Navigating SOAP: Your Essential Guide to Securing a Residency After Unmatched Status

Turning the Tables: How to Make SOAP Work for You After an Unsuccessful Match

The path to Residency is rarely linear. Even strong applicants may face the shock of not matching on Match Day. In that moment, the Supplemental Offer and Acceptance Program (SOAP) becomes more than just a process—it becomes your critical next strategy for Career Development.

This guide will show you how to turn an unsuccessful Match into a concrete opportunity. By understanding how SOAP works, preparing strategically, and staying emotionally grounded, you can significantly improve your chances of securing a Residency position and keeping your long-term goals on track.

---

Understanding SOAP: Your Second Chance After Match Day

SOAP (Supplemental Offer and Acceptance Program) is not “the leftover Match.” It is a formal, structured process created by the National Residency Matching Program (NRMP) to match eligible unmatched or partially matched applicants with unfilled Residency positions.

Think of SOAP as a highly compressed, high-stakes mini-application cycle that takes place over a few intense days during Match Week.

How SOAP Fits into Match Week

• Monday of Match Week (11:00 a.m. ET)

  • Applicants learn whether they are:
    • Fully matched
    • Partially matched
    • Unmatched
  • Unfilled positions for SOAP-eligible applicants become visible in ERAS (not all public; some are restricted to eligible participants).

• Monday–Tuesday: Application Window

  • You can submit applications to a limited number of programs (NRMP sets a maximum number of applications during SOAP).
  • No direct calling or emailing programs to solicit positions—communication is regulated.

• Wednesday–Thursday: Offer Rounds

  • Programs review applications and conduct interviews (often via phone or virtual platforms).
  • NRMP runs several offer “rounds” where programs extend offers to applicants.
  • Applicants can accept, reject, or let offers expire (within a strict, short time window).

• Friday and Beyond

  • Any remaining unfilled positions after SOAP may enter the “open” market, and programs can recruit outside SOAP rules.

Understanding this structure is essential because every hour during SOAP matters. Preparation before Match Week—and especially before you even know your Match outcome—can distinguish you from other applicants.

Eligibility Basics for SOAP

To participate in SOAP, you must:

• Be registered for the NRMP Main Match
• Be unmatched or partially matched after the Main Match (or have withdrawn appropriately and be SOAP-eligible)
• Have ERAS access and meet program-specific requirements (e.g., medical school graduation, USMLE/COMLEX exams, visa status)

If you are unsure about eligibility, confirm with your Dean’s office, student affairs, or NRMP resources as early as possible.

---

Step 1: Reflect Quickly but Honestly on Your Original Match Application

Your first reaction to not matching is emotional—and that’s normal. But once the initial shock settles, you need a clear-eyed, rapid assessment of your application. Understanding potential weaknesses lets you adapt intelligently during SOAP and beyond.

Gather Informed Feedback

In the 24–48 hours after learning you did not match:

• Schedule a rapid review with:
  • Your Dean or Student Affairs office
  • A trusted specialty advisor
  • A mentor in your target field (or a related field you’re considering)

Ask very specific questions:

• Were my Step scores, COMLEX scores, or class rank below typical ranges?
• Did my specialty choice align with my academic record and portfolio?
• Were my letters of recommendation strong and from the right people?
• Did I apply to enough programs and the right mix of academic vs. community sites?

Perform Your Own Structured Self-Assessment

Review each application component:

• Personal Statement

  • Was it generic or specialty-specific?
  • Did it clearly articulate your motivations, strengths, and fit?

• Letters of Recommendation

  • Were they from faculty who know you well?
  • Did you have letters from the correct specialty (e.g., internal medicine for IM)?

• CV / ERAS Experiences

  • Were your experiences clearly described with outcomes and responsibilities?
  • Did you highlight leadership, research, or unique skills?

• Application Strategy

  • Number of programs applied to
  • Geographic limitations
  • Competitiveness of specialty (e.g., Derm, Ortho, ENT) vs. your metrics

This is not about blame; it’s about understanding. The insights you gain now will guide your SOAP specialty choices, how you present yourself to programs, and what you may need to build if you have to reapply next cycle.

