Mastering SOAP Preparation for PM&R Residency: A Complete Guide

Preparing for the Supplemental Offer and Acceptance Program (SOAP) as an MD graduate targeting a PM&R residency can feel intense, but it is also a structured, predictable process you can master with the right preparation. For Physical Medicine & Rehabilitation (PM&R), where programs value maturity, communication skills, and a strong narrative of interest in physiatry, SOAP can still lead to an excellent match—if you treat it as strategically as the main cycle.

This guide walks you step‑by‑step through SOAP preparation tailored to allopathic MD graduates aiming for PM&R residency programs, including what SOAP is, how it fits into the allopathic medical school match, how to organize your documents, how to pivot specialty strategy, and how to interview effectively during a chaotic week.

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Understanding SOAP and Its Role in the PM&R Match

Before you can prepare, you need to be absolutely clear on what SOAP is and how it works—especially in the context of the physiatry match.

What Is SOAP?

SOAP (Supplemental Offer and Acceptance Program) is the structured process NRMP uses to fill unfilled residency positions after the main Match algorithm runs. It occurs during Match Week and is not a free‑for‑all scramble. Instead, it’s a time‑boxed, rule‑driven mini‑match with:

• A defined schedule (application window, interview windows, offer rounds)
• Strict communication rules
• Multiple rounds of electronic offers through NRMP

For an MD graduate residency applicant from an allopathic medical school, SOAP is your formal second chance at the allopathic medical school match, not a lower‑tier event. Many strong candidates, including U.S. MDs, successfully obtain PM&R residency or transitional/preliminary years through SOAP every year.

Eligibility: Who Can Participate in SOAP?

You are SOAP‑eligible if:

1. You registered for the NRMP Main Match, and
2. You are unmatched or partially matched at the start of Match Week, and
3. You are not withdrawn from the Match, and
4. You have an active ERAS application.

On Monday of Match Week, NRMP emails you one of three outcomes:

• Fully matched (not SOAP‑eligible)
• Partially matched (SOAP‑eligible)
• Unmatched (SOAP‑eligible)

If you are unmatched or partially matched, you’ll get access to the List of Unfilled Programs at the start of SOAP.

Where PM&R Residency Fits in SOAP

PM&R (Physical Medicine & Rehabilitation) has a few unique characteristics relevant to SOAP:

• Many core PM&R spots are advanced positions (PGY‑2), starting after a transitional/prelim year.
• A portion of PM&R positions are categorical, but relatively fewer than some other fields.
• Some PM&R positions or linked prelim years may remain unfilled and become available during SOAP.
• Many PM&R‑bound applicants end up SOAPing into:
  • Transitional year (TY) programs
  • Preliminary medicine or surgery spots
  • Occasionally, unfilled PM&R advanced positions

If you don’t match into a PM&R residency in the main Match, your SOAP strategy should consider:

• Whether to pursue unfilled PM&R spots directly (if available)
• Whether to prioritize a strong PGY‑1 year (TY or prelim) to reapply later
• Whether you’re open to pivoting to other specialties this year

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Pre‑SOAP Preparation: What You Should Do Months Before Match Week

SOAP is won or lost before Match Week. If you’re an MD graduate planning a PM&R career, you should quietly prepare for SOAP long before results are released—just in case.

1. Clarify Your PM&R Narrative and Backup Plan

Good SOAP preparation starts with honest self‑assessment.

Ask yourself early in the season:

• How competitive is my PM&R application (board scores, grades, PM&R rotations, LORs, research)?
• Did I apply broadly enough to PM&R programs?
• What is my Plan B if I don’t match into a PM&R residency?
• Am I willing to:
  • Do a TY or prelim year and reapply to PM&R?
  • Pivot to another specialty (e.g., Internal Medicine, Family Medicine, Pediatrics)?
  • Consider a different career trajectory?

