Mastering the SOAP Process: Secure Your Residency Spot with Confidence

The SOAP Process Explained: Your Path to a Residency Program Spot

Matching into a residency program is one of the highest-stakes transitions in medical education. For many graduates, the National Resident Matching Program (NRMP) main Match leads directly to a residency position. But each year, a significant number of otherwise qualified applicants do not match.

If you’re in that situation, the Supplemental Offer and Acceptance Program (SOAP) is your structured, official second chance.

This enhanced guide explains what the SOAP process is, how it works step-by-step, what to expect during Match Week, and specific career strategies to help you navigate it successfully. Whether you’re an unmatched US MD/DO graduate, an international medical graduate (IMG), or simply planning ahead, understanding SOAP can be the difference between continuing your training now versus delaying your career.

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What Is SOAP and Who Is It For?

SOAP stands for the Supplemental Offer and Acceptance Program, an organized process run by the NRMP during Match Week. It is designed to connect:

• Eligible unmatched or partially matched applicants, and
• Accredited residency programs with unfilled positions

in a controlled, time-limited, and rules-based way.

SOAP is not a free-for-all scramble. Programs and applicants must follow strict NRMP policies, timelines, and communication rules. When used well, SOAP can be an effective bridge to a strong residency opportunity.

Eligibility for SOAP Participation

Not every unmatched applicant is automatically eligible for SOAP. The NRMP defines specific criteria. In general, you may participate in SOAP if:

• You registered for the NRMP Main Residency Match, and
• You are unmatched or partially matched when Match Status is released (typically Monday of Match Week), and
• You are eligible to start residency training on July 1 (e.g., ECFMG certification status for IMGs), and
• You have no binding match to another residency position through the NRMP or another matching service.

You are not eligible to SOAP if:

• You did not register for the NRMP Main Match
• You are already fully matched to a PGY-1 and (if required) PGY-2 position
• You violated NRMP rules in a way that disqualifies you from participation

Always check the most current NRMP SOAP eligibility rules each year—these can change slightly and are precisely defined in NRMP’s official documentation.

Why SOAP Exists: Purpose for Applicants and Programs

SOAP serves strategic needs for both sides of the residency process:

• For applicants

  • Offers a structured second chance if you go unmatched or partially matched
  • Helps prevent the chaos and inequity of the old “scramble” system
  • Allows you to access a centralized list of unfilled residency positions across the country
  • Maintains professionalism by standardizing communication and offer acceptance

• For residency programs

  • Provides a rapid, organized way to fill remaining positions with vetted candidates
  • Reduces the administrative and ethical issues of uncontrolled post-Match recruiting
  • Ensures all candidates are treated under the same rules and timelines

In short, SOAP is a critical component of modern medical education and NRMP operations—if you’re serious about residency, you should understand it in detail, even if you never need it.

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Overview of the SOAP Timeline During Match Week

The SOAP process is time-compressed and emotionally intense. Knowing the schedule in advance reduces stress and helps you act efficiently.

While exact times vary slightly by year, the general Match Week structure looks like this:

Monday: Unmatched Status and SOAP Eligibility

• 11:00 AM ET (approx.) – NRMP releases match status

  • You log into your NRMP account and see one of several possibilities:
    • Fully matched
    • Partially matched (e.g., matched to advanced but not preliminary year)
    • Unmatched
  • If unmatched/partially matched and eligible, your account will indicate you may participate in SOAP.

• Unfilled Program List becomes visible (to eligible SOAP applicants)

  • Through ERAS (or other application platforms), you can access the official list of unfilled residency positions participating in SOAP.

• Critical emotional and planning window

  • Monday is often the hardest day emotionally. It’s also the time to:
    • Process the disappointment
    • Notify mentors/advisors
    • Begin rapid strategic planning for SOAP applications

Early SOAP Window: Application Period

Starting Monday after status release and continuing into Tuesday, you:

• Prepare and submit applications to unfilled programs via ERAS
• Can submit a defined maximum number of applications (often 45, but check the current year’s rules)
• Cannot contact programs directly outside of allowed channels; communication rules are strict

Wednesday–Thursday: SOAP Offer Rounds

SOAP includes several offer rounds (typically four) over two days. The structure usually follows:

• Programs review applications and conduct brief interviews (often via phone or video)
• During each round:
  • Programs submit preference lists of applicants
  • NRMP systems release electronic offers to applicants
  • You have a short, defined window (e.g., 2 hours) to accept or reject each offer
  • If you accept an offer, it is binding, and you exit SOAP

Friday: Match Day

• By the time the public Match results are released:
  • Many programs have filled their positions via SOAP
  • Unmatched applicants who did not secure a SOAP position begin planning next steps (research years, reapplication strategies, alternative pathways)

Because the dates, number of rounds, and precise times can change, always confirm the year’s official NRMP SOAP schedule well in advance.

