SOAP Preparation in Orthopedic Surgery: Essential Guide for Residency Success

Understanding SOAP in the Context of Orthopedic Surgery

Orthopedic surgery is one of the most competitive specialties in the residency match. Even strong applicants—solid scores, multiple away rotations, good letters—sometimes do not match in the main ortho match. When that happens, the Supplemental Offer and Acceptance Program (SOAP) becomes your immediate reality.

What Is SOAP?

SOAP (Supplemental Offer and Acceptance Program) is a structured process run by the NRMP during Match Week for applicants who are:

• Unmatched (did not match to any program), or
• Partially matched (matched to a preliminary position but not an advanced one, or vice versa)

In SOAP, eligible applicants can apply to unfilled residency positions through the ERAS system in several timed rounds of offers.

Key features:

• Happens Monday–Thursday of Match Week
• Applicants may apply only to programs with unfilled positions listed by NRMP
• All communication is through ERAS and program-initiated contact only
• There are multiple offer rounds (typically four), and offers must be accepted or rejected within tight time windows

Understanding what SOAP is and how it works is your first step in effective SOAP preparation—especially in a high-stakes, competitive field like orthopedic surgery.

Why SOAP Is Especially Complex for Orthopedic Applicants

Orthopedic surgery residency is highly competitive, and the number of unfilled categorical ortho positions in SOAP tends to be very small each year—sometimes close to zero. That means:

• You may not see any categorical orthopedic surgery residency positions available in SOAP.
• Some years, a handful of prelim or transitional-year spots at ortho-heavy institutions may appear.
• Many unmatched ortho applicants use SOAP to secure a strong backup position (prelim surgery, TY, or another specialty) that keeps them clinically active and competitive for a future ortho match cycle.

Therefore, for orthopedic surgery applicants, SOAP strategy is less about “grabbing an ortho spot” and more about:

• Staying in the game clinically
• Maximizing your strength for reapplication to orthopedic surgery
• Protecting your mental health and long-term career goals

Understanding this reality early will shape a smart, realistic SOAP preparation plan.

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

The best SOAP preparation starts months before Match Week. You hope you won’t need it—but if you do, being prepared can make the difference between chaos and a controlled, strategic response.

1. Assess Your Ortho Match Risk Realistically

Before SOAP ever becomes necessary, have an honest conversation about your competitiveness for the ortho match.

Consider:

• USMLE/COMLEX scores and attempts
• Class rank and AOA/Gold Humanism status
• Strength of letters of recommendation (particularly from orthopedic surgeons)
• Number and quality of away rotations
• Research in orthopedics, publications, and presentations
• Interview yield: How many ortho interviews did you receive?

Practical guidance:

• If you have fewer than ~10–12 ortho interviews, your overall risk of not matching is meaningfully higher.
• If you received 0–5 ortho interviews, you should plan very concretely for SOAP and for a possible dedicated reapplication year.

These numbers are not strict cutoffs but guides to how seriously you should prepare.

2. Clarify Your Backup Pathways Early

A common mistake among orthopedic applicants is not defining backup pathways until after they learn they are unmatched. This leads to rushed, emotionally driven decisions during SOAP.

Before Match Week, outline your priorities if you don’t match:

• Option A: Immediate categorical position in another specialty

  • E.g., Physical Medicine & Rehabilitation (PM&R), internal medicine, or general surgery.
  • Most appealing if you’re open to a career outside orthopedics.

• Option B: Prelim/TY year with plan to reapply to orthopedic surgery

  • E.g., prelim general surgery, transitional year, or even a research year plus part-time clinical work.
  • Best for those strongly committed to ortho, willing to re-enter the ortho match.

• Option C: Dedicated research year (possibly plus SOAP backup clinical role)

  • Often at an academic orthopedic department.
  • Very powerful for strengthening an ortho-specific application, especially if you lack research or strong institutional support.

Make a written decision tree before Match Week:
“If I don’t match in ortho, my first priority is X; if that is not available, then Y.” This reduces paralysis if SOAP becomes necessary.

