The Ultimate Guide to SOAP Preparation for Residency Success

Understanding SOAP: What It Is and Why Preparation Matters

If you’re aiming for residency in the United States, you must understand SOAP residency and start SOAP preparation early—even if you’re confident you’ll match. The Supplemental Offer and Acceptance Program (SOAP) is not a “backup after the Match fails.” It is an integral, time-compressed system with its own rules, strategy, and timeline.

What is SOAP?
SOAP is the formal NRMP (National Resident Matching Program) process that allows eligible unmatched or partially matched applicants to apply to unfilled residency positions between Match Week Monday and Thursday, before the main Match results are released on Friday.

Key features:

• It occurs during Match Week (not after Match Day).
• You apply only to programs with unfilled positions listed in the NRMP’s system.
• You use ERAS to submit applications, but offers and acceptances occur through the NRMP R3 system.
• The process is fast and highly structured with multiple offer rounds over a few days.

Why serious SOAP preparation is essential:

• You may only learn you’re unmatched or partially matched on Match Week Monday at 10:00 AM ET.
• You’ll have just a few hours before applications can be transmitted to programs.
• You are limited to 45 applications total via ERAS during SOAP.
• Programs may start reviewing, calling, and interviewing within hours.
• Strong materials and clear strategy often make the difference between securing a spot and remaining unmatched.

The time to create a competitive “SOAP-ready” profile is weeks before Match Week, not on Monday after you find out your result.

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SOAP Eligibility, Rules, and Timeline

Effective SOAP preparation starts with knowing if you’re eligible and how the week will unfold.

Who Is Eligible for SOAP?

You must satisfy both NRMP and ERAS criteria.

NRMP SOAP Eligibility:

You must:

• Be registered for the Main Residency Match.
• Be eligible to enter graduate medical education (GME) on July 1 of the Match year (e.g., have passed required exams, obtained ECFMG certification when needed).
• NOT be fully matched to a PGY-1 position at 11:00 AM ET on Match Week Monday.

You are typically SOAP-eligible if:

• You are unmatched (0 positions).
• You are partially matched (e.g., matched to an advanced PGY-2 position but not a PGY-1 preliminary/categorical position, or vice versa).

You are not SOAP-eligible if:

• You did not register for the NRMP Main Match.
• You were withdrawn or ineligible for the Match.
• You are fully matched to a PGY-1 spot (even if not your preferred specialty).
• You declined or failed to certify a rank order list in the Match (depending on NRMP policies for that cycle).

ERAS SOAP Eligibility:

• You must have an active ERAS application and be certified and ready to send.
• You must be designated for the same season as the NRMP Main Match.

Check NRMP and ERAS official guidelines each year, as technical criteria and dates can change.

Match Week and SOAP Timeline: Day-by-Day

While specific times can vary slightly by year, the structure is consistent. The following outline assumes Eastern Time and the usual pattern:

Monday

• 10:00 AM – You learn your Match Status via NRMP:
  • “You are matched” OR
  • “You are unmatched” OR
  • “You are partially matched”
• 10:00–11:00 AM – NRMP determines SOAP-eligible applicants.
• 11:00 AM – SOAP-eligible applicants:
  • See their SOAP eligibility status in R3.
  • ERAS opens for preparation of applications to unfilled programs (but you cannot transmit yet).
• Program lists of unfilled positions also become available.

Late Monday / Early Tuesday

• You refine your list of target programs (up to 45).
• You finalize and tailor your materials.

Tuesday

• 9:00 AM – ERAS opens for transmission of SOAP applications to unfilled programs.
• Programs begin reviewing applications almost immediately.
• Programs may start contacting applicants for brief interviews (often phone or video).

Wednesday–Thursday

• SOAP Offer Rounds occur through NRMP R3:
  • Typically four rounds, two on Wednesday and two on Thursday.
  • In each round, programs submit preference lists of SOAP applicants.
  • NRMP generates offers; you may receive 0, 1, or multiple offers per round.
  • You must accept or reject offers within a short window (often ~2 hours).

Thursday Afternoon/Evening

• Final SOAP rounds end.
• Any remaining unfilled positions may be pursued via outside-the-Match mechanisms, depending on institution and NRMP rules.

Friday (Match Day)

• Main Match results are public.
• Your SOAP outcome (if you participated) is also finalized.

Understanding this structure helps you plan what to prepare and when to use it.

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Building Your SOAP Toolkit: Documents and Content You Need Ready

SOAP preparation is about having a modular toolkit that you can quickly customize on Monday–Tuesday, not creating everything from scratch under pressure.

