Essential SOAP Preparation Guide for Non-US Citizen IMG in OB/GYN Residency

Understanding SOAP in the Context of OB/GYN for the Non-US Citizen IMG

The Supplemental Offer and Acceptance Program (SOAP) is often the most intense four days of an entire application season—especially for a non-US citizen IMG targeting OB GYN residency. Knowing what is SOAP, how it works, and how to prepare before Match Week can be the difference between securing a categorical position, gaining a preliminary/transitional year, or not matching at all.

In simple terms, SOAP is the structured process NRMP uses during Match Week to fill residency positions that remain unfilled after the main rank order list (ROL) deadline. For you as a foreign national medical graduate, SOAP can be:

• A second opportunity if you are unmatched or partially matched
• A path to pivot—e.g., apply broadly (including prelim/TY or other specialties)
• A way to enter the system and build US experience for future OB GYN attempts

Key points about SOAP for a non-US citizen IMG targeting OB/GYN:

• Eligibility is determined before Match Week by NRMP and ERAS.
• You cannot suddenly decide on Monday of Match Week that you want to SOAP if you are not already NRMP-registered and ERAS-certified for that season.
• Visa status is critical: many unfilled programs list “No visa sponsorship” or “J-1 only.” Your SOAP strategy must be realistic about this.

OBGYN is a moderately competitive specialty and tends to fill most, if not all, of its positions in the main Match. That means unfilled OBGYN spots are limited and highly competitive in SOAP. Your strategy must account for:

• The likelihood of very few OBGYN categorical openings
• The value of preliminary/TY or related specialties to stay clinically active in the US
• How you can still build an OB GYN–strong profile if you match into something else through SOAP

This article will walk you step-by-step through SOAP preparation specifically tailored to the non-US citizen IMG focused on obstetrics & gynecology.

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Pre–Match Week Foundation: Eligibility, Documents, and Strategy

1. Confirming Eligibility and Understanding Your Status

Before you can even think about SOAP preparation, you must ensure:

• ECFMG Certification (or certification expected before July 1):
  • All USMLE Steps required for certification completed.
  • Primary source verification and credentials approved.
• NRMP Registration:
  • You must be registered for the Match. SOAP is only available to NRMP-registered applicants.
• Unmatched or Partially Matched on Monday of Match Week:
  • Unmatched: did not match to any program.
  • Partially matched: matched to a preliminary but not an advanced position (or vice versa).

If you fully match in OB GYN or another specialty, you are not SOAP-eligible.

For a non-US citizen IMG, also confirm:

• Visa needs and flexibility:
  • Most residency programs sponsor J-1 visas.
  • A smaller subset sponsor H-1B (often requiring USMLE Step 3 passed).
• Anticipated start date:
  • Programs want confidence you can start on July 1 (visa timelines matter).

If any of these are unclear, clarify with:

• ECFMG/ERAS for certification or document status
• NRMP support for eligibility questions

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2. Core Application Components: What Must Be SOAP-Ready

Almost everything used in SOAP comes from the existing ERAS application. You will not be writing a brand-new application on Monday of Match Week—you will refine and redirect what is already there.

Make sure these elements are ready well before Match Week:

1. ERAS Common Application
   Ensure there are no red flags in:

   • Education history (explain gaps briefly in experiences or PS if significant)
   • USMLE attempts and scores (accurate, consistent with transcript)
   • Work authorization/visa preference

2. Personal Statement(s)
   For SOAP, you may need more than one version:

   • Core OB GYN personal statement (if you still plan to target any available OB GYN spots)
   • Alternative specialty statements (e.g., internal medicine, family medicine, preliminary surgery, transitional year), if you’re willing to SOAP broadly
   • Keep each PS shorter and sharper for SOAP (about 600–750 words), clearly addressing:
     • Why that specialty
     • Your strengths and experiences
     • As a foreign national medical graduate, your motivation to practice in the US and any OB/GYN–relevant exposure

3. Letters of Recommendation (LoRs)
   Before SOAP:

   • Secure 3–4 strong letters from:
     • OB GYN attendings (US clinical experience is ideal)
     • Other US-based clinical supervisors, especially in core fields (IM, surgery, FM)
   • Label them neutrally (e.g., “Clinical Letter – OB/GYN” rather than naming specific programs)
   • Make sure each letter is uploaded and assigned to relevant ERAS programs.

