings
  • Academic careers focused on med psych interfaces

Then build three variants:

1. Internal Medicine–Focused PS

   • Emphasize: complex medical decision-making, inpatient management, chronic disease in primary care.
   • Integrate: your psychiatric interest as an enhancement of your IM skill set (e.g., improved adherence, management of somatic symptom disorders, delirium, substance use in medical patients).

2. Psychiatry–Focused PS

   • Emphasize: your deep interest in the mind, psychopharmacology, psychotherapy foundations.
   • Integrate: strong comfort with medical complexity, EKGs, metabolic issues, and somatic comorbidities, making you well-suited for medically ill psychiatric patients.

3. Med Psych Residency–Focused PS

   • Blend both; highlight:
     • Cases where you navigated both medical and psychiatric aspects of care
     • Rotations like consult-liaison, addiction medicine, or inpatient psych with high medical complexity
     • Clear statement: “I am seeking medicine psychiatry combined training to practice at the intersection of internal medicine and psychiatry.”

During SOAP, you will choose among these statements depending on which programs (IM, psych, medicine psychiatry combined) have unfilled spots.

2. Clarify and Organize Letters of Recommendation

For SOAP, a flexible letter strategy is critical:

• Label letters in your own tracking sheet as:
  • “IM-strong,” “Psych-strong,” “Cross-over,” or “Med-Psych-specific”
• Ask your dean’s office or ERAS coordinator to review:
  • Which letters appear strongest
  • Which are best aligned with IM, Psych, or med psych residency

Aim for:

• IM SOAP applications: At least 2 strong IM letters (plus maybe 1 psych or med-psych letter as an enhancer)
• Psych SOAP applications: At least 1–2 psych letters, plus 1 internal medicine or cross-over letter
• Medicine Psychiatry combined SOAP applications (if any): one IM, one psych, ideally one letter that explicitly names your dual-discipline potential

3. Prepare a Targeted Program List Template

You won’t know which programs are unfilled until SOAP begins, but you can pre-build a spreadsheet structure so you can populate it quickly on Monday:

Columns to pre-create:

• Program name
• Specialty (IM, Psych, Med-Psych)
• Type (categorical, prelim, transitional, med psych residency)
• State/region
• ACGME ID
• Notes on med-psych features (CL psych, integrated care clinics, addiction services, dual board faculty)
• “Priority tier” (High / Medium / Low)
• “Applied?” Y/N
• “Response/Offer”
• “Decision” (Accepted / Declined / No offer)

This template becomes your command center during SOAP.

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One Month to Match Week: Risk Management and Scenario Planning

Rehearse Worst-Case and Best-Case Scenarios

Preparing emotionally and strategically for SOAP makes you more decisive when it counts.

1. Best-Case SOAP Scenario (for a med psych–interested MD graduate)

   • You receive an unfilled medicine psychiatry combined position at a solid academic center.
   • Your letters and PS are already aligned.
   • You can confidently accept in the first offer round.

2. Moderate Scenario

   • No med psych residency positions remain; you see a few attractive:
     • Categorical IM programs with strong CL psych and addiction medicine
     • Psychiatry programs with heavy medical comorbidity focus
   • You must choose which track to prioritize, knowing both can still lead to med psych–type careers (e.g., IM with a later psych fellowship or psych with heavy CL training).

3. Challenging Scenario

   • Only preliminary medicine, transitional year, or lower-tier categorical positions in either field appear.
   • You must decide:
     • Is it better to accept a prelim year and re-apply later to med psych residency or categorical IM/Psych?
     • Or to take a categorical psychiatry or internal medicine spot even if it’s not ideal, then craft a med-psych-oriented career path from there?

Writing down your preferred decision for each scenario before SOAP week prevents panic and regret under time pressure.

Double-Check SOAP Eligibility and Logistics

• Confirm with your Dean’s office and NRMP that you are:
  • Registered for the main Match
  • Eligible for SOAP (no contract violations, etc.)
• Verify:
  • Your ERAS login works
  • All documents are uploaded and certified
  • You know your school’s Match Week support process (advising meetings, wellness resources)

Have a quiet, stable work environment lined up for Monday–Thursday of Match Week. You’ll need:

• Reliable internet
• Access to printer/scanner (if needed)
• Minimal distractions
• A trusted support person available (mentor, friend, partner)

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Match Week: Tactical Execution During SOAP

Now, you’ve done the preparation. Here’s how to operate hour-by-hour for an MD graduate focused on med psych options.