1. Your SOAP-Ready ERAS Application

Before Match Week, thoroughly review and update:

• Education & Training: Ensure all degrees, internships, observerships, and experiences are accurate.
• USMLE/COMLEX Scores: Confirm scores are released and correctly reported. If you’re waiting on a score, know how that might affect your eligibility or competitiveness.
• Work/Volunteer/Research Experiences:
  • Emphasize continuity, responsibility, and clinical relevance.
  • Clarify any gaps in training with neutral, factual explanations.
• Publications/Presentations: Ensure formatting is clean and consistent.
• Certifications & Licenses: BLS, ACLS, etc., especially relevant for preliminary and categorical internal medicine, surgery, and EM.

Action Item:
Print a PDF of your ERAS application and review it as if you were a program director. Correct typos, unclear descriptions, or inconsistencies before Match Week.

2. Personal Statements: Primary and SOAP-Specific Variants

One of the most powerful aspects of SOAP preparation is having several pre-written, adaptable personal statements:

• Primary Specialty PS (standard): The one you used for the Match.
• SOAP-Revised PS (same specialty):
  • Shorter, more focused on resilience, readiness to start in July, and immediate value.
  • Acknowledge challenges subtly (e.g., exam retakes, prior non-match) without sounding defensive.
• Alternative Specialty PS (if you’re open to switching fields):
  • For example, Internal Medicine or Family Medicine as a flexible backup.
  • Emphasize your transferable skills: teamwork, communication, continuity of care, procedural interest, etc.
• Prelim/Transitional PS (if targeting PGY-1-only positions):
  • Focus on developing a solid clinical foundation applicable to your long-term specialty goals.
  • Highlight adaptability, work ethic, and enthusiasm for broad-based training.

Example SOAP Personal Statement Adjustments

Original Match PS line (General Surgery):

“I am deeply committed to a career in academic general surgery, with long-term goals in surgical oncology and translational research.”

SOAP-modified line (for a Preliminary Surgery spot):

“I am committed to a rigorous surgical training year that will develop my operative judgment, clinical decision-making, and ability to thrive on a busy service, forming the foundation for my long-term career in surgery.”

SOAP-modified line (for Categorical Internal Medicine as an alternative):

“While my initial applications focused on surgery, my clinical experiences showed me that what I value most is longitudinal patient care, diagnostic reasoning, and multidisciplinary collaboration—strengths that naturally align with internal medicine.”

3. Letters of Recommendation (LoRs): Planning and Contingencies

By Match Week, your letters are usually set; you can’t reliably add new letters during SOAP because there’s no time to collect, upload, and assign them.

SOAP preparation should include:

• Having 3–4 strong, specialty-relevant letters already in ERAS.
• Ensuring at least one letter speaks broadly to your clinical skills and professionalism (useful if you pivot specialties).
• For those with mixed letters (e.g., 2 surgery, 1 internal medicine):
  • You can selectively assign letters via ERAS to different programs or specialties even during SOAP.

Action Item:
Before Match Week, map which letters you will assign to which potential SOAP specialties (e.g., IM, FM, Psych, Prelim Surgery).

4. CV and Supplemental Documents

Although ERAS provides a structured application, keep:

• A one-page CV in case programs request it by email.
• A concise professional bio paragraph you can paste into emails or online forms.
• A document with bullet-point talking points for interviews:
  • Why this specialty/program.
  • Strengths and weaknesses.
  • Explanation of any red flags (e.g., exam failures, interruptions in training).

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Strategic SOAP Preparation: Specialty Choices, Program List, and Narrative

The biggest SOAP mistakes occur when applicants panic and either apply randomly or too narrowly. Strategic SOAP preparation lets you strike a balance between realism and aspiration.

1. Deciding Your SOAP Scope: Stay the Course or Pivot?

Well before Match Week, reflect on:

• Your true career goals.
• Your objective competitiveness: scores, attempts, clinical experience, visa status, graduation year, etc.
• Geographic flexibility.

You need a Plan A and Plan B for SOAP:

• Plan A: Same specialty as your original Match applications, but more:
  • Community-based programs
  • Less competitive geographic regions
  • Programs that often have SOAP openings historically
• Plan B: Alternative but acceptable specialties or roles:
  • Internal Medicine, Family Medicine, Pediatrics, Psychiatry, Pathology, etc.
  • Prelim Surgery or Prelim Medicine
  • Transitional Year programs

Important: Do not apply to a specialty during SOAP that you would never actually be willing to train in. SOAP acceptances are binding.

