Mastering SOAP Preparation for Nuclear Medicine Residency Success

Understanding SOAP in the Context of Nuclear Medicine

The Supplemental Offer and Acceptance Program (SOAP) can feel overwhelming, especially in a less common specialty like nuclear medicine. Yet with thoughtful planning, you can use SOAP as an opportunity rather than a last resort.

What Is SOAP?

SOAP is an NRMP-managed process that allows unmatched or partially matched applicants to obtain an unfilled residency position in the days following the Main Residency Match. It is not a separate match but a structured way to redistribute unfilled positions quickly and fairly.

Key features:

• Takes place the same week as Match Week (Monday–Thursday)
• Uses ERAS for applications and NRMP for offers
• Involves multiple offer rounds across two days (Wednesday–Thursday)
• You can apply to up to 45 programs total during SOAP

Understanding what is SOAP is the first step in effective SOAP preparation. For applicants interested in a nuclear medicine residency, this process is especially important because of the small number of programs and positions nationwide.

How SOAP Relates to Nuclear Medicine

Nuclear medicine has a unique training structure in the U.S.:

• Classic three-year nuclear medicine residency (PGY-2 to PGY-4) following at least one year of clinical training (often PGY-1 in Internal Medicine, Surgery, Transitional Year, or equivalent)
• Combined pathways, such as:
  • Diagnostic radiology with nuclear medicine emphasis
  • Integrated or independent nuclear radiology pathways (often after DR)
• A limited number of categorical nuclear medicine positions (including PGY-1) in some institutions

In the nuclear medicine match, positions may remain unfilled for a variety of reasons: limited applicant pool, less visibility compared to radiology, or geographic considerations. Because of small numbers, SOAP can be a highly strategic way to:

• Pivot from another specialty (e.g., internal medicine, surgery, preliminary year) into nuclear medicine
• Secure a preliminary or transitional year that positions you to pursue nuclear medicine afterward
• Identify PGY-2 nuclear medicine positions for future entry

Understanding how your background fits into these pathways is central to your SOAP preparation strategy.

---

Pre-Match SOAP Preparation: What to Do Before Match Week

The best SOAP outcomes usually come from planning before you know if you matched. Think of SOAP preparation as an essential risk-management strategy, not an admission of failure.

1. Clarify Your Nuclear Medicine Career Pathway

Even before Match Week, you should clearly understand:

• Your current training status:
  • Are you an MS4 applying directly to PGY-1?
  • Are you an IMG or graduate already with some clinical training?
  • Are you currently in a preliminary or transitional year?
• Your eligibility for nuclear medicine:
  • Do you have, or will you have, at least one year of accredited clinical training by the time a PGY-2 spot would begin?
  • Are you eligible for ECFMG certification (if IMG)?
• Your long-term goal:
  • Dedicated nuclear medicine specialist?
  • Diagnostic radiologist with strong nuclear medicine expertise?
  • Academic career in molecular imaging / theranostics?

This clarity helps you decide during SOAP whether to:

• Target direct nuclear medicine residency positions (PGY-2 or PGY-3)
• Target preliminary or transitional year positions that facilitate later nuclear medicine entry
• Consider related fields (e.g., diagnostic radiology, internal medicine with future nuclear cardiology focus) if nuclear medicine spots are not available

2. Assemble and Update Core Application Materials

You cannot write or upload major documents for the first time during SOAP day; there will not be enough time to do this well. Before Rank Order List certification:

1. Update your CV

   • Emphasize:
     • Imaging-related experiences (radiology rotations, electives, observerships)
     • Research in nuclear medicine, radiology, oncology, cardiology, or physics
     • Quantitative or analytic skills (math, engineering, physics, data science)
   • Prepare a clean, updated CV you can reference for quick edits.

2. Create SOAP-focused personal statement templates Prepare 2–3 adaptable versions:

   • Nuclear medicine–focused statement
     • Why nuclear medicine specifically (e.g., interest in molecular imaging, theranostics, oncology, cardiology imaging)
     • Any exposure: shadowing, electives, research, case discussions
     • Your comfort with physics, technology, and interdisciplinary collaboration
   • Internal medicine / prelim / transitional year statement
     • Emphasize broad clinical skills and adaptability
     • Mention eventual plan to pursue nuclear medicine if relevant
   • Diagnostic radiology / imaging-focused statement (if appropriate)
     • Focus on imaging, pattern recognition, and your interest in advanced modalities

   You can then tightly customize these to individual programs in SOAP but will not start from scratch.

