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Navigating the SOAP program

By OnlineMedEd March 16, 2020

Waiting to hear back from the programs where you’ve applied for your residency is an incredibly stressful time as a med student. After almost a year of researching programs, applying, and interviewing, it all comes down to this moment when a computer algorithm swiftly and decisively determines the fate of countless med students. It’s tough to accept that all your hard work culminates in such a fast and impersonal process.

The odds are good that you’ll match with one of your choices, as almost 95% of students find a match, and about 75% match with one of their top three choices. However, preparing for the possibility that you won’t immediately match with a program will help you make the best possible decisions regardless. After all, students who don’t match have to quickly scramble to find another option. In fact, the Supplemental Offer and Acceptance Program® (SOAP), which helps students who didn’t match to find a spot, was formerly called “the Scramble” for that very reason.


All About SOAP

If you don’t end up matching with any of your desired programs, there’s still hope. The SOAP program, which takes place during Match Week, aims to fill all vacant spots. Run by the National Resident Matching Program, it includes three rounds of offers that go from Monday through Thursday, with the aim of filling all available spots. Each round lasts for two hours, beginning with all offers that will be given during that round. You can accept or reject any offers you receive during this time. According to the NRMP, most positions are filled in round one. On Thursday, after all three rounds are completed, applicants who are still unmatched or partially matched can review a final list of programs that still have unfilled positions. 

Woman using a tablet

To enter SOAP, you must be either partially matched (meaning matched for either a preliminary or advanced position at an institution, but not both) or fully unmatched. You’ll need to register for SOAP immediately after the main matching process culminates. If you are partially matched, SOAP will allow you to vie for the type of program that you have not yet matched with (either preliminary or advanced). Most institutions hold interviews by phone on SOAP week with the candidates they match with.

If you’re still searching for a match after Monday of Match week, chances are your anxiety is skyrocketing, your palms are sweating, and you’re beginning to think in terms of worst-case scenarios. You might be ready to seize upon the first opportunity that presents itself, terrified that you won’t match anywhere else. Now more than ever, though, you need to think with a level head. Talk with a trusted mentor or practice a meditation technique to get your stress under control. When you’re not acting out of panic and fear, you’ll make choices that will propel your career in the right direction. 

During SOAP week, unmatched med students can utilize the AMA Residency & Fellowship Database®, FREIDA™, to research residencies.


Preparing for SOAP week—just in case

Before Match Week arrives, think about whether you’d be willing to consider other specialties if opportunities open up outside of your chosen specialization. Know which ones you’d consider and why. By being open-minded, you might discover a new passion in a related field while keeping your momentum going. On the other hand, don’t settle for a career that doesn’t truly interest you. 

Also, consider where you would and would not compromise in regard to location. Would you be willing to move to a small town even though you prefer big cities or vice versa? What parts of the country would you consider? Know in advance where you could and could not compromise to avoid having to make those big decisions under tremendous pressure. 

Writing out these criteria in list form may help you think through your options if you don’t match with your top schools. Make a list for each set of criteriaspecialty, location, and anything else that matters to youstating your preferences in one column and acceptable options in another. 

It makes sense to draft an application letter for an alternative specialty prior to Match Week, outlining the reasons why you’re drawn to that field. That way, you won’t be starting from scratch at the very moment when you’re most stressed and time-strapped if you happen not to match with your top schools.


Understanding Your Options

three people looking at an x-ray
Photo by EVG Kowalievska via Pexels

You have options regardless of whether you match with your chosen schools. In fact, even without a residency, you could continue honing your skills over the coming year. You might seek a clinical fellowship in your area of specialty or talk with your program director about staying on at your school for an extra year, during which time you could take part in research and rotations. Remember, your program director and dean want you to succeed, so there’s a good chance that they’ll offer such opportunities if the need arises!

Some states allow unmatched applicants to work as physicians’ assistants. Consider finding a job in a clinical practice to keep your skills and knowledge fresh. “There are different routes to the same destination,” as the AMA points out. If you ultimately wish to specialize in the competitive field of orthopedic surgery, for instance, you might opt to first specialize in family medicine and later find a fellowship in sports medicine.
Take the USMLE Step 3 exam to help you become more competitive in the next round if you need to wait a year to try again. Passing the Step 3 exam will give program directors more confidence in you, boosting your prospects because they won’t have to worry about whether you’ll pass it after beginning your residency.

You could also consider pursuing an additional degree that will make your CV more impressive or versatile, like an MPH or MBA. 

If you take these steps, you’ll be prepared for anything, and that will give you more control over the big decisions affecting your life. Whatever direction you may go in, you have an exciting road ahead. Practicing staying calm and centered throughout this tumultuous time will give you a leg up as you step into your medical career, where remaining poised and level-headed throughout unpredictable situations is the name of the game!


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