Understanding the Supplemental Offer and Acceptance Program (SOAP)

The Supplemental Offer and Acceptance Program, or SOAP, is the process by which unmatched or partially matched medical students can apply for residency matching spots left unfilled following the NRMP match. SOAPing is the dreaded outcome of the match. I will never forget the grief and anxiety I felt after opening my email to find the “you have partially matched” email from the National Resident Matching Program (NRMP). As someone who partially matched my first time and failed to SOAP, only to match into my top-ranked program after my second attempt at ERAS and residency matching, my goal is to be a resource for my students who either fail to match or partially match and choose to participate in SOAP.

Residency Matching: Overview of SOAP

Medical students who go fully unmatched or partially matched are given the option to either re-apply for the match the following year (or don’t) or apply to programs through the SOAP, also known as SOAPing. The process takes place during match week, starting the Monday preceding the third Friday in March. Starting the Monday of match week, students who decide to SOAP can see programs with unfilled spots. SOAP participants can apply to up to 45 programs and update their application materials should they choose to do so. At 8:00 AM on the next day (Tuesday), programs can begin reviewing SOAP applications. On the following day, Wednesday, programs can call SOAP applicants review applications, and interview applicants. These brief interviews – usually phone calls – typically last anywhere from five to thirty minutes and must follow all NBME and ACGME regulations regarding interview etiquette and appropriate questioning. On the Thursday prior to Match day, applicants will receive offers for residency spots from programs. There are typically two to three more cycles of this process that day. The total number of SOAP cycles depends on the number of slots and unmatched students available. Students who SOAP match through the NRMP and are given the same protections and rights as other residents who matched without SOAPing. Students can also SOAP into any specialty they want, given there are open residency spots available in that specialty. If a student matches, they are no longer able to participate in SOAP. If a student does not match and does not SOAP, then they will not be able to enter a residency class via the NRMP. 

The full timeline and details can be found on NRMP website. The NRMP has also published a 6-minute video describing the SOAP process, which can be found here.

The History of SOAP

Before SOAP, applicants participated in “the scramble,” a loosely structured, hectic two-day matching system that forced fully unmatched or partially matched applicants to choose from programs with open positions (often within minutes). In 2011, the NRMP decided this was a terribly unorganized and stressful way to fill unfilled residency spots and introduced the SOAP. This was done for several reasons. First, matching into residency was becoming increasingly competitive and the Scramble was not effective or equitable. Additionally, the Scramble encouraged applicants to be unprofessional and allowed privileged residents to take advantage of connections, socioeconomic status and personal resources, and other advantages not available to all students. SOAP allowed the NRMP to be stewards of the process, mandating the use of ERAS for SOAP and reducing the above advantages for select applicants. Also, SOAP released unmatched applicant and unfilled residency programs simultaneously, reducing the amount of time some applicants might have to network and increase their advantages.

Why Do People/Programs Have Unmatched Spots?

When a program or a medical student doesn’t match, it always raises the question, “why?” Often, there is no clear answer as to why a student didn’t match or why a program didn’t fill one of their spots, or the answer isn’t clear. Sometimes programs don’t match because they are bad or malignant, new, non-academic, overconfident in creating their match list, or in an undesirable specialty. Many times, however, a great program can have an unfilled spot due to no fault of their own, just like some phenomenal applicants can go unmatched without any red flags. For example, following reports about emergency medicine physician oversaturation before the 2022 NRMP Match, there were 219 (+7.5%) unfilled emergency medicine residency spots in 2022. Aside from high fill rates and match rates, the total number of residency spots has not matched the growth in the number of total applicants, increasing the likelihood of an applicant going partially matched or fully unmatched.  

For more information about SOAP, please check out any of the following links.

–    NRMP and ERAS SOAP Guide for Applicants 

–    ERAS Applicant Checklist for SOAP 

–    ERAS Applicant SOAP FAQs

–    Supplemental ERAS Application SOAP FAQs 

If you are planning to apply for residency matching, and need some extra help choosing programs, editing your CV and personal statements, navigating ERAS, getting ready for your interviews, etc. Elite Medical Prep is here to help! For more information about our residency advising program, please feel free to schedule a consultation call here.