3. Confirm your recommendation letters

   • Ensure at least three strong letters are in ERAS and assigned globally:
     • Ideal mix:
       • One from nuclear medicine or radiology faculty
       • One from internal medicine or surgery (for clinical skills)
       • One from research mentor, program director, or faculty who knows you well
   • You generally cannot add new letters during SOAP (depending on timing), so whatever is in ERAS on Match Week is what you’ll work with.

4. Prepare a Professional Headshot and Contact Details

   • Ensure your ERAS photo is professional and current.
   • Double-check email and phone numbers—SOAP moves fast, and missed calls can mean missed opportunities.

3. Academic and Credential Preparation

SOAP eligibility requires:

• Registration with NRMP
• Application through ERAS
• No unmatched outside the Match (no prior binding contract)

Before SOAP:

• Verify USMLE/COMLEX scores are correctly reported.
• Ensure ECFMG certification status timelines (for IMGs) are accurate.
• Gather documents you may need to reference quickly:
  • Score reports
  • Dean’s letter/MSPE
  • Medical school diploma (for graduates)
  • Visa documents if applicable

---

Strategic SOAP Planning for Nuclear Medicine

1. Understand the Nuclear Medicine Landscape in SOAP

Because nuclear medicine is a small specialty, the number of unfilled nuclear medicine residency positions in SOAP can vary widely from year to year and may be very limited. Possible configurations:

• A handful of PGY-2 nuclear medicine positions (often starting one year later)
• Occasional PGY-3 entry spots (for those with two years of clinical training)
• Rare categorical nuclear medicine positions with PGY-1 attached
• Some preliminary or transitional year positions at hospitals with strong nuclear medicine programs, which can be stepping-stones

In parallel, you may see:

• Diagnostic radiology positions (often competitive even in SOAP)
• Internal medicine or other specialties at institutions with strong nuclear medicine departments

Your SOAP strategy should rank options by realistic feasibility and long-term alignment:

1. Direct nuclear medicine PGY-2/3 positions (if you’re eligible)
2. Prelim/TY positions at nuclear medicine–rich institutions
3. IM or DR positions with strong imaging exposure
4. Broader prelim/TY options that keep your pathway open

2. Align Your Profile With Nuclear Medicine Strengths

Nuclear medicine programs often value:

• Strong exam performance, especially in:
  • USMLE Step 2 CK or COMLEX Level 2
  • Solid performance in radiology or internal medicine clerkships
• Evidence of interest in imaging or physics:
  • Electives in radiology or nuclear medicine
  • Research in imaging, oncology, cardiology, or medical physics
  • Engineering, physics, or computer science background
• Professional attributes:
  • Attention to detail and patient safety (radiation safety, dosimetry)
  • Comfort with interdisciplinary teams (oncologists, cardiologists, surgeons)
  • Communication skills, particularly explaining complex imaging to clinicians

Before SOAP, identify 3–5 aspects of your profile that most strongly match nuclear medicine values. These become core talking points for:

• Personal statement customization
• Phone or video interviews
• Email communications with coordinators or program directors

3. Develop a Tiered Program Targeting List

You cannot see which programs are unfilled until the NRMP releases the List of Unfilled Programs on Monday of Match Week. However, pre-SOAP you can build a provisional targeting map:

1. Identify nuclear medicine residency programs nationwide:

   • Note which:
     • Take PGY-2 or PGY-3 entries
     • Are associated with large academic centers or cancer centers
   • List their:
     • Program codes
     • Program directors and coordinators
     • Key features (theranostics, PET/CT, cardiac imaging, research focus)

2. Identify prelim/TY programs near strong nuclear medicine centers:

   • Transitional Year at large academic medical centers
   • Preliminary internal medicine at hospitals with prominent imaging departments

3. Classify them into tiers:

   • Tier 1: Ideal fit (strong nuclear medicine, geographic preference, your qualifications closely match)
   • Tier 2: Good fit, slightly less ideal location or alignment
   • Tier 3: Reasonable but less optimal choices (e.g., purely stepping-stone prelims)

During SOAP, once the unfilled list is available, you’ll match it against your tiers and rapidly prioritize applications.

---

Executing During SOAP Week: Step-by-Step

Monday: Verification and Mindset Reset

On Monday of Match Week, you receive one of three NRMP statuses:

• Matched
• Partially matched
• Unmatched

If you are eligible for and plan to participate in SOAP:

1. Stay calm and task-focused. Many excellent physicians have entered their specialty through SOAP. Nuclear medicine, in particular, often attracts later decision-makers and career changers.
2. Access the NRMP R3 system at the designated time (usually late morning ET) to download the List of Unfilled Programs.
3. Filter for nuclear medicine and related programs:
   • Nuclear medicine residency
   • Transitional year or prelim positions at nuclear medicine–rich centers
   • Imaging-heavy programs (DR if realistically attainable)

Monday Afternoon: Rapid Targeting and Application Setup

1. Map unfilled programs to your pre-made tier list

   • See where your target nuclear medicine programs appear.
   • Add new possibilities that you hadn’t previously considered.

