NRMP SOAP Process for Residency: How to Match
/How does the NRMP SOAP process work? Learn everything you need to know to successfully match into a residency program through SOAP
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Part 1: Introduction
Entering the NRMP Main Residency Match, you undoubtedly dream of opening a “Congratulations, you have matched!” email on the Monday morning of Match Week. However, this doesn’t happen for every residency applicant.
Don’t fear—all hope is not lost for landing a residency spot! Should you find yourself in this position at the start of your Match Week, there is another road towards residency that you can pursue: SOAP.
In this guide, we will help you understand everything you need to know about what happens if you don’t match and how to navigate this often confusing process.
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Part 2: What is SOAP?
SOAP, or the Supplemental Offer and Acceptance Program, is a system that allows programs to uniformly offer unfilled positions to eligible applicants during Match Week.
SOAP was created to provide a more equitable system for applicants who did not match. Previously, there were “under the table” communications between medical schools and residency programs to find applicants positions at unfilled programs. However, this often led to impartial candidate selection.
How does SOAP work?
The SOAP process happens in a series of offer rounds throughout the Thursday of Match Week. Though people often mistakenly think SOAP is another match, this isn’t the case.
Instead, SOAP uses an offer-and-acceptance model that is contained to four rounds. In a certain sense, it is like an expedited medical school admissions process—a residency program, or perhaps multiple programs, offer you unfilled positions, and you have a certain deadline by which to accept or reject their offers. We will go further into the dynamics of the rounds later in this guide.
(Suggested reading: The Ideal ERAS Timeline)
Who can use SOAP?
To be eligible for SOAP, you must be:
Registered for the NRMP Main Residency Match
Able to enter graduate medical education by July 1st (i.e., you are on track for graduation and verified by your medical school)
Partially or fully unmatched on the Monday of Match Week
The dynamics of being partially unmatched may initially be confusing, requiring a quick review of how residency programs can be structured. While many residency programs are categorical, meaning they provide residents with full training in their field starting as a PGY-1 (postgraduate year 1), others work differently.
Programs in certain specialties require residents to complete a preliminary year in a general area, such as surgery or internal medicine, before going on to the advanced, specialized portion of their training. Therefore, applicants in these fields must match into both a preliminary program (to start as a PGY-1) and an advanced program (to start as a PGY-2), ideally at the same time.
An example would be dermatology, in which a residency applicant would apply to a preliminary year separately from their advanced dermatology training. This two-program structure is applicable to several fields, including anesthesiology, ophthalmology, radiation oncology, interventional radiology, diagnostic radiology, neurology, and physical medicine and rehabilitation. Some of these fields also have options for categorical training within the Match.
If you find yourself applying to preliminary years and advanced programs, it is possible to match into just a preliminary program or just an advanced program. If this is the case, you would be considered partially matched. You could then enter the SOAP process for whichever program type you went unmatched in.
On the other hand, if you are fully unmatched, you can SOAP into any specialty and any program type available. Many people in this situation will consider SOAPing into a preliminary program to begin their postgraduate training and then apply into a physician-reserved or advanced program in the following year’s Match.
In this scenario, physician-reserved spots are ideal as they allow a PGY-1 applicant to match into a PGY-2 spot the July of the Match year, meaning applicants can go straight from their preliminary to advanced programs. In contrast, advanced positions begin during July of the following year and would involve taking a year off prior to starting advanced training.
However, the logistics of how to best optimize your specific SOAP approach should be discussed in detail with the dean and advisors at your medical school.
How to prepare for SOAP
The best preparation for SOAP will be the same preparation you’ll do for residency application in general.
Talking with your medical school advisors in advance about how to best target programs that are compatible with your application should set you up for success. If your advisors indicate that you may have a challenging time matching in a certain specialty and you end up proceeding with the application, then be sure to review the logistics of SOAP in advance.
However, the true preparation will be submitting the most detailed and well-rounded ERAS application you can so you have the best hopes of matching through the primary match process.
(Suggested reading: Residency Personal Statement: The Ultimate Guide (Example Included))
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Part 3: Logistics of the SOAP process
Now, let’s get into the nitty gritty of what the SOAP process looks like. Here’s a breakdown of the process, spanning the Monday through Thursday of Match Week.
Monday: Apply to programs
On Monday of Match Week at 9 a.m. EST, you will learn if but not where you matched. If you are one of the applicants who did not match, you will want to begin speaking with your advisors and medical school about your options in order to decide if the SOAP process is best for you.
Having these conversations right away is important because the SOAP process happens quickly throughout the week. You will want to submit your SOAP application on Monday or, at the very latest, before programs start reviewing applications on Tuesday at 8 a.m. If you are on the fence, we would advise you to go through the process regardless, as you always have the option on Thursday to refuse offers.
Deciding not to SOAP will involve taking the next year off to improve your application so you can apply for the Match the following year. If you are 100% certain you want to be in a specific field, you will likely not want to enter the SOAP process for more general residency spots. Regardless, you should enter the SOAP process for your desired field, assuming that field is still of interest to you.
Should you decide to SOAP, you will go into the R3 system and find the button for SOAP in the upper right-hand corner. There will be a dropdown menu that says “Unfilled Programs.” Upon clicking this link, you will be able to view any program that did not fully fill their spots. Here you can review and eventually select which programs you would like to submit your SOAP application to.
