I Didn’t Match. What’s Next?

It is Monday of Match Week, and all your friends found out they have matched, but you received unexpected news: You not only didn’t match but you also didn’t match into a preliminary position.

What do you do next?

This is where the Supplemental Offer and Acceptance Program (SOAP) comes into the picture as the next step on the residency application journey. The National Resident Match Program (NRMP) is well known among residency applicants, but not everyone fully understands the details about the SOAP.

So, what is the SOAP? How does it work? What happens next? We aim to answer these questions in this viewpoint article and help demystify “the SOAP” you may have heard about.

What Is the SOAP?

According to the NRMP, the SOAP is a system for which eligible unmatched or partially matched applicants may be offered unfilled residency program positions. This system works through a series of offer rounds.

The SOAP gives you an opportunity to apply both in your initial specialty and in other specialties in which you may be interested. It is important to recognize that the SOAP is not another Match program, and the applicants do not submit rank lists.

Applicants create lists of programs to which they would like to apply, then these are reviewed by the residency programs. Applications are submitted through the Electronic Residency Application Service (ERAS), and offer reviews occur through the NRMP. For programs using the ERAS, up to 45 applications can be submitted across all rounds by applicants for categorical, preliminary, or transitional residency positions.

If you are partially matched to an advanced program, you may only apply to preliminary or transitional year programs. Conversely, if you are partially matched to a preliminary program, you may only apply to advanced programs. If you are fully unmatched, you may apply to any available program.

During the SOAP process, applicants can only contact programs through their application on the NRMP Registration, Ranking, and Results system—a web-based software application through which all NRMP matches are managed. Applicants are not permitted to contact programs outside of this forum until the program initiates contact first.

Next, phone or video interviews are offered by programs to applicants during the week. Offers may be sent on Thursday of Match Week. Each applicant then has a set time to review and accept or decline the offers. Once an applicant declines an offer from a program, they will not be offered the same position in the following rounds.

The SOAP consists of 1 day submitting applications, 2–3 days of interviewing with the programs, and another day of reviewing and accepting and/or declining offers. Four cycles of offers occur on the Thursday of Match Week, and this is the final day of the SOAP.

Applying for residency is both exciting and stressful. It also can be mentally and emotionally challenging to process the news you received on Match Day and then proceed to prepare for the SOAP.

How to Apply for the SOAP

First, you need to review the available spots on the SOAP and make a list of programs to which you would like to apply. It is important to have a clear goal in mind when applying to the SOAP and when you conduct interviews with the programs. For most applicants, this is to find out if the position can help you move forward in your career. Just like the main residency match, figuring out if you would be a good fit for the program and if you would enjoy training in the chosen specialty also are important considerations.

You should review the resources available prior to the start of the SOAP and be ready to apply in the SOAP on Match Monday, as it is recommended that you apply to all the programs in which you are interested. The NRMP and the American Medical Association have multiple guidelines that are published and updated every year. These resources cover a broad variety of topics and explain the SOAP steps in detail. They also include a review of the process, tips and tricks on how to prepare your application, and experiences of previous applicants.

In addition, social media platforms and forums can provide insights into the experiences of applicants. These can be a great resource and a good way to obtain updated information about available spots.

Post-SOAP Match Process

I know residents who found their positions after the SOAP process was over. After the SOAP, there are typically several unfilled positions. If you are applying in general surgery, the Association of Program Directors in Surgery (APDS) can be a helpful resource.

Following the Match, unfilled positions are posted on the APDS website, and you can apply to programs outside of the Match. This process usually consists of a similar application package and enables you to find out about open positions. For preliminary residents, this provides you with categorical postgraduate year (PGY)-1 spots, as well as preliminary PGY-2 and categorical PGY-2 spots.

When the SOAP process is over, you might also consider applying to another specialty. Important questions to think about include:

• Am I genuinely interested in the specialty and the spot to which I am applying?
• Does this contribute to my growth as a physician?
• Does this align with the goals I set for my career and for myself?

Many physicians have never imagined training in the specialty that they ultimately chose. Have clear goals for yourself, and thoroughly consider whether applying to a different specialty is something that fits your short- and long-term objectives.

A colleague of mine, Bora Cengiz, MD, summarizes his experience of matching into a different specialty after a preliminary year in general surgery:

“Matching into a program once you go unmatched is exceptionally hard. Not only did I have to find a program that fits my career goals, but I also had to work with other people to have them send letters of recommendation. Once you get an offer, you are urged to take it since the thought of not having a job after a year of hard work crumbles on you. It was a rough time, but everything works out in the end for the better.”

Support from Peers and Mentors

Receiving unexpected news and then spending Match Week looking for a position are extremely stressful. I want to highlight the importance of your social circle and people who support you during this process. Don’t hesitate to reach out to individuals who have gone through these steps before you. There are numerous successful physicians who had to go through the SOAP process to get a training position and now excel in their fields.

During this process, your mentors, program director (if you are a preliminary resident applying for the second time), and peers are vital. Reaching out to them not only makes a big difference in terms of finding out about positions outside of the SOAP, but the support and guidance you receive boosts your motivation to continue your journey.

I can’t emphasize enough the importance of supportive peers while you are going through this process. As a preliminary resident who went through the SOAP process myself, I was in a class with multiple other preliminary residents, and we would share resources we found with each other and frequently check in to make sure we were all doing okay and moving forward. I distinctly remember the chief resident of my service giving me time away from clinical duties during Match Week so I could focus on the SOAP process and increase my chances of finding a position.

Remember, other people have done this before you, and for many successful physicians, the SOAP was the first step in their stellar careers. It is important to keep a positive mindset and continuously look for opportunities and available residency spots. Do not be discouraged by the setbacks along the way and look at the SOAP as a pathway forward. Resilience, hard work, and support from your friends and family will lead you to success.

Disclaimer

The thoughts and opinions expressed in this viewpoint article are solely those of the author and do not necessarily reflect those of the ACS.

Dr. Ipek Sapci is a PGY-3 general surgery resident at the University of Illinois College of Medicine Peoria. Prior to residency, she completed a research fellowship in colorectal surgery. Her interests include colorectal surgery, surgical ergonomics, and clinical outcomes research.

Bibliography

American Medical Association. Match Week FAQ: How to move forward when you don’t match, February 21, 2024. Available at: https://www.ama-assn.org/medical-students/preparing-residency/match-week-faq-how-move-forward-when-you-don-t-match. Accessed May 1, 2024.

National Resident Matching Program. Residency applicants. SOAP. Available at: https://www.ama-assn.org/medical-students/preparing-residency/match-week-faq-how-move-forward-when-you-don-t-match. Accessed May 1, 2024.