3. Prepare SOAP-Ready Documents in Advance

Even though SOAP is fast, your written materials still matter. Most programs will glance at your:

• SOAP-specific personal statement
• Updated CV
• Transcript, MSPE, and board scores (already in ERAS)
• Letters of recommendation, including potentially non-ortho letters if aiming at other specialties

For orthopedic applicants, consider preparing two or three versions of your personal statement:

1. Ortho re-application PS (short, SOAP-ready)

   • If by chance orthopedic surgery residency spots appear in SOAP.
   • Emphasizes: commitment to ortho, away rotations, technical skills, and insight into the specialty.

2. Procedural backup PS (e.g., prelim surgery, TY)

   • Focus on surgical interest, teamwork, OR environment, resilience, and your long-term goal (which might still be orthopedic surgery, framed professionally).

3. Non-surgical backup PS (if relevant)

   • If considering PM&R, internal medicine, EM, or another field through SOAP.
   • Reframe your strengths (musculoskeletal interest, patient communication, multidisciplinary care).

Action item:
Upload all likely personal statement variants to ERAS ahead of time (or at least have them fully drafted and ready). During SOAP, you can quickly assign the right statement to the right programs.

4. Strategically Update Your Program List and Contacts

A strong SOAP preparation plan includes awareness of institutions that:

• Know you already (via away rotations, interviews, research)
• Have historically taken SOAP applicants
• Have prelim or TY spots with strong operative exposure or ortho presence

Practical steps:

• Identify 10–20 institutions where you have existing relationships (attendings, PDs, research mentors).
• Ask mentors discreetly:
  • How does your department typically handle SOAP?
  • Are there prelim or TY routes that interface well with your ortho department?
• Save updated contact lists (emails for mentors, letter writers, advisors) to reach out quickly during SOAP if needed.

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What Happens During SOAP Week: Timeline and Logistics

When SOAP begins, chaos and emotions run high. Having a clear mental model of the timeline reduces panic and allows you to focus on strategy.

Monday Morning: The Unmatched Email

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

• Matched – You’re done with SOAP; you don’t participate.
• Partially matched – You may still be eligible for SOAP (e.g., prelim only).
• Unmatched – You are eligible to enter SOAP if you are SOAP-eligible per NRMP/ERAS rules.

If you are unmatched or partially matched:

1. Meet with your dean or advisor immediately.
   • Most schools have a rapid-response SOAP advising system.
2. Stabilize emotionally first.
   • You have a few hours before applications open; take 30–60 minutes to process the shock if needed.
3. Log in to NRMP/ERAS to confirm SOAP eligibility and view the List of Unfilled Programs when it is released.

The Unfilled Positions List: Orthopedic Implications

Once the List of Unfilled Programs is posted:

• Filter by Orthopedic Surgery
  • Some years, you may see no categorical ortho positions; occasionally, a very small number.
• Then search:
  • Preliminary Surgery
  • Transitional Year
  • PM&R, General Surgery categorical, or other fields you’ve considered

Realistic expectations for ortho applicants:

• SOAP is unlikely to be your primary pathway into a categorical orthopedic surgery residency.
• Instead, think: “How can I position myself now to be a better ortho candidate for next cycle?”

Application Limits and Strategy

In SOAP, there is a limit to the number of programs you can apply to (historically 45 programs, but verify the current year’s rules). This cap means you must prioritize:

1. Any rare orthopedic surgery residency positions that appear.
2. Strong prelim surgery or TY programs with:
   • Heavy operative experience
   • A robust orthopedic department
   • Known history of supporting residents who reapply to ortho
3. Backup categorical specialties if you’re open to pivoting out of ortho.

Coordinate with your advisor to decide how many of your 45 applications to allocate to:

• Ortho (if spots exist)
• Prelim/TY
• Other categorical specialties (if desired)

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Crafting a Smart SOAP Strategy as an Ortho Applicant

Given the scarcity of ortho spots in SOAP, your strategy must be deliberate and flexible.