It is important to note that, although you view the eligible programs through R3, you will submit SOAP applications via ERAS, the system through which you submitted your initial residency application.
You are eligible to submit up to 45 applications to unfilled programs across all four rounds of SOAP. These programs include categorical, preliminary, advanced, and physician reserved. However, you must be eligible to apply to the program based on your level of training.
For example, if you are currently graduating medical school, you would not be eligible for an advanced program spot unless you had already partially matched into a preliminary program that would give you the appropriate training for the timeline of the advanced position. Fortunately, the ERAS SOAP system only allows you to see the programs for which you are eligible.
If you are fully unmatched, you can apply to a variety of types of programs, including categorical and preliminary. You can decide to SOAP or “scramble” into different specialties than what you initially applied to as well.
Tuesday–Thursday: Interviews
Once you submit your ERAS SOAP application, you will wait until Tuesday morning when programs start contacting applicants. This communication can be via telephone or email, but notably it is always from program to applicant.
On that note, it is vital to understand that you cannot directly contact programs via phone or email. Instead, all applicant-to-program communication should come through the ERAS application software. This rule also applies to school officials and mentors reaching out on the applicant’s behalf.
If an applicant violates this rule, they may be investigated and possibly barred from matching in future years. While this may feel strict, these rules are ultimately in place to make sure the process is equitable for all applicants.
Between Tuesday and Thursday of Match Week, programs will interview applicants and create preference lists of applicants. Applicants will not create preference or rank lists. Similarly, programs are not allowed to ask applicants at any point if they will accept an offer if provided one.
Thursday: SOAP rounds take place
On the Thursday of Match Week, the four SOAP rounds take place in which programs will post offers to applicants for unfilled positions. Round 1 is at 9 a.m. EST, Round 2 at 12 p.m. EST, Round 3 at 3 p.m. EST, and Round 4 at 6 p.m. EST. Each round lasts two hours.
In this time, applicants can find their offers in the R3 system. All offers are extended simultaneously within these blocks of time. The applicant has the option of accepting the offer(s), rejecting the offer(s) or letting the offer(s) expire (after the two-hour time limit). If an applicant rejects or lets an offer expire, the offer will not be given to the applicant again. If an applicant has multiple offers, by selecting one they automatically reject the others.
Accepting an offer establishes a binding commitment that is enforced by the Match participation agreement. As when you match into any program through NRMP or SOAP, you are obligated to start training at that program for a set amount of time.
At the end of each round, the list of unfilled programs will be updated. Notably, the majority of positions are filled during Round 1, so take this into account when making your decisions throughout the rounds. It is generally advisable to take an offer during the first round if you can.
With the conclusion of the four rounds, the Match is officially over. At 9 p.m. on Thursday, the R3 system will show unfilled programs or programs with spots that did not participate in SOAP. If an applicant remains unmatched, they can contact programs directly about their availability to see if there are any other avenues to a position. The contact rules no longer apply as they did during the official SOAP process.
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Part 4: Frequently asked questions
How much does SOAP cost?
SOAP is included in the ERAS application. There are no additional fees for entering the SOAP application.
What is the success rate of SOAP applicants?
Generally, the SOAP process is most utilized by international medical graduates (IMGs), who make up half of all applicants participating in SOAP. There were almost 6,000 IMG applicants who filed for SOAP in 2021.
In this same year, there were about 1,800 spots filled through the SOAP process. Half of the positions were accepted by allopathic trainees, osteopathic graduates accepted 27%, and IMGs accepted approximately 18%. Of course, these numbers change annually depending on application conditions and specialty preference, but trends remain similar across the years.
Remember that the most spots are filled in the first round of SOAP. In 2021, 1,100 positions were filled in the first round of the 1,800 total. Only 4 spots were filled in the fourth and final round.
What are the most common specialties to match into via SOAP?
Internal medicine and family medicine make up the specialties most commonly filled through SOAP. Each of these specialties fill about 350 spots in the SOAP process annually.
Keep this in mind if you are in a position to SOAP; even if your goals lie elsewhere, you could always include applications to these fields if you could see yourself training in internal medicine or family medicine. Further down the list you have pediatrics, neurology, and pathology.
More than half of SOAP positions are PGY-1-only spots—these are intern-year positions that will allow you to apply to advanced spots the following year. Preliminary surgery and preliminary medicine make up the most common PGY-1 spots filled through SOAP.
What should you do if you don’t match during SOAP?
If you don’t match during SOAP, the first thing you should do is discuss the outcome with your medical school. Most schools have programs that allow trainees to spend an additional year with the institution participating in research or additional education while enhancing their applications in preparation for the next ERAS and Match cycle.
You should also think about your interest in specialties and decide if you are still most interested in the specialty you’ve just applied to. If you were unable to match into a more competitive specialty and you can see yourself in an alternative field, consider gaining mentors and networking in a different field to possibly dual-apply to both specialties in the next cycle. You could also decide to change specialties all together.
Discussing this with mentors and advisors is highly recommended. If you find yourself in this position, we would be happy to advise you on how to best strategize your application!
Final thoughts
While entering the SOAP process may not be what you had envisioned for Match Week, you now know the steps for success should you find yourself needing to SOAP. It is important to remember that this isn’t another match but, instead, an offer-and-acceptance process. Understanding the rules of communication are also vital as they are strict! Again, remember that early conversations with your medical school advisors are key to navigating the dynamics of this process and best optimizing your postgraduate training options.