Learning that you have not matched into your chosen specialty is one of the most stressful events of medical school. Students sometimes feel depressed, anxious, angry, frustrated, or that they are a failure. These are all normal feelings. However, there are multiple reasons for not matching including:
Some specialties are so competitive that even good students are routinely unable to obtain spots;
Geographic or familial limitations;
Inadequate number of applications to programs or gone on enough interviews; and
Some simply have unrealistic expectations of their capabilities.
The Supplemental Offer and Acceptance Program (SOAP) is a program that the NRMP developed and implemented in the 2012 Match. Prior to that time, programs would be forced to “scramble” to fill unmatched slots: Aptly named by Program Directors (PDs) and Graduate Medical Education (GME) offices. As soon as the match results were posted, the fax machine would blow up and email inboxes would crash. I’ve even seen candidates show up with their relatives to PD’s door steps in the hopes of gaining a coveted residency spot. The SOAP takes place when students learn they have not matched into any residencies and must then seek out new opportunities among the unmatched residency slots that are still available. The SOAP allows the opportunity for programs to electronically peruse applications and for candidates to cast applications on ERAS in a more organized fashion. Afterwards, both the program and candidate cast rank order lists, and hopefully make a match. Several rounds of these “matches” are made until all residency slots are filled. The numbers of unmatched slots are very small and the numbers of folks seeking them are ever increasing. Picture the entire recruitment season that takes place over several months and includes planning and thoughtful decision making; the SOAP crams this into a few hours.
To be eligible to participate in the SOAP, you must be partially matched or fully unmatched on Monday of Match Week.
The SOAP begins on Monday of Match Week. As you wait to find out whether your own fate has a happy ending, know these basics so you can have Plan B
SOAP is made up of a series of rounds in which participating programs seek to fill their unfilled residency positions.
SOAP begins at 11 a.m. EST on Monday of Match Week when applicants find out whether or not they’re matched
Plan to check unfilled programs on Match Day List of Unfilled Programs in the NRMP Registration, Ranking, and Results (R3) system starting at 12 p.m. EST on the Monday of Match Week.
You can begin submitting your applications through ERAS at 2 p.m. EST. You’ll be able to apply only for the categorical, preliminary, and/or advanced unfilled positions that you’re eligible for.
That same day, at 3 p.m. EST, programs can begin downloading applications through ERAS.
A series of rounds starts at 12 p.m. EST 2 days later on Wednesday, at which time the first SOAP offers go to the unmatched applicants listed at the top of programs’ preference lists.
Each SOAP round lasts two hours, during which applicants can accept or reject any offers they receive.
Offers are sent again at 3 p.m. Wednesday and on Thursday at 9 a.m., 12 p.m., and 3 p.m. SOAP ends at 5 p.m. EST on Thursday of Match Week.
Be ready if you’re contacted for an interview. A program will contact you first by phone or email and conduct brief phone interviews. Keep in mind that, as an applicant, you’re not allowed to initiate contact. Some programs will want to have video interviews or, if you’re local, they may offer to have in-person interviews. No matter what the format, be ready during your residency interview to show that you’re the right candidate for the program.
Nothing is more anxiety provoking than learning you haven’t matched into your preferred specialty choice. Below, I try to highlight some key points to know about the SOAP and hopefully increase your chances of matching into a program.
It has been my experience, the graduates who end up in SOAP or unmatched completely:
- Had an overly optimistic assessment of their competitiveness.
- Unwilling to consider any other specialty
- Did not apply to enough programs.
- Did not rank enough programs.
- Did not apply to residencies where they had a realistic chance to match.
- And most importantly, had no Plan B.
Know your competitiveness:
The National Resident Matching Program (NRMP) posts an annual report that will help you assess your relative competitiveness for a given specialty. Dermatology, urology, neurosurgery and plastics remain near the top.
- For U.S. seniors who preferred the highly competitive specialties USMLE Step 2 scores were significant, but USMLE Step 1 scores were a better predictor of match success;
- Neither the number of research experiences nor the number of publications was a significant predictor of match success for U.S. seniors who preferred either a highly competitive or other specialty;
- Having another type of graduate degree was not a significant predictor of match success for any U.S. Seniors;
- According to recent data, MD graduates who re-enter the Match a year or more after graduation have less than a 50% chance of obtaining a position;
- IMGs face even deeper challenges;
The Importance of a Plan B
As an Administrator we learn through experience that a plan B (and sometimes a plan C) is critical to systems and operational success. As a student, your experience is limited to what you already know and hopefully what others have shared. If you are applying in a highly competitive specialty, it’s important to develop a Plan B. Generally, having parallel plans and to dually apply in an alternative specialty can lower your chances of ending up in SOAP. This may be somewhat less necessary if your Step I score is at or above the average for your specialty and you are at the top of your class. Although, this is not a guarantee it just allows you to say that you’re competitive. Remember it’s not just your class you’re competing with but everyone else in the world.
Once you match, TAKE Step3 before starting residency. That is when you have time to study! Putting it off until you begin residency will be detrimental.
As always, comments and suggestions are welcomed. If you have an idea for future topics please share and we can collaborate.
Michael Farca served as a residency program coordinator for the Department of Medicine at one of the largest training programs in the country. He became the Department Administrator with continued oversight of the residency program, 2 primary site fellowships and 3 rotating fellowships. Michael has dedicated over a decade to graduate medical education and is board certified in Teaching Administrators for Graduate Medical Education (C-TAGME).
Disclaimer: Michael Farca is an entrepreneur and is part owner and operator of Master the Wards, which provides Observership U.S. clinical experiences for IMGs, CV and personal statement development.