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Step-by-Step: How to Navigate the SOAP Process

To make the SOAP process feel more manageable, break it down into concrete steps and decision points.

Step 1: Confirm Your Status and Regroup

Once you see that you are unmatched or partially matched:

1. Pause and breathe

   • Take a short, deliberate break—15–30 minutes. Step away from your computer.
   • This is a major emotional blow; acknowledging that helps you think clearly.

2. Reach out to your support system

   • Contact your Dean’s office / student affairs, residency advising office, or faculty mentor.
   • Let them know your status and request an urgent advising meeting the same day.

3. Clarify your SOAP eligibility

   • Confirm in NRMP whether you’re eligible for SOAP.
   • If there’s any confusion (e.g., about ECFMG timing, partial matches), ask your school or advisor for help immediately.

Step 2: Review the List of Unfilled Residency Positions

Once the SOAP-eligible unfilled list is available:

1. Filter by key criteria

   • Specialty and level (categorical vs preliminary vs transitional year)
   • Geographic constraints or preferences
   • Visa sponsorship (for IMGs)
   • Requirements such as USMLE/COMLEX scores, prior experience, or graduation year

2. Be realistic yet flexible

   • If you went unmatched in a competitive specialty, strongly consider:
     • Applying to less competitive programs in your specialty, and/or
     • Applying to backup specialties where you can still have a satisfying career
   • Flexibility in geography and setting (academic vs community) increases your chances.

3. Prioritize a preliminary/transitional year if needed

   • For applicants who matched into an advanced specialty (e.g., radiology, anesthesia) but lack a PGY-1:
     • Focus on preliminary medicine, preliminary surgery, or transitional year positions
   • These positions are critical stepping stones to starting your advanced specialty on time.

Step 3: Strategically Prepare SOAP Application Materials

Even before Match Week, it’s wise to prepare “contingency” materials in case SOAP becomes necessary. During SOAP itself, there is very little time to write from scratch.

Key components include:

• Curriculum Vitae (CV)

  • Ensure it is updated with:
    • Recent rotations and evaluations
    • Research, presentations, publications
    • Leadership roles, volunteer work

• Personal Statements

  • Have at least one general personal statement ready for your main specialty.
  • Consider preparing:
    • A modified version for potential backup specialties (e.g., Internal Medicine, Family Medicine, Psychiatry)
    • A concise statement tailored to preliminary/transitional year positions (focus on your future plans, professionalism, and clinical readiness).

• Letters of Recommendation (LoRs)

  • Use letters already in ERAS; new letters are rarely feasible during SOAP.
  • If faculty previously wrote a general letter (not hyper-specialized to a single field), that can be advantageous for broader SOAP applications.

• USMLE/COMLEX updates

  • Ensure all score reports and ECFMG certification (if applicable) are correctly uploaded.

During SOAP, your task is more about rapid customization and selective targeting than building materials from scratch.

Step 4: Apply Thoughtfully Within Application Limits

SOAP typically limits how many programs you can apply to (e.g., 45). To use these strategically:

1. Create tiers of priority

   • Tier 1: Strong fits based on your profile and interests
   • Tier 2: Reasonable options where you meet criteria but competition may be higher
   • Tier 3: Safety options where you’re confident you meet or exceed requirements

2. Avoid “spray and pray”

   • Applying indiscriminately wastes limited slots.
   • Target programs where:
     • Your academic record is aligned with their stated preferences
     • You can genuinely articulate interest and fit

3. Customize within reason

   • While you can’t completely rewrite personal statements for each program, you can:
     • Adjust a few lines to reference program-specific strengths (community focus, patient population, educational philosophy)
     • Tailor ERAS experiences or use the “Significant Experiences” section strategically to highlight relevant strengths

Step 5: Responding to Program Contact and Interviews

During SOAP, programs may:

• Review applications
• Contact you for brief phone or video interviews
• Ask targeted questions to quickly assess fit

Key points:

• Be available and responsive

  • Keep your phone nearby and your email open.
  • Ensure your voicemail is professional and not full.

• Prepare a concise story

  • Why you went unmatched (if asked) – keep it honest, neutral, and non-blaming
  • Why you’re interested in their Residency Program specifically
  • What makes you a reliable, teachable, team-oriented resident

• Practice short, focused answers

  • SOAP interviews are often 10–20 minutes.
  • Prepare tight responses about:
    • Strengths and weaknesses
    • Clinical challenges you’ve overcome
    • Career goals and how their program fits those goals

Step 6: Understanding and Managing SOAP Offer Rounds

SOAP offers are not like regular job offers; they are time-limited and binding.