---

Step 2: Research and Prioritize Unfilled Positions Strategically

Once SOAP begins, the list of unfilled Residency positions becomes available to SOAP-eligible applicants through ERAS. This list is dynamic and may change as positions are filled during offer rounds.

Understand the Landscape of Unfilled Positions

Unfilled positions may include:

• Categorical positions (e.g., full Internal Medicine, Pediatrics, Family Medicine)
• Preliminary or transitional year positions
• Advanced positions (e.g., Neurology, Anesthesiology starting after a prelim year)
• Programs across a wide geographic and institutional spectrum (community, university-affiliated, academic centers)

During SOAP, you should:

• Scan the entire list quickly to identify:
  • Specialties you are open to
  • Locations you can realistically consider
  • Programs where you meet minimum criteria
• Note patterns:
  • Some specialties (e.g., Family Medicine, Internal Medicine, Psychiatry) often have more SOAP openings.
  • More competitive specialties may have few or no positions available.

Create a Realistic, Tiered Priority List

Given the limited number of applications you can submit in SOAP, you must prioritize:

1. High-Fit Programs (Top Tier)

   • Specialty you strongly want and realistically fit
   • Geographic preference if feasible
   • Programs where your metrics are at or above their usual range

2. Moderate-Fit Programs (Middle Tier)

   • Specialty is acceptable, even if not your original target
   • Slightly less ideal location or less ideal program type
   • You still meet minimum criteria but might be slightly below average

3. Backup Options (Safety Tier)

   • Specialties you can see as a step toward your long-term goals, even if not your first choice (e.g., Preliminary Medicine or Surgery, Transitional Year)
   • Community programs with strong clinical training but less prestige
   • Positions where you may significantly exceed minimum criteria

Be brutally honest about your competitiveness. In SOAP, overreaching can lead to missing out entirely, while a strategic mix of options may secure you a position that still advances your Career Development.

---

Step 3: Optimize and Tailor Your ERAS Application for SOAP

SOAP moves fast, but you still have opportunities to refine and target your ERAS profile before and during Match Week.

Refresh Your Personal Statement for SOAP

You may not have time to write a fully custom statement for each program, but you can:

• Create 1–2 strong, specialty-specific personal statements tailored to:
  • Internal Medicine / Family Medicine / Pediatrics
  • Surgery / Transitional Year / Preliminary Medicine
• Emphasize:
  • Resilience and growth from challenges
  • Concrete clinical experiences that show readiness for intern responsibilities
  • Your commitment to learning, teamwork, and patient-centered care

If you have a few absolute top-choice programs, consider minor edits (e.g., a paragraph referencing their mission, patient population, or training strengths) to show you did your homework.

Recheck and Update Key ERAS Sections

Before SOAP opens:

• Experiences

  • Clarify roles and impact: add bullet points that show leadership, initiative, or outcomes.
  • Ensure all key activities (sub-internships, research, volunteer work) are included.

• USMLE/COMLEX and Transcript

  • Make sure everything is uploaded and accurate.
  • If you’ve recently passed a new exam (e.g., Step 3 for IMGs), ensure it’s visible.

• Program Signaling (if applicable)

  • For SOAP, signaling may not function the same as in the Main Match, but any existing signals that align with programs in SOAP can still be helpful context when they review your file.

Leverage Letters of Recommendation (LORs)

In the tight SOAP time frame, new letters can be challenging, but if you have:

• A recent strong clinical rotation with a supportive attending
• An advisor willing to quickly write a targeted letter

You may be able to add or swap an LOR in ERAS. Prioritize:

• LORs from the specialty you are applying to during SOAP
• Letters from faculty who know you well and can speak to:
  • Work ethic
  • Clinical reasoning
  • Professionalism and teamwork

---

Step 4: Execute Efficiently During the SOAP Timeline

SOAP has strict rules and a narrow window. Organization and responsiveness directly impact your outcome.