Monday Morning: Unmatched Notification & Unfilled List Release

1. Receive Your Status

If you’re notified that you are:

• Unmatched or
• Partially matched (e.g., matched to an advanced position but not to a prelim year)

You are eligible for SOAP if registered and not withdrawn or in violation.

2. Immediate Steps

• Schedule urgent meetings (often same-day) with:
  • Dean of students or academic affairs
  • A trusted IM/Psych/Med-Psych faculty advisor
• Access the first NRMP Unfilled Programs List (via your school/ERAS).

Filter for:

• Internal Medicine
• Psychiatry
• Medicine Psychiatry combined
• Related: Transitional year, Prelim IM, Family Medicine, or Neurology if they align with your long-term med-psych goals.

3. Rapid Program Research

In the first several hours:

• Fill your pre-built spreadsheet with:
  • Program names
  • Locations
  • Number of spots
  • Key characteristics from their websites/FRIEDA
• Mark:
  • Programs with significant CL psych or integrated care
  • Programs with dual-boarded med-psych faculty
  • Safety-net hospitals where medical and psychiatric comorbidity is high (often ideal for med psych–oriented training)

Monday Afternoon: Selecting Programs & Submitting Applications

You can apply to up to 45 programs total in SOAP (subject to NRMP rules; always confirm current limits each year).

For a med psych–interested MD graduate, a balanced portfolio might look like:

• 10–15 Categorical Internal Medicine programs
• 10–15 Categorical Psychiatry programs
• 5–10 Med Psych / CL-heavy / integrated-care-strong programs (overlap between IM and Psych categories)
• 5–10 Preliminary IM or transitional year spots (only if part of your scenario plan)

Prioritize:

1. Programs combining high clinical volume with strong interdisciplinary work (medicine + psychiatry teams).
2. Geographic locations you can realistically see yourself living in for 3–5 years.
3. Environments where your dual-interest profile (IM+Psych) will be viewed as a strength, not as indecisiveness.

Upload the most appropriate PS and letters for each specialty:

• For IM SOAP programs: use IM-focused PS + IM letters, with at most one psych/med-psych letter.
• For Psych SOAP programs: use Psych-focused PS + psych letters, with one IM or med-psych letter to showcase your dual strength.
• For any medicine psychiatry combined (if present), use your med psych–targeted PS and strongest dual-interest letters.

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Tuesday–Thursday: Responding to Offers

How SOAP Offers Work

• Programs review applications and may conduct brief interviews (phone, Zoom) Tuesday–Wednesday.
• Offers are sent in several rounds (e.g., four rounds) via NRMP.
• In each round, you may receive:
  • No offers
  • A single offer
  • Multiple offers

You cannot hold multiple offers at once; each must be accepted or rejected within the specified time window.

Evaluating Offers for a Med Psych–Interested MD Graduate

When you receive an offer, answer these questions quickly:

1. Specialty Alignment

   • Is this categorical IM or Psych, consistent with your long-term med psych goals?
   • Is it a med psych residency (rare but ideal) or a program with a clear path toward integrated care?

2. Training Environment

   • Does the program have:
     • CL psychiatry rotations
     • Addiction medicine exposure
     • Significant medically complex psych or psychosocially complex medical populations?
   • Are there mentors who bridge IM and Psych (e.g., CL attendings, dual-boarded faculty)?

3. Future Pathways

   • From this program, could you:
     • Enter CL psychiatry, addiction, or psychosomatic medicine?
     • Become a strong primary care physician comfortable with severe mental illness?
     • Develop a career in integrated behavioral health?

If the answer to these is yes, and the program is reasonably supportive and accredited, accepting the offer is often wise—especially by Round 2 or 3.

When Might You Decline an Offer?

You might decline if:

• The program has serious quality or accreditation concerns.
• The specialty does not align with your long-term direction (e.g., a surgical prelim year if you are firmly committed to med psych).
• Your advisor strongly believes better-aligned options are likely still forthcoming.

Keep in mind:

• Declining an offer early in SOAP is risky; there’s no guarantee of a better one.
• For most MD graduates interested in medicine psychiatry combined care, a solid IM or Psych categorical position is a strong foundation.

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After SOAP: If You Match, If You Don’t, and Long-Term Med-Psych Strategy

If You Secure a Position Through SOAP

1. Stabilize and Reflect

   • Acknowledge the stress you’ve experienced; use school and personal supports.
   • Review your signed NRMP contract and onboarding requirements.