1. Prioritizing Programs: A Tiered Approach

Create tiers before sending out applications:

Tier 1 – Ideal Ortho-Adjacent Positions

• Preliminary general surgery at institutions with:
  • Strong orthopedic presence
  • High case volume
  • Active orthopedic research
• Transitional year programs with:
  • Strong surgical exposure
  • Clear pathways to interact with ortho faculty

Tier 2 – Strong Surgical Foundations

• Prelim surgery spots at reputable community or academic hospitals
• Positions where graduates historically match into competitive specialties

Tier 3 – Alternative Career Paths (Categorical)

• PM&R with strong musculoskeletal focus
• Internal medicine or EM if you’ve decided you can be genuinely satisfied outside ortho

Within each tier, prioritize programs where:

• You have geographic ties
• You have connections via mentors or alumni
• You’ve already rotated or interviewed

This targeted approach makes your SOAP preparation more focused and increases your odds of traction where it matters.

2. Tailoring Your Messaging During SOAP

Although SOAP is fast, programs may still read your:

• Personal statement
• Application summary
• Short messages if they contact you

For orthopedic surgery residency (if any SOAP spots exist), your message should emphasize:

• Sustained interest in orthopedics
• Prior orthopedic exposure (clerkships, sub-Is, research)
• Fit with their specific program (location, culture, patient population)

For prelim surgery or TY with a plan to reapply to ortho:

• Be honest but strategic:
  • State you are passionate about surgery and thrive in the OR.
  • You aim to develop core surgical skills and prove yourself clinically.
  • You are committed to being a reliable, hardworking team member, regardless of long-term specialty.

You do not need to over-share your reapplication plans; programs know prelims often reapply to advanced specialties, including ortho. Emphasize being an asset now, not just using the position as a stepping stone.

3. Interview Skills in the Compressed SOAP Environment

SOAP interviews are often:

• Short (sometimes just 10–20 minutes)
• Virtual or by phone
• Focused on fit, reliability, and your immediate readiness to start residency

Common questions in SOAP residency interviews for an unmatched ortho applicant:

• “What happened in your primary ortho match, and what did you learn from it?”
• “Why are you interested in our prelim/TY program specifically?”
• “How will you handle the emotional/mental aspects of not matching into your first-choice specialty?”
• “If you reapply to orthopedics, how will you remain fully engaged and committed to our program this year?”

Actionable tips:

• Prepare a concise, non-defensive explanation of why you think you didn’t match initially:
  • “Orthopedic surgery is extremely competitive, and my application had strengths—X, Y, Z—but also weaknesses such as fewer interviews than ideal. I’ve reflected on this and am focused on improving [specific areas] while giving my absolute best to my residency program.”
• Practice a 2–3 minute pitch explaining why this specific program and position make sense for you.
• Emphasize resilience, professionalism, and coachability—all highly valued in high-intensity surgical environments.

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Life After SOAP: Planning for the Next Ortho Match

Whether you secure a position through SOAP or not, your long-term orthopedic surgery goals still matter. SOAP is just one chapter in that story.

1. If You Match via SOAP (Prelim/TY or Alternative Specialty)

If you secure a preliminary surgery or transitional year:

• Treat it as a 12-month audition:
  • Excel clinically: be reliable, proactive, and a team player.
  • Seek formal feedback and act on it.
• Build relationships with:
  • Orthopedic attendings and residents
  • General surgery faculty who can vouch for your work ethic
• Continue or start orthopedic research:
  • Case reports, retrospective studies, QI projects
  • Collaborate with ortho faculty or your prior mentors

If you match into another categorical specialty (e.g., PM&R) and still want ortho:

• Understand that transferring to ortho is possible but rare.
• Some physicians discover they truly enjoy their SOAP specialty and choose to stay.
• If you remain committed to ortho, you’ll need:
  • Strong, honest mentorship
  • A clear plan and timeline for re-application or transfer

2. If You Do Not Match in SOAP

If SOAP ends without a position:

1. Meet with your dean and orthopedic mentors to discuss:

   • A dedicated research year in orthopedics
   • Possible clinical roles (e.g., surgical assistant, hospitalist assistant roles that accept unmatched graduates, depending on local regulations)
   • How to maintain clinical skills and professional momentum

2. Create a 12–18 month re-application plan:

   • Identify 1–2 academic orthopedics departments where you can do a full-time research fellowship.
   • Clarify expectations: publications, conference presentations, involvement in clinics/OR.
   • Strengthen weaknesses in your original application (e.g., Step scores, letters, lack of ortho-specific research).