2. Decide your application mix (up to 45 programs): Example strategy for an applicant interested strongly in nuclear medicine:

   • 5–10 nuclear medicine PGY-2 positions (if available and eligible)
   • 10–20 transitional or prelim year programs at centers with strong nuclear medicine or radiology
   • Remaining slots: internal medicine or DR programs that can still support an imaging-focused career

3. Customize personal statements by category

   • Nuclear medicine programs: Use your nuclear medicine–focused statement, tightly tailored to each program’s strengths.
   • Prelim/TY programs: Emphasize broad clinical skills and professionalism, with a brief mention (where appropriate) of long-term interest in nuclear medicine.
   • DR or other specialties: Adjust accordingly, highlighting imaging and analytic skills.

4. Double-check all ERAS assignments

   • Correct letters attached to each program
   • Proper personal statement assigned
   • Photo and CV finalized

Tuesday: Interviews and Communication

SOAP rules restrict unsolicited contact from applicants outside of allowed channels, and programs must follow NRMP policies. But within those rules, you can and should present yourself professionally when contacted.

1. Prepare for rapid-fire interviews

   • Many SOAP interviews are:
     • Short (10–20 minutes)
     • Phone or video-based
     • Conducted by program directors, associate program directors, or faculty

2. Craft concise answers to key questions:

   • “Why nuclear medicine?”

     • Example:
       “I’m drawn to nuclear medicine because it integrates advanced imaging, quantitative analysis, and direct impact on oncology and cardiology care. During my elective in nuclear medicine, I saw how PET/CT findings changed staging and therapy for cancer patients. I enjoy the combination of technology, physics, and interdisciplinary collaboration, and I see myself building a career in molecular imaging and theranostics.”

   • “Why are you applying through SOAP?”

     • Keep it honest but constructive:
       “I did not match into my primary specialty, which was [X], but through that process I realized that the aspects I enjoyed most—imaging, data interpretation, and working with multidisciplinary teams—are central in nuclear medicine. I’ve taken time to reflect on my strengths and long-term goals, and I believe nuclear medicine is a better alignment for my skills and interests.”

   • “What strengths will you bring to our program?”

     • Highlight analytic mindset, reliability, teamwork, and communication.
     • Give specific examples (e.g., research projects, team-based clinical work).

3. Have your schedule clear

   • Keep your phone on and your email open.
   • Respond promptly but professionally to any invitations.

Wednesday–Thursday: Offer Rounds and Decisions

During official SOAP rounds:

• Programs submit a pre-ranked list of applicants.
• The system extends offers in multiple rounds.
• You can either:
  • Accept an offer (binding, ends your participation in SOAP)
  • Reject or let it expire (you stay eligible for subsequent rounds)

Critical advice:

• Do not accept an offer you cannot commit to. Once accepted, it is binding, and you exit the nuclear medicine match/SOAP process.
• Be realistic. A solid prelim/TY or internal medicine position at a hospital with a strong nuclear medicine department may be an excellent path to your eventual nuclear medicine residency, especially in a year with few direct nuclear medicine SOAP positions.

---

Tailoring Your Application Materials for Nuclear Medicine in SOAP

Optimizing Your Personal Statement for Nuclear Medicine

Your nuclear medicine SOAP personal statement should:

1. Answer “Why nuclear medicine?” with specificity

   • Mention:
     • Molecular imaging
     • PET/CT, SPECT/CT
     • Theranostics (e.g., Lu-177 therapies, radioiodine)
     • Impact on oncology, cardiology, and neurology

2. Connect past experiences to future goals

   • Clinical: Cases where imaging guided management.
   • Research: Imaging-based oncology, cardiology, or neurology projects.
   • Academic: Physics, engineering, data analysis, or informatics coursework.

3. Demonstrate realistic understanding

   • Show you appreciate the:
     • Mix of non-interpretive work (e.g., protocoling, dosimetry)
     • Radiation safety responsibilities
     • Need for interdisciplinary communication

4. Acknowledge the SOAP context without overemphasis

   • Briefly:
     “While I am entering your consideration through the SOAP process, I see this as a valuable opportunity to pursue a specialty that truly fits my strengths and long-term aspirations. My experiences in [X, Y] have reinforced my commitment to a career in nuclear medicine.”