For many PM&R‑bound MDs, a practical Plan B is:

• Target PM&R residency initially
• If unmatched in PM&R, pursue:
  • A strong transitional year or prelim medicine spot through SOAP
  • Then reapply to PM&R as a PGY‑1 with bolstered experience

Write down your hierarchy of preferences before Match Week when emotions are calmer.

2. Build Reusable Application Components

You don’t want to be revising fundamental documents under high stress on Monday of Match Week. Prepare these ahead:

a. Core CV and Activities List

Ensure your ERAS CV is complete and polished:

• Clearly highlight PM&R‑relevant experiences:
  • Inpatient rehab rotations
  • Outpatient MSK/spine clinics
  • Sports medicine clinics
  • Neurology/orthopedics/geriatrics exposure
  • Research or quality improvement projects in rehab, disability, or function
• Emphasize skills PM&R programs value:
  • Longitudinal patient relationships
  • Interdisciplinary teamwork
  • Communication with patients, therapists, nurses, families
  • Interest in neurorecovery, MSK, chronic pain, disability medicine

b. Multiple Personal Statement Templates

You should prepare at least 3 personal statement versions:

1. PM&R‑Focused PS

   • Deeply explains your path to physiatry, exposure to rehab medicine, and long‑term goals.

2. Transitional/Prelim Year PS (PM&R‑oriented)

   • Emphasizes:
     • You are committed to PM&R long‑term
     • You seek a broad, rigorous PGY‑1 foundation to become a stronger physiatry resident
     • You value teamwork, adaptability, and patient‑centered care.

3. General Medicine/Other Specialty PS (if applicable)

   • If you are genuinely open to turning to IM, FM, or another field this year, write a tailored statement that:
     • Does not sound like PM&R is your only love
     • Focuses on the aspects of medicine that fit both PM&R and that specialty: communication, continuity, systems‑based care, etc.

You can customize these quickly during SOAP (e.g., a slightly different PS for a prelim medicine vs. a TY), but the core text should be drafted well in advance.

c. Letters of Recommendation Strategy

For SOAP, you generally cannot obtain new letters quickly. Plan early:

• Aim for:
  • 1–2 strong PM&R letters (from physiatrists)
  • 1 strong medicine or surgery letter (for TY/prelim options)
  • Possibly 1 additional letter (e.g., from research or a sub‑I attending)

You do not need separate “SOAP” letters; you need flexible letters that:

• Highlight your clinical competence and professionalism
• Reflect well on you in multiple contexts

Organize letters in ERAS so you can quickly assign them to different program types.

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Understanding the SOAP Timeline and Rules

SOAP is heavily rule‑driven. Violating these rules can disqualify you or programs. As an MD graduate in the allopathic medical school match system, you should know this structure cold.

General SOAP Timeline (Approximate Structure)

Exact times vary slightly by year; refer to NRMP and ERAS each season. But the pattern is:

1. Monday (Match Week)

   • 11:00 AM ET: You learn if you are matched, partially matched, or unmatched.
   • 11:00 AM – 3:00 PM ET:
     • Unmatched/partially matched applicants learn SOAP eligibility.
     • You gain access to the List of Unfilled Programs.
   • Early afternoon: You can start preparing and submitting applications via ERAS.

2. Monday–Wednesday

   • You apply to unfilled programs (up to the ERAS limit—typically 45 programs total).
   • Programs review applications and conduct virtual interviews or phone calls.

3. Wednesday–Thursday

   • Multiple offer rounds occur through NRMP (usually 3–4 rounds).
   • You accept or reject offers electronically.

4. Friday

   • Finalization of SOAP; remaining unfilled programs may be posted publicly.

Critical SOAP Rules (You Must Follow)

• You cannot contact programs outside ERAS-approved channels.
  No cold emails, no social media messages, and no calling programs unless they initiate contact. Some institutions allow communication within structured guidelines; follow NRMP instructions carefully.

• You must use ERAS to apply to SOAP positions.
  No paper or email applications.

• You have a limited number of programs (usually 45) you can apply to during SOAP.
  This makes your program list strategy crucial.

• You must respond to offers within the designated NRMP windows.
  If you don’t respond in time, the offer expires.