4. USMLE Transcript & Step 2 CK Performance
   For OB GYN, Step 2 CK is often heavily weighted, especially for IMGs.

   • Ensure USMLE transcript is released in ERAS.
   • If you retook an exam, be ready to explain the improvement in your PS or during SOAP interviews.

5. MSPE (Dean’s Letter), Medical School Transcript, and ECFMG Status Report
   These typically remain unchanged during SOAP but must be:

   • Uploaded and verified
   • Free of obvious errors (name, dates, degree)

By the time rank lists are due, imagine SOAP starting the very next day. If you had to pivot to SOAP immediately, would your file be ready?

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3. Strategic Planning: Primary Goal vs. Contingency Paths

SOAP is fast. To make good decisions under pressure, you need a pre-defined hierarchy of goals for your career path.

For a non-US citizen IMG whose dream is OB GYN residency, consider this tiered strategy:

Tier 1: Unfilled OB GYN categorical positions

• Realistically, there may be few or none every cycle.
• If they exist and you’re competitive (strong scores, OB-GYN-relevant USCE, LoRs), you should prioritize them.

Tier 2: Preliminary year or Transitional Year (TY) programs

• A preliminary internal medicine or surgery year can:
  • Provide US clinical experience
  • Build new letters
  • Allow reapplication to OB GYN with stronger credentials
• A strong transitional year can keep your options flexible:
  • Good for those considering OB GYN, family medicine, or other fields in the future.

Tier 3: Alternative categorical specialties
Based on your background and risk tolerance, you might consider:

• Family Medicine (FM)
• Internal Medicine (IM)
• Pediatrics

If you match here via SOAP, your long-term decision is:

• Stay in that specialty
• Or try to transfer to OB GYN later (challenging but not impossible, especially early PGY-1 and with strong reasons and performance)

Tier 4: Research or observer roles (if no match)
If SOAP fails, you should already have:

• A plan to apply for research positions, OB GYN fellowships (non-ACGME), or observerships
• A strategy to improve your profile for next cycle:
  • US clinical experience (OB/GYN or women’s health)
  • Publications or case reports
  • Step 3 (especially helpful for visa flexibility)

Write these tiers down and review them with a mentor or advisor before Match Week.

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Building a SOAP-Ready OB/GYN Profile as a Non-US Citizen IMG

1. Clinical and Academic Profile: What OB GYN Programs Look For

Even though SOAP is last-minute, programs still evaluate you as rigorously as in the main Match. Typical OB GYN criteria include:

• USMLE Step scores (especially Step 2 CK)
• No or minimal exam failures
• Strong OB GYN letters of recommendation
• US clinical experience in women’s health (clerkships, electives, sub-internships, or observerships)
• Evidence of commitment to women’s health:
  • Research in OB GYN or reproductive health
  • Leadership in OB GYN/women’s health organizations
  • Volunteer work with women’s health clinics or community programs

As a foreign national medical graduate, you must also show:

• Ability to adapt to US healthcare
• Clear communication skills in English
• Professionalism and reliability

If you don’t fully match “ideal” criteria, a SOAP application can still succeed when:

• You are realistic about where you apply
• You tailor your application and communication effectively
• You consider prelim/TY or adjacent specialties to gain a foothold

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2. Tailoring Your Personal Statement and Experiences for SOAP

During SOAP, programs may read your personal statement more quickly. Make it easy to see:

• Your specific motivation for OB GYN
• Your clinical readiness (hands-on experiences)
• Your understanding of the specialty’s demands
• As a non-US citizen IMG, your long-term vision in US healthcare

For example, a concise paragraph might include:

“My experience assisting in high-risk antenatal clinics in [country] and my subsequent OB/GYN observership in [US institution] confirmed that I thrive in fast-paced, team-based environments that demand both technical skills and empathetic communication. As an international graduate, I have worked intentionally to understand the US healthcare system, and I am committed to contributing to women’s health care for diverse and underserved populations.”

If you are writing an OB GYN–focused personal statement but anticipate applying broadly in SOAP:

• Avoid naming specific programs.
• Emphasize transferable skills:
  • Teamwork
  • Procedural ability
  • Comfort with emergencies
  • Continuity of care

For alternative specialty personal statements (e.g., IM, FM), make genuine links:

• Example: An FM personal statement can highlight your interest in women’s health, prenatal care, and continuity of care but should still show that you understand and accept FM as its own distinct specialty.