Prepare a SOAP Action Plan Before Match Week

Before Match Week, create:

• A SOAP timeline checklist (deadlines, offer rounds, internal school meetings)
• A communication plan:
  • Keep your phone on and charged at all times
  • Check email and ERAS notifications frequently
  • Set up a professional voicemail greeting if you miss a call
• A document folder:
  • Updated CV
  • Specialty-specific personal statements
  • List of top programs with key talking points

Share your plan with a trusted friend or family member who can help you stay organized and grounded.

Be Responsive and Professional with Programs

During SOAP, programs may:

• Reach out for very short, focused virtual interviews or phone calls
• Ask about your interest, geographic flexibility, or start-readiness

Treat every interaction like a high-yield interview:

• Answer calls from unknown numbers professionally
• Be ready with a 30–60 second introduction:
  • Who you are
  • Your medical school
  • Your interest in their specialty and type of program
• Have 3–4 concrete reasons you’re a good fit:
  • Prior clinical experiences
  • Ties to the region (if any)
  • Commitment to their patient population or mission

Manage Offers Wisely During SOAP Rounds

In each offer round, you may:

• Receive multiple offers
• Receive one offer
• Receive no offers

You typically have a short time window (often just a couple of hours) to accept or reject each offer.

Guiding principles:

• If you receive an offer from a program you would be satisfied training at—strongly consider accepting.
• Avoid declining a decent offer just to gamble on a possibly “better” one later. SOAP is inherently unpredictable.
• Discuss quickly with:
  • Your advisor or Dean’s office
  • A mentor who understands your goals and the specialty

Residency, even if not at your dream program, is a powerful platform for growth, board eligibility, and future Career Development options.

---

Step 5: Use Networking and Relationships Strategically—but Ethically

SOAP rules limit unsolicited program contact during the process. However, appropriate networking beforehand and within permitted guidelines can support your candidacy.

Relationships to Activate

• Faculty who know you well

  • Ask if they know anyone at SOAP-participating programs and if they are comfortable reaching out on your behalf when permissible.

• Residents and alumni from your school

  • They may provide insight into program culture and what specific programs value in candidates.

• Specialty Interest Groups and National Organizations

  • Some offer guidance, webinars, or support for unmatched applicants during SOAP.

Ensure any outreach complies with NRMP and institutional policies. When in doubt, confirm with Student Affairs.

---

Step 6: Protect Your Mental Health and Maintain Resilience

Not matching can feel devastating, especially after years of effort in Medical Education. Yet, many excellent physicians did not match on their first attempt and went on to have outstanding careers.

Acknowledge the Emotional Impact

It’s normal to experience:

• Shock, anger, sadness, or embarrassment
• Anxiety about the future
• Comparison with peers who matched

Healthy responses include:

• Talking with trusted friends and family
• Seeking support from your school’s counseling or mental health services
• Connecting with other unmatched students—shared experiences reduce isolation

Build a Resilient Mindset

Resilience during SOAP means:

• Separating your self-worth from a single outcome
• Focusing on what you can control: preparation, communication, professionalism
• Recognizing that:
  • Many pathways can still lead to your ultimate career goals
  • A less “prestigious” program can still provide excellent clinical training and open doors

---

Step 7: Consider Alternative Paths and Long-Term Career Development

Not every SOAP outcome will align perfectly with your original plan—but many can still move you forward professionally.

Being Flexible with Specialty and Program Type

Alternate options to consider:

• Primary Care Pathways

  • Family Medicine, Internal Medicine, or Pediatrics can lead to:
    • Hospitalist roles
    • Primary care leadership
    • Subspecialty fellowships in some cases

• Preliminary or Transitional Year Positions

  • If your long-term goal is an advanced specialty, a solid prelim or transitional year:
    • Builds your clinical competence
    • Generates strong LORs
    • Buys you time to reapply with a stronger record

• Different Geographic Regions

  • Being open to underserved or rural areas can:
    • Improve your chances in SOAP
    • Offer unique, high-volume clinical experience
    • Align with missions focused on health equity

If You Don’t Secure a Position in SOAP

If SOAP ends without a position, your career is not over. Next steps might include:

• Dedicated Research or Postgraduate Year

  • Research fellowship, MPH, or academic position that strengthens your CV

• Non-Residency Clinical Roles (where allowed)

  • Some systems allow roles like clinical research coordinator or scribe with patient exposure.