Understand these rules beforehand so you can focus on content and strategy during SOAP.

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Strategic SOAP Planning for PM&R‑Bound MD Graduates

When the unfilled list appears, you won’t have time to build a strategy from scratch. You should already know how you’ll pivot if your PM&R residency match doesn’t pan out.

Step 1: Know Your Priority Pathways

For a PM&R‑bound MD graduate, your likely pathways in SOAP are:

1. Unfilled PM&R (Physiatry) Advanced or Categorical Spots

   • Ideal outcome if any are available and you are competitive.

2. Transitional Year (TY) or Preliminary Medicine/Surgery Programs

   • Very common route for unmatched PM&R applicants:
     • You secure a PGY‑1 spot.
     • You reapply to PM&R during that year with additional experience.

3. Alternate Specialty Categorical Spots (If You Are Truly Open to Pivoting)

   • Internal Medicine, Family Medicine, Pediatrics, etc.
   • Only advisable if you are sincerely ready to pursue that specialty long‑term or are the type of applicant who values a categorical backup.

Before Match Week, decide:

• Would I be satisfied with TY + reapply?
• Under what circumstances would I accept a categorical non‑PM&R spot?

Write this plan out, and talk it through with:

• Your home PM&R advisor
• Your Dean’s office or career advisor

Step 2: Pre‑Draft a SOAP Application Strategy

Create a template “SOAP strategy sheet” with:

• Columns for:
  • Program name
  • Specialty type (PM&R, TY, prelim med, etc.)
  • Location
  • Priority (high/medium/low)
  • Required PS version
  • LOR set (e.g., 2 PM&R + 1 IM)

During SOAP, when you get the unfilled list, you’ll:

• Filter programs by:
  • PM&R vs. TY vs. prelim vs. other categorical
  • Geography preferences (if critical)
  • Visa requirements (if applicable)
• Quickly plug them into your sheet and assign priorities.

Step 3: Realistic Self‑Assessment

SOAP is compressed, but you must stay realistic:

• If your PM&R application was borderline (e.g., just one PM&R rotation, limited exposure), unfilled PM&R slots may be limited and highly competitive.
• You may have a higher chance of success aiming for:
  • A well‑regarded transitional year
  • Or prelim internal medicine spot
• Many PM&R program directors appreciate applicants who:
  • Complete a strong, broad PGY‑1 year
  • Reapply with improved clinical skills and more mature narratives

Your self‑assessment should directly shape your SOAP target list.

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Executing During SOAP Week: Applications, Communication, and Interviews

Once Monday of Match Week hits and you learn you’re SOAP‑eligible, your job is to execute a calm, structured plan under time pressure.

Monday: Triage and Application Submission

1. Process the News Quickly, Then Shift to Action

Give yourself a short, defined window to process your emotions. Then pivot to task mode:

• Contact your Dean’s office/career services.
• Notify your PM&R mentor/advisor and ask:
  • “I’m SOAP‑eligible and would value your help prioritizing programs, especially PM&R and TY slots.”

2. Analyze the Unfilled Program List

Filter for:

• PM&R programs (advanced, categorical)
• Transitional year programs
• Preliminary medicine or surgery programs
• Any alternative specialties you’re genuinely open to

Sort programs into:

• Tier 1: High‑priority (best fit by location, training quality, PM&R alignment)
• Tier 2: Acceptable but less ideal
• Tier 3: Safety/last resort

3. Assign Appropriate Materials

For each program type, assign:

• Personal Statement:

  • PM&R PS → PM&R programs
  • TY/prelim PM&R‑oriented PS → transitional/prelim programs
  • Non‑PM&R PS (if you’ll pivot) → other categorical specialties

• Letters of Recommendation:

  • PM&R programs: 1–2 PM&R letters + 1 IM/surgery or strong general letter
  • TY/prelim IM: 1 medicine letter + 1–2 PM&R or general strong letters
  • Other specialties: 1 letter from that specialty (if available) + strong clinical letters

Aim to submit your SOAP applications on Monday, ideally within the first few hours once ERAS opens for SOAP submissions. Programs begin reviewing quickly.