Key features of offer rounds:

• You may receive zero, one, or multiple offers in a given round.
• You have a short window (often 1–2 hours) to accept or reject each offer.
• If you accept an offer, you are bound to that program and exit SOAP. You cannot continue seeking other SOAP positions afterward.
• If you do not accept any offers in that round, you may:
  • Be considered in later rounds
  • Apply to newly unfilled positions that appear between rounds (if rules allow)

Decision strategy during offer rounds:

• Before offers begin, clearly define for yourself:
  • Which specialties and program types you would accept immediately
  • Which situations would prompt you to wait for a potentially better offer in later rounds
• Discuss these preferences with a trusted advisor; it’s hard to make high-stakes decisions under severe time pressure.

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Best Practices and Career Strategies for Success in SOAP

To make the most of SOAP, you need more than just knowledge of the timeline. You need a strategy that aligns with your long-term career goals and current realities.

Be Proactive: Prepare for SOAP Before You Need It

Even if you fully expect to match, it is wise to:

• Create a SOAP contingency plan with your advisor:

  • Backup specialties you would consider
  • Geographic flexibility
  • Priority lists (career satisfaction vs starting training this year)

• Draft flexible personal statements:

  • One main specialty
  • One for a likely backup (e.g., Primary Care, Psychiatry, IM, FM)
  • One for preliminary/transitional positions

• Understand your own risk factors for going unmatched:

  • Limited number of interviews
  • Late interview cancellations
  • Low scores, failed attempts, or significant red flags
  • Applying only to highly competitive specialties

This preparation doesn’t mean you expect to fail; it means you are approaching your career like a professional.

Tailor Your Applications to the Program and Specialty

In SOAP, programs receive many applications in a short time. Make it easy for them to see why you fit:

• Align your experiences with their mission:

  • Community programs: emphasize continuity of care, community engagement, and patient-centered communication
  • Academic programs: highlight research, teaching interest, or complex case exposure
  • Rural or underserved programs: focus on service, resourcefulness, and adaptability

• Reference specific program features:

  • Unique clinics, patient populations, or curriculum elements
  • Faculty interests that overlap with your own goals

Even 2–3 sentences of targeted customization can differentiate you from generic applications.

Use Your Network Strategically (Within NRMP Rules)

Networking remains powerful during SOAP, as long as you follow NRMP communication policies:

• Contact mentors and prior attendings:

  • Let them know your SOAP status.
  • Ask if they know any PDs or faculty at programs with unfilled positions.

• Ask for targeted advocacy:

  • A mentor who knows you well might email or call a Program Director to briefly highlight your strengths (if allowed by policy and done professionally).

• Leverage your institution’s leadership:

  • Deans and program directors at your school often have relationships with other programs and can sometimes help “open a door” for your application.

Always confirm that any outreach is compliant with the current NRMP SOAP communication rules, as these are taken very seriously.

Stay Highly Organized Under Pressure

The SOAP week moves fast and involves multiple moving parts. Create a simple but clear system:

• Spreadsheet or tracker with:

  • Programs applied to
  • Specialty and program type
  • Contact dates and interview times
  • Notes from conversations
  • Priority ranking (e.g., 1–3)

• Calendar reminders:

  • For each SOAP offer round
  • For scheduled calls or interviews
  • For any deadlines your school sets (e.g., required advising check-ins)

Organization allows you to make rational decisions, not last-minute guesses.

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Real-World Examples: Successful SOAP Journeys

Case Study 1: Max’s Story – Turning a Setback into Opportunity

Max was a US MD graduate who applied to Internal Medicine. His Step 1 score was below average, and he had a failed attempt on one exam. He received only a handful of interviews and went unmatched.

On Monday of Match Week:

• Max immediately met with his school’s residency advisor.
• They reviewed the unfilled list and identified multiple Family Medicine and some Internal Medicine positions in community hospitals that aligned with his interest in primary care.

Max’s SOAP strategy:

• Applied broadly but strategically to Family Medicine and Internal Medicine programs that:
  • Accepted applicants with his score range
  • Emphasized strong clinical skills and patient communication
• Revised his personal statement overnight to:
  • Emphasize continuity of care, underserved populations, and long-term patient relationships
  • Honestly but briefly contextualize his exam challenges as learning and growth opportunities

Outcome:

• In the second SOAP offer round, Max received an offer from a Family Medicine Residency Program at a community hospital.
• He accepted, and is now thriving in a specialty that suits his career goals and values.

Key lessons from Max:

• Flexibility in specialty (IM to FM) can open excellent career paths.
• A thoughtful explanation of academic challenges can be acceptable if framed with insight and growth.