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3. Preparing for SOAP Interviews: OB GYN and Beyond

SOAP interviews are often:

• Short (10–20 minutes)
• Virtual (phone or online platforms)
• Scheduled with little notice

Common themes for a non-US citizen IMG pursuing OB GYN:

• “Why OB GYN?”
  Be specific: mention experiences with labor & delivery, gynecologic surgery, or women’s health advocacy.

• “Why did you go unmatched?”
  Answer honestly yet positively:

  • High competition in OB GYN
  • Limited number of interviews
  • Late improvement in scores or late USCE
  • Emphasize what you’ve learned and how you’ve improved your application.

• “Tell us about a challenging clinical case.”
  Choose one that shows:

  • Multidisciplinary work
  • Communication with patients and families
  • Good judgment under pressure

• “Any concerns about starting on a J-1/H-1B?”
  Be clear and prepared:

  • Confirm that you understand J-1 obligations.
  • If you qualify for H-1B (Step 3 done, if required), mention it briefly but don’t insist if they only support J-1.

Practice mock SOAP interviews in advance, focusing on:

• Simple, direct English.
• Clear structure in answers (Situation–Action–Result).
• Confidence without exaggeration.

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The Mechanics of SOAP Week: Step-by-Step for Non-US Citizen IMGs

1. Monday: Unmatched Notification and List of Unfilled Programs

On Monday of Match Week:

• You receive an email from NRMP indicating if you are:
  • Matched
  • Partially matched
  • Unmatched

If you are SOAP-eligible (unmatched or partially matched and NRMP-registered):

• You gain access to the List of Unfilled Programs at 11:00 a.m. ET.
• You may start preparing your applications through ERAS.

As a non-US citizen IMG focused on OB GYN:

1. Immediately review:

   • Are there any OB GYN categorical or preliminary positions unfilled?
   • Which of these sponsor J-1 or H-1B?
   • Which explicitly state “No visa sponsorship”?

2. Decide where to apply first, given the 45-program limit in Round 1 (typical NRMP rule; verify current year’s rules).

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2. Tuesday–Thursday: SOAP Rounds, Offers, and Acceptances

SOAP typically has multiple offer rounds on Wednesday and Thursday. Each round consists of:

1. Programs reviewing ERAS applications from the SOAP pool.
2. Programs conducting rapid virtual interviews.
3. Programs submitting preference lists.
4. Applicants receiving offers (if any) and deciding whether to accept.

Key mechanics:

• You can apply to a limited number of programs per SOAP round (traditionally 45 in total for the entire SOAP, not per round; verify rules each year).
• Once you accept an offer, you are locked out of SOAP and cannot accept another position.
• If you reject an offer, you may not receive another one in later rounds.

Practical advice:

• Prioritize programs realistically likely to rank you:

  • Programs with a history of taking IMGs.
  • Programs that accept J-1 or H-1B, matching your status.
  • Programs where your profile (scores, attempts, graduation year) meets or nearly meets their expectations.

• Keep your phone and email available constantly.

• Respond promptly to interview invitations, even at short notice.

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3. Realistic OB GYN SOAP Scenarios for Non-US Citizen IMGs

Consider three realistic profiles and SOAP strategies:

Scenario A: Strong OB GYN–Focused IMG

• Step 2 CK: >245
• One US clinical elective in OB GYN
• 2 OB GYN US LoRs + 1 IM LoR
• ECFMG certified, J-1 needed
• Unmatched due to high specialty competitiveness

SOAP plan:

• Apply to all unfilled OB GYN categorical or prelim spots that accept J-1.
• Use OB GYN personal statement.
• In addition, apply to selected prelim IM or TY programs known to be IMG-friendly.

Scenario B: Average Scores, Strong USCE, Multiple Attempts

• Step 2 CK: ~225, one Step 1 failure
• Several months of USCE in IM and FM, limited OB GYN-specific
• 3 LoRs (2 IM, 1 FM)
• ECFMG certified, J-1 needed

SOAP plan:

• Still apply to any OB GYN spots available (though chances may be low).
• Heavily apply to prelim IM, prelim surgery, FM categorical, and TY programs.
• Use different personal statements accordingly.

Scenario C: No USCE, Older Graduate (≥5 years)

• Step 2 CK: ~230
• Graduated 7 years ago
• No USCE, no US letters
• ECFMG certified, J-1 needed

SOAP plan:

• Chances for OB GYN in SOAP are extremely low.
• Focus on categorical IM/FM or research-friendly prelim/TY positions, especially in community hospitals that accept older graduates.
• Start planning actively for USCE, research, and potential Step 3 if SOAP is unsuccessful.