Highlighting Relevant Experiences on Your CV

To optimize for nuclear medicine:

• Move imaging-related experiences upward:
  • Radiology or nuclear medicine electives
  • Observerships in nuclear medicine departments
  • Imaging conferences or electives (RSNA, SNMMI, etc.)
• Feature quantitative or analytic strengths:
  • Projects using statistics, coding, or image analysis
  • Publications involving imaging, even if not nuclear
• Emphasize teamwork and communication:
  • Tumor boards or multidisciplinary conferences you’ve attended
  • Presentations of imaging cases or research posters

---

After SOAP: Next Steps, Whether You Match or Not

If You Match Into Nuclear Medicine Through SOAP

• Celebrate, then plan.
  • Reach out promptly to your new program to express gratitude.
  • Confirm onboarding requirements, licensing, and visa steps if applicable.
• Strengthen your preparation.
  • Review basic nuclear medicine physics, radiopharmaceuticals, PET/CT, and radiation safety.
  • Engage with resources from:
    • SNMMI (Society of Nuclear Medicine and Molecular Imaging)
    • Journal articles on theranostics and molecular imaging

If You Match Into a Prelim/TY or Other Specialty

If you aimed for nuclear medicine but ended up in a prelim/TY or internal medicine spot:

• Use the year strategically:
  • Seek nuclear medicine or radiology electives.
  • Participate in nuclear medicine tumor boards.
  • Join imaging-related research projects.
• Network within nuclear medicine.
  • Identify nuclear medicine faculty mentors.
  • Ask about future PGY-2 or fellowship opportunities.

This can position you strongly for a future nuclear medicine residency outside SOAP, either in the next nuclear medicine match cycle or through off-cycle openings.

If You Do Not Match Through SOAP

Not matching through SOAP is disappointing but not the end of your nuclear medicine aspirations.

1. Request feedback

   • From advisors, deans, or mentors.
   • Identify specific areas needing improvement: scores, clinical performance, communication, or clarity of goals.

2. Strengthen your profile for the next cycle

   • Consider:
     • Research positions in nuclear medicine, radiology, or oncology.
     • Structured clinical experience (e.g., non-ACGME fellowships, observerships).
     • Additional academic work (publications, presentations).

3. Reassess your overall strategy

   • Confirm that nuclear medicine remains your primary goal.
   • Consider complementary paths (e.g., internal medicine with nuclear cardiology focus, radiology with nuclear emphasis) if that better aligns with your situation.

---

FAQs: SOAP Preparation in Nuclear Medicine

1. Is nuclear medicine commonly available in SOAP?

Nuclear medicine has fewer total positions than many other specialties, so the number of unfilled nuclear medicine residency positions in SOAP can be small and variable. Some years may have several PGY-2 or PGY-3 openings; others may have very few. Because of this, it is wise to build a SOAP strategy that includes:

• Direct nuclear medicine positions (when available)
• Prelim/TY or internal medicine spots at nuclear medicine–rich institutions
• Alternative imaging-related pathways based on your profile

2. If I didn’t initially apply to nuclear medicine, can I pivot to it during SOAP?

Yes, it is possible, especially if:

• You have at least one year of clinical training (or will have by start date) for PGY-2 entry.
• Your background supports interest in imaging or quantitative disciplines.
• You can clearly explain your shift in interest and demonstrate sincere commitment.

Your SOAP preparation should include a nuclear medicine–focused personal statement and a clear narrative that connects your prior experiences to this new direction.

3. How is SOAP different from scrambling, and what is SOAP’s impact on my future chances?

SOAP replaced the old “scramble” with a structured, rule-based process. Compared to scrambling:

• SOAP is more orderly and fair, with defined rounds and offer acceptance windows.
• Programs cannot offer positions outside the NRMP system during SOAP.
• Applicants are limited to a maximum number of program applications.

Participating in SOAP does not inherently harm your long-term prospects. Many physicians obtain excellent training and successful careers after matching through SOAP, including in competitive and niche fields like nuclear medicine.

4. How can I balance applying to nuclear medicine and other specialties during SOAP?

Consider your:

• Eligibility for nuclear medicine (PGY-2/3 vs. categorical needs)
• Strength of your nuclear medicine–relevant experiences
• Geographic flexibility

A common approach is:

• Prioritize nuclear medicine positions if available and you are eligible.
• Use remaining application slots on prelim/TY or internal medicine programs at academic centers with strong nuclear medicine departments.
• Adjust in real time depending on the year’s actual unfilled position list.

Thoughtful SOAP preparation—including clear goals, adaptable documents, and a realistic understanding of the nuclear medicine match landscape—will give you the best chance to turn an unexpected outcome into a meaningful opportunity.