2. Researching Likely SOAP Specialties and Programs

No one can perfectly predict which programs will be unfilled, but historical patterns help:

• Some specialties commonly have more unfilled positions:
  • Family Medicine
  • Internal Medicine (especially community or rural programs)
  • Pediatrics
  • Psychiatry
  • Pathology
• Competitive specialties (Dermatology, Plastic Surgery, Orthopedics, etc.) rarely have numerous SOAP spots, and if they do, they are extremely competitive.

Actionable Steps (2–6 weeks before Match Week):

1. Review NRMP’s “Results and Data” reports for prior years to see:
   • Which specialties had higher numbers of unfilled positions.
   • Which program types (community vs university) tend to participate in SOAP.
2. Create a spreadsheet with:
   • Columns for program name, ACGME ID, specialty, state, type (university/community), visa sponsorship, and “fit notes.”
   • Notes on why you could be a good fit: clinical background, language skills, geographic ties, research, etc.
3. Identify broad geographic regions you’re willing to train in, including rural and less popular regions, assuming they are ACGME-accredited and meet your personal constraints.

When the unfilled positions list is released on Monday, you can quickly:

• Filter by specialty and state.
• Cross-check with your prepared spreadsheet.
• Prioritize programs where you are both eligible and plausibly competitive.

3. The 45-Program Limit: How to Allocate Your Applications

During SOAP, ERAS allows you to send a maximum of 45 applications to unfilled programs.

General strategy:

• Prioritize categorical PGY-1 positions in a specialty you’d be happy to train in.
• Consider preliminary or transitional positions as:
  • A bridge year while you reapply for your long-term specialty.
  • A way to continue clinical training and build a stronger profile.

Example Allocation Scenarios:

Scenario A – Staying in Internal Medicine
Applicant: US graduate, decent scores, no major red flags.

• 35 applications: Categorical Internal Medicine (various states, mostly community programs).
• 10 applications: Prelim Internal Medicine and/or Transitional Year.

Scenario B – Pivoting from Surgery to IM/FM
Applicant: IMG, lower scores, no US clinical gap.

• 25 applications: Categorical Internal Medicine.
• 15 applications: Family Medicine (particularly community, rural, or underserved-focused).
• 5 applications: Prelim Surgery / Prelim Medicine.

4. Crafting Your SOAP Narrative

Programs know applicants in SOAP are under stress. What stands out is a calm, honest, forward-looking narrative:

Core elements:

• Acknowledgment of challenge: Without dwelling on disappointment.
• Emphasis on learning and growth: How prior experiences shaped you.
• Clear fit: Why this specialty and this type of program.
• Readiness: Assurance that you can start and contribute on Day 1 (July 1).

Example short narrative for interviews or emails:

“I participated in the Match this year focused on general surgery. When I learned I was not fully matched, I took a step back to reevaluate. My strongest clinical feedback and personal satisfaction have consistently come from internal medicine rotations—especially managing complex patients on the wards and working in continuity clinics. I’m using the SOAP process to pursue categorical internal medicine positions, where I can contribute immediately with strong work ethic, communication skills, and a genuine commitment to patient-centered care.”

Having this narrative prepared makes you more confident when programs reach out unexpectedly.

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Communication, Interviewing, and Professionalism During SOAP

SOAP is not only about paperwork; it’s an intense period of high-volume, fast-turnaround communication.

1. Phone, Email, and Availability

During SOAP:

• Keep your phone on, charged, and nearby at all times.
• Use a professional voicemail greeting with your name (“This is Dr. [Last Name]…”).
• Check email frequently (every 10–15 minutes during business hours).
• Respond politely and promptly to program messages.

Create:

• A professional email signature (Name, degree, AAMC ID, phone, time zone).
• A template response you can quickly personalize for interview invitations or follow-ups.

2. Fast, Focused SOAP Interviews

SOAP interviews are often:

• Shorter (10–20 minutes).
• Scheduled on very short notice (same day or within hours).
• Conducted by phone or video rather than in person.

Prepare concise answers for:

• “Tell me about yourself.”
• “Why this specialty now?”
• “Why our program?”
• “What did you learn from your previous application cycle?”
• “What are your strengths and areas for improvement?”

Use STAR (Situation–Task–Action–Result) for behavioral questions (teamwork, conflict, mistakes).

