SOAP: What to Expect and How to Survive

Opening your email on the Monday of Match Week to see "We are sorry, you did not match to any position" is not how most people want to close out their medical school experience.

Thus begins the Supplemental Offer and Acceptance Program (SOAP), the weeklong gauntlet where students who did not match into a residency position traditionally are able to get back into the ring and fight for any program that advertises unfilled spots. Historically, if the match rate for US MD seniors is 92%-95%, that leaves 5%-8% who enter SOAP or choose other options. While faculty will console you as best they can — that SOAPing is not a reflection on your capabilities as a future physician — it is certainly quite difficult to feel like anything but a failure in the moment.

I admit that I had expected to go through SOAP as soon as the traditional Match application season began. Due to an incident outside of my control in May, my application wasn't considered complete until late autumn, and I was only able to procure four interviews by the end of the season.

They were strong programs, but I knew that submitting such a short rank list meant that the numbers were against me. So, I prepared for the worst come Match Week.

SOAP is typically chaotic, but since the schedule was altered in recent years, nothing that I read online seemed to match up with what I was going through day by day.

In this post, I will detail my own experience with SOAP and delineate the timeline for future students who might find themselves in the same position.

Match Monday – Pick Your 45

If, on Monday morning, you receive the same email that I did, understand that you don't have any time to feel sorry for yourself. Upon logging onto the National Resident Matching Program (NRMP) website, you can view the entire catalogue of open residency positions across the country, where hundreds of programs with thousands of unfilled spots are listed by specialty.

You can send up to 45 applications to these programs via Electronic Residency Application Service (ERAS), and thankfully, the fee is waived for all of them. You must have them in by the end of Monday, as they are opened to programs for review the next day.

Upon scanning the list, you might face disappointment; if your desired specialty doesn't have unfilled spots in any programs, you cannot match into your specialty that year.

Decide what's important to you. Are you willing to brave this week and SOAP into another field? Delay graduation and strengthen your application for next year? Find a 1-year preliminary medicine or surgery position and reapply as a graduate?

For some, this means pivoting from the very reason you came to medical school. For others, it is more important to start residency ASAP and provide working support for family. In my case, it was finding the best course of action that would minimize the effects of my aforementioned incident — thus reapplying. I applied to 45 programs in my desired specialty, physical medicine & rehabilitation (PM&R), internal medicine, preliminary medicine, and family medicine.

Once you decide on your course of action, decide on backups, send your applications, and try to turn in early for the night.

Tuesday & Wednesday – Every Call Matters

Programs can review SOAP applications starting Tuesday at 8 AM Eastern time. This begins the abbreviated interview cycle: the entirety of the past few months boiled down into two hectic days. Programs can message you on ERAS for a "traditional" interview-day Zoom, email you an invite for a quick video chat, or even just call your phone. These happen with minimal prep time, so you will not be able to thoroughly research or rehearse your answers.

Keep your business outfit ready for a potential video call on the fly! Programs will ring you while you are interviewing with others. Maintain your composure the best you can and make a mental reminder to get back to them as soon as you're done. You can't afford to be sloppy, and you can't afford to be late. Every call matters.

By the end of Wednesday, I had an interview in PM&R, two in internal medicine, two in preliminary medicine, and two in family medicine. This ended up being almost twice the number of interviews that I had earlier this year (and still rather low compared with my SOAPmates). Come Wednesday night, order yourself a good meal — you deserve it!

Thursday – Decision Time

On Thursday, programs will make offers in rounds, each lasting about 3 hours. At 8:55 AM Eastern, programs must certify their Round 1 offers, and at 9 AM Eastern, these will be made available to applicants. Applicants then have until 11 AM Eastern to accept or reject these offers.

Programs will then take another hour to discuss, recertify their rank lists, and certify their Round 2 offers at 11:55 AM. Again, applicants will have 2 hours to accept or reject.

This process repeats twice more until the final round of offers are accepted by 8 PM Eastern. In SOAP, applicants do not submit rank lists — only the program does — and they proceed through rounds from their #1, if rejected, to #2, to #3, and so on, until their unfilled positions are filled. Thus, it is usually in your best interest to take the earliest offer possible.

This presents a gamble. Suppose you are offered a 1-year preliminary medicine residency in Round 1. Would you take it and the security of being offered a job for next year, even though you might have to spend your intern year reapplying?

Would you reject and wait for a "better" offer to come in Round 2? Perhaps it's in a more desirable area for your family, or a categorical position that guarantees the rest of your training? Your spot offered in Round 1 has now gone to someone else; that door is closed. What if that Round 2 offer never comes? Where would you draw the line? You have just hours to deliberate. You can't afford to sleep on it. Decision time is here and now.

Finally, programs can continue to interview between the rounds. It seems strange, but take my experience. I did not receive any offers in Round 1, and as the list of unfilled programs constantly updates, it became clear to me that I was not one of the applicants selected for the PM&R program for which I had interviewed. Round 2 also gave me nothing, and most of my programs were filled up at this point. Round 3 passed by similarly.

On the eve of surrender, right before Round 4, I received a call from one of the internal medicine programs to which I had applied, but for which I had not interviewed. I then ran through the most stressful interview of my life, thanked the interviewer, and ended the call 10 minutes before Round 4 offers were certified. At 6 PM Eastern, offers went out. That program had extended me one. I clicked "accept."

Friday – Match Day Experience

For me, the surprise of Match Day lost its magic, but I still attended and took pictures with everyone else, proudly holding up my "I MATCHED" sign with my destination. The biggest thing one should remember is that nobody knows (or cares, really) who had to SOAP or not!

Unless you are like me and writing about it, if you don't tell anyone, no one has any reason to suspect. And if you are uncomfortable sharing your results or lack thereof, you can always ask your school to be excluded from the Match Day statistics and presentation.

For whatever reason, a few of my classmates took this option. Some of them were my SOAPmates from that week; some of them were not. Maybe they will be taking a research year to buff their stats for next cycle. Perhaps they even matched but pulled their names off the list.

If you still did not match through SOAP, it is not the end of your story. Thus begins the "scramble" process, where unfilled positions that exist at the end of SOAP are still advertised on the NRMP website. Formally known as the flat fee program post-SOAP, the scramble begins on Friday afternoon.

Unlike SOAP however, each application submitted through ERAS now costs $10. There is also no specific weeklong schedule for this process; offers will be extended as they are available, and 5 PM Eastern on May 31 is the only deadline that programs need to abide by. It truly seems daunting but still provides one final avenue for those who have decided to move forward with matching in this cycle.

Epilogue – Countdown to July

Am I disappointed that I was not able to match into my originally desired specialty? To be completely honest, a part of me still is, even weeks later. But I know that these scars will fade soon. I know that residency is just one building block in my career, and that I can still pursue my interests in medicine no matter what field I am training in. Hopefully, I will be able to open doors in sports medicine down the road, or I might even discover a new passion throughout residency. My post-graduation Asia trip has been dead since 2020, but I'm still counting down to July with a nervous excitement. For now, this is a time to catch up with friends, build my dream PC, and get some R&R before the most challenging year of my life begins.

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About Austin Kim

Austin is a fourth-year medical student at Tulane University who will soon begin his internal medicine residency training at Piedmont Macon Medical Center. With a theater degree from Emory University, he found himself drawn to medicine for its unique appreciation of the human body and its import as the vehicle of human expression — an ethos he pursued extensively as a student of dramaturgy. Some of his career interests naturally include sports and performing arts medicine. In his free time, Austin enjoys board games, watching VTubers, and playing a certain critically acclaimed MMORPG.

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