2. Med-Psych Career Optimization in Your New Program

   Whether you matched IM, Psych, or medicine psychiatry combined, you can steer your training toward med psych:

   • Seek CL psychiatry electives if you’re in IM.
   • If in Psych, maximize rotations on medically complex units, ED psych, or CL.
   • Get involved in quality-improvement projects that straddle medical and psychiatric dimensions (e.g., suicide risk screening on medical wards, metabolic monitoring projects).

3. Stay Connected to Med Psych Networks

   • Join relevant organizations (e.g., ACLP – Academy of Consultation-Liaison Psychiatry).
   • Attend med-psych–themed conferences or local grand rounds.
   • Look for mentors who practice at the medicine–psychiatry interface.

If You Remain Unmatched After SOAP

It’s emotionally difficult, but many future residents have stood where you stand and later matched successfully.

1. Immediate Post-SOAP Steps

   • Meet with your dean and at least one specialty advisor (IM, Psych, or Med-Psych).
   • Request a candid analysis:
     • Were application numbers too low?
     • Were there significant academic or professionalism red flags?
     • Was your strategy misaligned with your competitiveness?

2. Bridge-Year Options Aligned With Med Psych

   Consider roles that maintain your clinical skills and support a future application:

   • Research fellowships in psychiatry, behavioral medicine, or psychosomatic medicine
   • Clinical research coordinator positions in IM or Psych departments
   • Hospitalist scribe roles or advanced clinical assistant roles (where allowed)
   • Additional electives or observerships at institutions with medicine psychiatry combined programs

3. Rebuilding for Next Cycle

   • Strengthen your CV specifically at the interface of medicine and psychiatry:
     • Publish or present a case report on delirium, somatic symptom disorder, or comorbid SMI and diabetes.
     • Engage in quality-improvement in integrated care, substance use treatment in primary care, etc.
   • Revise your application:
     • Sharpen your PS with updated experiences.
     • Address red flags honestly and constructively.
     • Broaden your application target list (both geographically and across IM/Psych/med psych).

For many MD graduates, a well-planned re-application yields excellent positions the following year.

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FAQs: SOAP Preparation for MD Graduates in Medicine-Psychiatry

1. How likely is it that a true med psych residency spot will be available in SOAP?

Medicine psychiatry combined programs are small and relatively few, so unfilled med psych residency spots in SOAP are uncommon but not impossible. You should absolutely check the unfilled list for them, but do not rely on this as your only path. Plan SOAP primarily around categorical IM and psychiatry programs that can still support med psych–oriented careers.

2. Should I prioritize internal medicine or psychiatry in SOAP if I’m equally interested in both?

If you are truly neutral, many med psych mentors suggest:

• Choose internal medicine if you’re especially drawn to managing complex medical disease, ICU, and chronic medical conditions, and see psychiatry as a critical “second language” that improves your medical care.
• Choose psychiatry if your primary passion is psychiatric illness and therapies, with confidence that your strong medical background will help you care for medically complex psych patients.

Both paths can lead to med psych–style careers, especially with CL psychiatry, psychosomatic medicine, or integrated behavioral health roles.

3. Can I still get into a med psych–type career if I match only into a categorical IM or Psych program through SOAP?

Yes. Many clinicians working at the medicine–psychiatry interface did not train in formal med psych combined residency programs. From internal medicine, you can:

• Do additional training in addiction medicine or consult-liaison psychiatry (as a psychiatrist collaborator)
• Focus your practice on patients with serious mental illness in primary care or hospitalist settings

From psychiatry, you can:

• Complete a CL psychiatry fellowship
• Work in medical hospitals, transplant services, oncology-psych, etc.
• Become an expert in medical comorbidities in psychiatric populations

Your SOAP outcome does not preclude a med psych career; it just shapes the path.

4. How should I use the SOAP period if I have examination failures or other red flags?

For MD graduates with red flags:

• Address them directly in your PS and interviews, focusing on:
  • Insight into what happened
  • Concrete steps taken to improve
  • Evidence of sustained improvement since
• Choose programs that:
  • Have histories of supporting residents with non-traditional paths
  • Emphasize mentorship and remediation structures
• Use SOAP to apply broadly, including programs that:
  • Serve vulnerable populations
  • May more readily recognize the value of your resilience and lived experience

Over time, strong performance in residency can completely overshadow earlier stumbles.

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Thoughtful SOAP preparation allows an MD graduate focused on medicine psychiatry combined care to navigate Match Week with clarity rather than crisis. By building flexible materials, planning realistic scenarios, and understanding how categorical IM and psychiatry can both support med psych careers, you give yourself the best chance to emerge from SOAP with a position that keeps your long-term vision fully alive.