• Focused Reapplication Strategy

  • Reassess specialty choice (e.g., moving from a highly competitive specialty to a more accessible one)
  • Improve key areas:
    • Exam scores (where retakes are possible)
    • US clinical experience (for IMGs)
    • Additional strong LORs

Work closely with advisors to design a one-year plan that maximizes your readiness for the next application cycle.

---

Conclusion: Turning Disappointment into Direction

An unsuccessful Match is one of the most emotionally challenging moments in Medical Education, but it is not a verdict on your potential as a physician. SOAP exists precisely to give capable, motivated applicants another structured opportunity to enter Residency training.

By:

• Understanding the SOAP process and its timeline
• Reflecting honestly on your original application
• Researching and prioritizing unfilled positions strategically
• Tailoring your ERAS materials for high-impact communication
• Acting quickly and professionally during offer rounds
• Leveraging appropriate networking and mentorship
• Maintaining your mental health and long-term vision

…you can transform a moment of uncertainty into a stepping-stone toward your ultimate career goals.

Residency is just one phase—albeit a critical one—of a lifelong journey in medicine. How you respond to this challenge can showcase the very qualities programs and future colleagues value most: resilience, adaptability, and dedication to patient care.

---

Frequently Asked Questions (FAQ) About SOAP and the Residency Match

1. How is SOAP different from the Main Match?
SOAP is a secondary, structured process that occurs during Match Week after the Main Match algorithm runs. While the Main Match involves ranking programs and applicants months in advance, SOAP is a rapid application and offer system focused only on unfilled positions. You do not submit new rank lists; instead, programs extend offers during several rounds, and you accept or decline within strict time windows.

---

2. How many programs can I apply to during SOAP, and can I contact them directly?
The NRMP sets a maximum number of applications you can submit during SOAP (the exact number can change year to year—check current NRMP guidelines). You must apply through ERAS only. Direct, unsolicited contact with programs to solicit positions is typically prohibited during SOAP. Some communication may occur if programs reach out to you; always follow NRMP and institutional rules.

---

3. Should I apply to a different specialty during SOAP than I did in the Main Match?
It depends on your situation. If your original specialty is extremely competitive and your metrics are significantly below average, you may improve your chances by applying to a less competitive specialty in SOAP (e.g., Family Medicine, Internal Medicine, Psychiatry). However, you must be honest with yourself about:

• Your genuine interest in that specialty
• Your long-term goals and whether that path can still support them
  Discuss this thoroughly with advisors before making a decision.

---

4. If I accept a SOAP position, can I reapply to a different specialty next year?
In most cases, once you start a Residency program, you are expected to complete at least the contracted year, and often the full program, before considering a switch. Some residents do successfully change specialties later, but it can be complex and not guaranteed. If you think you may want to reapply to a different field, discuss this carefully with mentors before committing to a SOAP position, and understand the contractual and professional implications.

---

5. What if I don’t get a Residency position through SOAP—what are my options?
If SOAP ends without a position, you still have options for Career Development:

• Strengthening your application with research, advanced degrees (e.g., MPH), or additional clinical experience
• Reassessing your specialty choice and application strategy
• Applying in the next Match cycle with targeted improvements
  Many physicians who did not match on their first attempt ultimately went on to successful, fulfilling careers. The key is to create a structured one-year plan with your advisors that directly addresses prior application weaknesses and aligns realistically with future goals.

---

Use SOAP not just as a backup, but as a strategic opportunity. With preparation, adaptability, and support, you can turn this challenging week into the beginning of a strong Residency journey.