Case Study 2: Lisa’s Story – An IMG Leveraging Strengths in SOAP

Lisa was an international medical graduate (IMG) with strong clinical evaluations and extensive international volunteering. She applied to Internal Medicine but did not match.

Her SOAP situation:

• As an IMG, she knew visa sponsorship and ECFMG requirements were critical.
• She carefully filtered the unfilled list to Internal Medicine programs that sponsor her visa type and are historically IMG-friendly.

Lisa’s SOAP strategy:

• Reached out to mentors and prior attendings who had successfully guided IMGs through SOAP before.
• Emphasized in her materials:
  • Adaptability to new health systems
  • Cross-cultural communication skills
  • Fluency in multiple languages, valuable for diverse patient populations

Outcome:

• Within two SOAP rounds, Lisa received an offer from an Internal Medicine Residency Program at a mid-sized community hospital known to value diverse backgrounds.
• She accepted and is now building a career that integrates her international and US clinical experience.

Key lessons from Lisa:

• IMGs must be especially strategic about visa and program history.
• International and multicultural experience can be a major asset when clearly articulated.

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SOAP FAQs: Common Questions and Clear Answers

1. How is SOAP different from the old “scramble” and from the main Match?

• Compared to the old scramble:

  • SOAP is structured, rule-based, and conducted through NRMP systems instead of chaotic phone calls and faxed CVs.
  • It is designed to be more equitable and less stressful for both applicants and programs.

• Compared to the main Match:

  • The main Match uses rank order lists and an algorithm to pair applicants and programs.
  • SOAP occurs after unmatched status is known and involves direct electronic offers from programs to applicants—no ranking algorithm.

Both are official NRMP processes, but SOAP is specifically for filling unfilled positions after the Match.

2. Can I apply to multiple specialties during SOAP?

Yes, as long as you:

• Stay within the overall application limit (e.g., 45 programs total; confirm current rules), and
• Meet eligibility requirements for those positions, and
• Can reasonably justify your interest and fit in each specialty.

However, applying to too many unrelated fields (e.g., Radiology, Psychiatry, General Surgery, Pediatrics all at once) can appear unfocused. Try to keep your target list coherent and aligned with your long-term career strategies.

3. How important is timing during SOAP?

Timing is critical in several ways:

• Application submission:

  • Apply as early as you can within the allowed window so programs can review your file before offer rounds begin.

• Responding to interviews or contact:

  • Answer calls and emails promptly; missing a call in this compressed timeline can cost you an opportunity.

• Offer rounds:

  • Each offer has a strict expiration time (often 1–2 hours).
  • Failing to respond is equivalent to declining.
  • Prepare clear decision rules in advance so you’re ready to act quickly.

4. What if I still don’t secure a position through SOAP?

If you go through all SOAP rounds without an offer:

1. Meet with your advisor as soon as possible:

   • Review your application profile, interview history, and feedback from programs (if available).

2. Consider structured alternatives:

   • Research or fellowship years in your field of interest
   • Additional clinical experience (e.g., observerships, sub-internships, prelim year in another specialty)
   • Strengthening your academic record (e.g., Step 3, additional publications)

3. Plan for the next application cycle:

   • Identify specific weaknesses to address: limited applications, few interviews, exam failures, narrow specialty choices.
   • Develop a realistic, data-driven reapplication plan with revised specialty and program strategy.

Not matching—even after SOAP—is painful, but many physicians have gone on to have fulfilling careers after a “gap” year strategically used to strengthen their candidacy.

5. Is accepting a SOAP offer binding, and can I back out if something better appears?

Accepting a SOAP offer is binding under NRMP rules:

• You must withdraw from SOAP once you accept.
• You are contractually committed to that Residency Program.
• Backing out without a valid reason can result in NRMP violations, which may seriously harm your career prospects.

This is why it’s crucial to think through your priorities and decision thresholds in advance of the first offer round.

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Final Thoughts: Using SOAP as a Strategic Career Tool

The SOAP process is intense, time-limited, and emotionally charged. But it is also a powerful tool within the NRMP and broader medical education landscape—one that has helped thousands of graduates transition into residency programs and move forward in their careers.

To make SOAP work for you:

• Educate yourself early about the process and rules
• Prepare contingency materials and backup plans before Match Week
• Stay flexible with specialties, locations, and program types where possible
• Rely on your mentors, advisors, and network for guidance and advocacy
• Stay organized and professional at every step

Going unmatched is not the end of your medical career. It is a detour—sometimes painful, sometimes unexpected—but with the right strategy and support, SOAP can help you get back on track and into a Residency Program that will allow you to grow into the physician you set out to become.