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After SOAP: Decisions, Acceptance, and Next Steps

1. When You Receive an Offer

When an offer appears in a SOAP round, you typically have a short window (often 2 hours) to accept or reject it.

Factors to consider, especially as a foreign national medical graduate:

• Visa sponsorship:

  • Confirm that they sponsor your required visa type.

• Specialty and position type:

  • OB GYN categorical: usually accept if this is your top goal.
  • Prelim or TY: consider the program’s reputation and how it may help future OB GYN reapplication.
  • Other categorical specialty: decide if you can see yourself practicing that field long-term.

• Geography and support:

  • Programs in areas with strong IMG communities and support services may be more welcoming.
  • Consider cost of living and access to cultural/community networks.

If you accept:

• You are matched to that program.
• SOAP ends for you, and you begin onboarding: visa processing, licensing paperwork, background checks.

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2. If You Do Not Match in SOAP

Not matching in SOAP is emotionally difficult but far from the end of your OB GYN journey. For a non-US citizen IMG, your post-SOAP preparation should be as intentional as your SOAP preparation:

Immediate next steps (Weeks 1–4 post-SOAP):

• Review your application honestly:

  • Scores
  • Attempts
  • LoRs
  • USCE
  • Time since graduation

• Seek feedback from mentors (especially OB GYN faculty if possible).

• Identify short-term opportunities:

  • OB GYN or women’s health research positions
  • Clinical observer or externship roles
  • Volunteer work in women’s health clinics or prenatal services

Medium-term steps (Next 6–12 months):

• Strengthen your CV in OB GYN and general clinical preparation:

  • Publications, posters, or QI projects in women’s health
  • Step 3 (if feasible), which can help with H-1B sponsorship and show clinical readiness
  • More USCE, ideally hands-on where allowed

• Plan for the next ERAS cycle:

  • Update personal statements with current experiences.
  • Obtain new, stronger US-based LoRs.
  • Apply earlier and widely (more than in the previous cycle, including prelim/TY or related specialties if OB GYN remains highly competitive for you).

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Frequently Asked Questions (FAQ)

1. As a non-US citizen IMG, is it realistic to match into OB GYN through SOAP?
It is possible but uncommon. OB GYN tends to fill most of its positions in the main Match, leaving very few unfilled spots. The non-US citizen IMG faces additional filters related to visa sponsorship and sometimes graduation year and scores. Your best strategy is to prepare for OB GYN SOAP opportunities but also be open to prelim/TY positions or other specialties while staying focused on women’s health in your long-term career.

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2. How should I balance OB GYN applications with other specialties during SOAP?
Create a hierarchy before Match Week:

• If any OB GYN categorical or prelim spots appear and accept your visa type, prioritize them in your first wave of applications.
• Fill remaining allowed SOAP applications with prelim IM, prelim surgery, TY, or FM/IM programs depending on your long-term vision.
• Avoid applying so narrowly to OB GYN that you end up with no position when you would have been happy with a strong prelim or TY year.

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3. What is SOAP, and how is it different from the main Match?
SOAP (Supplemental Offer and Acceptance Program) is a structured process during Match Week used to fill unfilled residency positions with unmatched or partially matched applicants. Unlike the main Match:

• You apply only to programs that have unfilled spots.
• Applications are made in rapid cycles.
• Offers and acceptances occur in multiple short rounds over two days.
• There is no formal rank list on your side; instead, programs submit preferences for SOAP-eligible applicants and the NRMP issues offers directly.

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4. Does participating in SOAP hurt my chances in future OB GYN matches if I don’t match?
No. Simply participating in SOAP does not harm future chances. What matters for future OB GYN applications is how you use the time afterward:

• Gaining strong USCE, especially in OB GYN or women’s health
• Improving your academic profile (e.g., Step 3, research output)
• Obtaining strong and updated US-based LoRs Residency programs often respect persistence and growth—especially when your application shows clear improvement and well-reflected career decisions.

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Preparing thoroughly for SOAP as a non-US citizen IMG interested in OB GYN means starting months before Match Week: setting realistic pathways, strengthening your application, and understanding the mechanics of offers and acceptances. Whether you secure an OB GYN spot directly, enter through a prelim/TY year, or take an indirect path via another specialty or research, a structured SOAP preparation plan puts you in the best possible position to advance toward your goal of practicing obstetrics and gynecology in the US.