Tuesday–Wednesday: Responding to Program Outreach and Interviewing

Programs will start to contact you for:

• Phone interviews
• Video interviews (Zoom, Teams, etc.)
• Occasionally, written responses to questions

Critical SOAP Rule:
You may respond to programs that contact you, but do not initiate contact unless NRMP guidance allows it in that year.

1. Prepare an Interview Script for PM&R‑Related Paths

You should be ready to answer:

• “Tell me about yourself.”
• “Why PM&R?” or “Why are you pursuing PM&R long‑term?”
• “Why TY/prelim medicine as part of your path?”
• “What happened in the main Match?” (Answer honestly but professionally.)
• “How do you handle setbacks and uncertainty?”
• “What are your long‑term career goals in physiatry?”

Sample framework for “What happened in the main Match?”:

“My primary goal has been to train in Physical Medicine & Rehabilitation. I applied to a range of PM&R programs and some preliminary medicine positions. Unfortunately, I did not secure a position in the main Match. I recognize PM&R is competitive, and I may have underestimated my need to apply even more broadly. I’ve reflected on this and am using SOAP as an opportunity to pursue either an unfilled PM&R spot or a rigorous PGY‑1 year that will strengthen my clinical base and allow me to re‑enter the physiatry match as a stronger candidate. I remain fully committed to the field and to growing from this experience.”

2. Emphasize Transferable Strengths

In all interviews (PM&R, TY, prelim), emphasize skills valued by physiatrists:

• Interdisciplinary teamwork (PT/OT, nursing, SLP, social work)
• Communication across care settings
• Interest in function, recovery, and quality of life
• Reflective capacity and resilience

For TY/prelim programs, frame your goals as:

“I want a broad, rigorous foundation so I can be the kind of PM&R resident who can confidently manage medically complex rehab patients.”

3. Logistics: Create a SOAP Interview Binder

Keep everything organized:

• Daily schedule with time zones and video links
• Program notes (3–5 bullet points per program)
• Question bank to ask programs:
  • “How do your graduates match into advanced PM&R positions?”
  • “What opportunities exist for exposure to rehab medicine or neuro/MSK?”
  • “How are residents supported in career advising and reapplying if needed?”

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After SOAP: Outcomes, Reflection, and Next Steps for a PM&R Career

By Thursday, you’ll know the outcome of the SOAP residency process. Each scenario demands a clear plan forward.

Scenario 1: You SOAP into a PM&R Residency

If you successfully enter a PM&R residency (categorical or advanced) via SOAP:

• Celebrate—this is a fully legitimate pathway into physiatry.
• Early steps:
  • Reach out to your new program’s coordinator and PD.
  • Get onboarding information and visas/credentialing started (if needed).
  • Thank your mentors and advisors who helped during SOAP.

Use your time before residency to:

• Shore up your intern‑level skills (medicine, neurology, MSK).
• Read about core physiatry topics (SCI, TBI, stroke rehab, MSK, EMG).

Scenario 2: You SOAP into a Transitional or Prelim Year

Many PM&R attendings started here. Treat this as a deliberate step, not a failure.

Actions:

• Commit fully to being an outstanding PGY‑1:
  • Show up early, work hard, be reliable.
  • Build strong relationships with faculty—these may become your next LORs.
• Stay engaged with PM&R:
  • Seek electives in rehab or neuro/MSK if allowed.
  • Attend PM&R grand rounds at nearby institutions if feasible.
• Plan your reapplication early:
  • Update your CV with intern experiences.
  • Draft an updated PM&R personal statement reflecting your growth.
  • Keep in touch with your prior PM&R mentors and add new mentors where possible.

Programs value resilience and maturity. Performing well as a PGY‑1 often transforms your candidacy in the next physiatry match cycle.