Example SOAP interview response (explaining not matching):

“I applied broadly in surgery and had several interviews, but ultimately I did not match. Reviewing my application, I realized my Step 1 score and the timing of my US clinical experiences may have been limiting factors. Since then, I completed an additional subinternship, improved my Step 2 score, and received stronger clinical evaluations. I’m looking for a program where I can continue to grow clinically and contribute from day one.”

3. Handling Offers in the NRMP R3 System

During each SOAP offer round:

• You may receive:
  • No offers
  • One offer
  • Multiple offers
• You must accept or reject offers within a limited window (often ~2 hours).

Guidelines:

• Accepting an offer is binding; you are done with SOAP.
• If you receive multiple offers, choose the program that:
  • You can realistically see yourself in for the year (or full training, if categorical).
  • Meets your minimum personal and professional requirements (training quality, location, visa, etc.).
• If you receive no offers in an early round, do not panic:
  • Programs refine their lists across rounds.
  • Your chances are not zero after Round 1.

Have your priorities pre-defined (e.g., categorical > prelim, certain specialties > others) so you can decide quickly under time pressure.

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Emotional Resilience and Long-Term Planning

SOAP is not only technical; it is emotionally intense. SOAP preparation should include personal support and a plan for “what if” you do not secure a position.

1. Manage Expectations and Emotions

• Acknowledge disappointment if you are unmatched; it’s normal.
• Avoid comparing yourself constantly to peers on social media.
• Identify a small support circle (family, friends, mentors) to talk to.

If you can, limit time on social media during Match Week—it often amplifies stress.

2. Use Your School or Institution’s Support

Most medical schools and some hospitals have:

• Advisors or deans specifically assigned to help SOAP participants.
• Career counseling, mock interviews, and strategy support.
• Up-to-date information on programs known to consider SOAP applicants favorably.

Contact them immediately on Monday if you are unmatched or partially matched. They can:

• Help refine your specialty strategy.
• Review your personal statement or program list.
• Make calls or send advocacy emails to programs where appropriate.

3. If SOAP Does Not Result in a Position

While this article focuses on SOAP preparation, realistic planning includes the possibility of remaining unmatched after SOAP. Start thinking (in advance, if possible) about:

• Research positions (clinical or basic science).
• Pre-residency fellowships (often in internal medicine, radiology, or other fields).
• Additional clinical experience:
  • Observerships or externships (for IMGs).
  • Non-residency clinical roles where permitted.
• Exam or application strengthening:
  • Improving Step 3 (if eligible).
  • Additional publications or quality improvement (QI) projects.

Having an outline of this Plan C can reduce anxiety and help you make rational decisions during SOAP.

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Frequently Asked Questions (FAQ)

1. If I match to a preliminary position but not a categorical one, can I still participate in SOAP?
Yes, in many cases you can be SOAP-eligible if you are partially matched (for example, you matched to an advanced PGY-2 position but not a PGY-1, or vice versa). However, specific rules and scenarios can vary by year and contract type. Check your NRMP status page on Match Week Monday and read the NRMP’s detailed eligibility criteria or speak with your dean’s office.

2. Can I change or add new letters of recommendation during SOAP?
Technically you can add letters to ERAS during SOAP, but in practice there is usually not enough time to request, write, and upload new letters before programs make their decisions. That’s why SOAP preparation should include having all your strong letters in place before Match Week. Focus your SOAP efforts on application strategy, personal statements, and communication rather than scrambling for new letters.

3. Should I apply to any program that has an unfilled spot, even if I’m not truly interested?
No. Any position you accept through SOAP is binding, just like a Main Match commitment. Applying to programs or specialties where you would not actually be willing to train can trap you in an unhappy or unsuitable residency. Use your 45 SOAP applications strategically: broad, but still aligned with paths you could genuinely pursue.

4. Does participating in SOAP hurt my chances in future Match cycles if I don’t get a position?
Simply participating in SOAP residency does not inherently harm your future chances. Many successful residents and attendings went through SOAP or multiple application cycles. Programs will, however, evaluate what you did after an unsuccessful cycle—did you gain meaningful clinical, research, or academic experience? Did you address previous weaknesses? Thoughtful SOAP preparation and a strong follow-up plan can demonstrate resilience, maturity, and commitment, which ultimately help in future applications.

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Thorough SOAP preparation transforms Match Week from a chaotic emergency into a structured, strategic second chance. By understanding what SOAP is, clarifying your goals, preparing materials early, and planning your communication and emotional support, you give yourself the best odds of securing a residency position—even under intense time pressure.