3. Protect your mental health and finances:

   • Unmatched and SOAP experiences are emotionally taxing.
   • Seek counseling, peer support, and clear financial planning (especially if you relocate for a research year).

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Practical SOAP Preparation Checklist for Ortho Applicants

As you approach Match Week, use this focused checklist:

3–4 Months Before Match Week

• Honestly assess your competitiveness for orthopedic surgery residency.
• Meet with an advisor to discuss backup plans.
• Decide on potential backup specialties and prelim/TY preferences.
• Begin drafting multiple personal statements: ortho, prelim/TY, and potential alternative specialty.

1–2 Months Before Match Week

• Finalize and upload SOAP-ready personal statements to ERAS.
• Update your CV and experiences in ERAS.
• Identify 10–20 programs with strong prelim/TY options and ortho presence.
• Talk with ortho and surgery mentors about realistic outcomes and letters.

1–2 Weeks Before Match Week

• Review what SOAP is and how the NRMP process works.
• Block your schedule for Match Week so you can respond quickly.
• Practice brief “what happened in the match” explanations and elevator pitches.

During SOAP Week

• Meet immediately with your dean or advising team once you learn you’re unmatched/partially matched.
• Review the List of Unfilled Programs with your advisors.
• Allocate your limited SOAP applications across ortho (if any spots), prelim/TY, and any categorical backup.
• Prepare for short-notice interviews; keep your phone and email available.
• Stay professional, responsive, and organized during offer rounds.

After SOAP

• Debrief with advisors and mentors, regardless of outcome.
• If you matched via SOAP, integrate quickly into your new program and make a strong first impression.
• If you did not, immediately begin structured planning for research, re-application, or alternate career paths.

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FAQs: SOAP Preparation in Orthopedic Surgery

1. How common is it to get an orthopedic surgery residency spot through SOAP?

It is uncommon. Most years, there are very few or no categorical orthopedic surgery positions in SOAP. When ortho positions do appear, they are extremely competitive and often quickly filled by very strong applicants. For this reason, your SOAP preparation should emphasize prelim/TY and backup pathways, not rely on SOAP as your main avenue into orthopedics.

2. If I take a prelim surgery or transitional year via SOAP, will that hurt my chances of matching ortho later?

Not inherently. In many cases, a strong performance in a prelim/TY year improves your chances of matching into orthopedic surgery later, provided you:

• Excel clinically and earn strong letters
• Stay engaged in ortho research and mentorship
• Present a coherent, professional narrative for your re-application

Programs value residents who have already proven themselves in a rigorous clinical year.

3. Should I mention that I plan to reapply to orthopedic surgery during SOAP interviews for prelim/TY spots?

You can acknowledge your continued interest in orthopedics, but frame it professionally:

• Emphasize your immediate focus on being an excellent intern in their program.
• Acknowledge that many prelims do reapply to advanced specialties.
• Avoid sounding like you see the position only as a “stepping stone” or that you’d be disengaged if reapplication doesn’t work out.

Balance honesty with reassurance that you will be fully committed to your intern responsibilities.

4. Is taking a research year better than taking a SOAP prelim or TY spot if I want orthopedics long-term?

It depends on your specific weaknesses:

• If your primary deficit is lack of research, publications, or academic connections in ortho, a dedicated research year at a strong ortho department can be extremely high yield.
• If your main gap is clinical performance, professionalism, or limited letters from residency-level supervisors, a prelim/TY year might be more valuable.
• Many successful reapplicants combine both over time (e.g., prelim year followed by a research year, or vice versa), guided by mentor advice.

Discuss your situation with trusted advisors before deciding between clinical SOAP positions and research.

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Thoughtful SOAP preparation gives you structure and control in what can feel like a chaotic, high-stakes week. For orthopedic surgery applicants, that preparation is not just about this Match Week—it’s about strategically positioning yourself for the career you ultimately want, whether through SOAP, re-application, or a carefully chosen alternative path.