Scenario 3: You Do Not Match During SOAP

If you emerge from SOAP without a position:

• Take time to process emotionally, but do not disappear.
• Work with:
  • Your Dean’s office
  • PM&R mentors
  • Career advisors

Options may include:

• Research fellowships, particularly in PM&R‑related fields
• Clinical assistant or pre‑residency positions
• Additional PM&R observerships or sub‑internships (if still possible as a recent graduate)

You can then re‑enter the next allopathic medical school match cycle with:

• A stronger application
• Clarified goals
• More robust PM&R exposure and letters

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Practical Tips to Maximize Your Physiatry Match Chances via SOAP

To close, here are concrete, actionable steps for PM&R‑bound MDs preparing for SOAP:

1. Start SOAP preparation early. Treat it as a parallel plan, not a sign of pessimism.
2. Craft multiple personal statements:
   • PM&R
   • TY/prelim with PM&R focus
   • Optional: other specialty if genuinely considered
3. Balance your LORs: at least one strong PM&R letter plus one strong medicine/surgery letter.
4. Clarify your priority sequence:
   • PM&R via SOAP, if available
   • TY/prelim → reapply PM&R
   • Categorical alternate specialty (only if truly acceptable to you)
5. Learn “what is SOAP” rules by heart:
   • Limited programs
   • No unsolicited program contact
   • Strict offer timelines
6. Stay professional and composed in all interactions. Programs note how you handle adversity.
7. Leverage mentors: They can quickly help you prioritize programs and refine messaging.
8. If you reapply later:
   • Use your PGY‑1 or gap year to deepen your PM&R experience.
   • Show progression, insight, and resilience.

SOAP is not the end of your PM&R dream; for many MD graduates, it’s simply a more complex route to the same destination: a fulfilling career in physiatry.

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FAQ: SOAP Preparation for MD Graduates in PM&R

1. As an MD graduate, is it realistic to match into PM&R through SOAP?

Yes, it is possible but not guaranteed. Some PM&R positions go unfilled each year, and MD graduates can secure them via SOAP, especially if:

• They have solid PM&R rotations and letters.
• Their application issues are modest (e.g., applied too narrowly).
• They interview and communicate well under pressure.

However, unfilled PM&R spots are often limited and competitive. Many PM&R‑bound applicants more reliably secure a transitional or prelim year during SOAP, then match into PM&R in the following cycle.

2. How should I prioritize PM&R vs. transitional/prelim programs during SOAP?

A common strategy is:

1. Apply to all reasonable unfilled PM&R programs that fit your credentials and geographic flexibility.
2. Simultaneously apply to robust TY or prelim medicine programs, focusing on those with:
   • A track record of sending graduates to PM&R
   • Strong general medicine training
3. If your PM&R chances seem very low (e.g., no unfilled rehab programs or significant application weaknesses), focus more heavily on TY/prelim programs as a deliberate stepping stone.

Decisions should be informed by advice from your PM&R mentors and Dean’s office.

3. Should my SOAP personal statement admit that I didn’t match?

Your SOAP personal statement does not need a detailed recounting of not matching. Focus on:

• Your genuine interest in PM&R (or TY/prelim medicine).
• Your clinical strengths, experiences, and growth.
• Your goals and how the program fits them.

If asked directly in interviews about the allopathic medical school match outcome, address it briefly, honestly, and with reflection—showing insight, not self‑criticism.

4. What can I do now, months before Match Week, to be better prepared for SOAP?

Key steps you can implement immediately:

• Draft multiple versions of your personal statement.
• Ensure your ERAS CV and experiences clearly reflect PM&R interests.
• Secure a balanced set of strong LORs, including at least one from a physiatrist and one from internal medicine or surgery.
• Meet with:
  • A PM&R faculty advisor
  • Your school’s career advisor or Dean’s office to discuss a SOAP and backup plan.
• Learn the SOAP residency rules and timeline so they’re second nature when Match Week arrives.

Being prepared does not mean you expect to fail; it means you are serious about ensuring you ultimately succeed in the physiatry match, regardless of the path.