To SOAP or Not to SOAP? Is SOAPing Right for You?

After going partially unmatched during Match Week, I relied on the advice of trusted mentors, residents who had SOAPed, and internet forums to help me decide whether I should put myself through the SOAP. Fortunately for me, most of the advice I received was good advice. Yet, I had no way of knowing if that advice was good or bad in the heat of the moment. How do you know if advice is good? How do you know who to trust? Should you SOAP, or should you postpone and re-apply? 

This dilemma is why medical students and residents seek out consultation from trusted mentors and tutors like those at Elite Medical Prep. My goal has always been to give good advice to my students about their careers and their test preparation. The truth is… it’s not possible to promise results. Anyone who promises you results is either lying to you or trying to sell you something.

Before we start, I want to communicate an important point. Ultimately, you will be the only one who can decide whether or not SOAPing is the right decision for you and your career. My goal in writing this guide is to help you decide whether to SOAP. I can’t tell you what to do. All I can do is outline the reasons SOAPing would be a good idea and the reasons it wouldn’t. Keep in mind even if you decide to SOAP, you still might not Match. *

Let’s break down the reasons you should and should not SOAP.

Reasons Why You Should SOAP

1. Personal reasons

Many applicants have compelling personal reasons for SOAPing. For example, someone might have a family and need a stable source of income immediately following medical school. You may have mental or physical health reasons that make going through the application process again feel insurmountable. You may have financial constraints and need a stable income. You may have tried to couples match and went Unmatched or Partially Unmatched and are trying to Match in a program in the same city as your significant other’s training program. There are an infinite number of personal reasons why someone might choose to SOAP. It will be up to you to weigh these reasons and decide for yourself if they are compelling enough to SOAP.

2. There is more than one way to achieve your career goals

When you’ve spent years building up your dream specialty in your mind, it’s hard not to be disappointed if you don’t match into your specialty of choice. But the truth is there are often many avenues to achieve your career goals. For example, if you want to guide women through their pregnancy, you can achieve similar results by pursuing a family medicine residency and an OB fellowship if you don’t match into an OB/Gyn program. Don’t limit yourself!

3. You can see yourself in multiple specialties

Imagine you’re about to submit ERAS, but you don’t feel strongly about your specialty choice. If you don’t Match, then maybe you weren’t meant to be that kind of doctor. That’s okay! SOAPing could be an opportunity for you to explore other specialties. Who knows? You might love your SOAPed program. I can’t tell you how many people I know who are grateful they didn’t match into their specialty or program of choice before SOAPing.

4. You just want to practice medicine

If you don’t want to delay graduation and you want to practice medicine, then strongly consider SOAPing. I tried to SOAP because I couldn’t wait to practice clinical medicine and I wanted to explore other career options.

5. You are applying to a field with many SOAP spots available

If your specialty has a lot of SOAP openings following Match Day (or you think it will), then consider trying to SOAP into a program in your specialty of choice. Emergency Medicine had 219 unfilled positions in 2022 – a more than 7 percentage point increase from 2021 (not including SOAP matches). If you applied and didn’t Match, then maybe you applied to too competitive or too few programs, or maybe programs didn’t rank applicants well. If you didn’t Match and there are many SOAP spots in your specialty of choice, it might be a good idea to give the SOAP a chance. Just because you didn’t Match in your top program doesn’t mean you can’t Match in your field in a less competitive program (E.g., general surgery, dermatology, ENT). Be warned: the number of SOAP spots can be volatile and it’s impossible to predict what the cycle will look like compared to previous year. The number of SOAP spots is influenced by many things, including but not limited to federal or state policy changes, funding, or even a global pandemic.

Reasons Why You Should Not SOAP

1. Personal reasons or extenuating circumstances

Just as you might have personal reasons for SOAPing, you may have reasons not to SOAP. Only you can decide if these reasons prevent you from SOAPing. I knew someone in medical school who developed severe psoriatic rheumatoid disease in their hands and feet. They didn’t SOAP that year after not Matching because they weren’t sure if they would be able to practice medicine. Fortunately, they re-applied the following year when their disease was better managed and Matched into the specialty of their choice.

2. You have competitive career aspirations

If you want to Match into a hyper-competitive specialty (e.g., dermatology), then you should accept the reality that you may not Match. I would argue this is the most common reason for choosing not to SOAP. For example, the match rate for PGY-2 MD dermatology applicants in 2023 was approximately 58 percent. That means, of the 864 people who applied to dermatology, 368 applicants don’t match into an advanced position. If you fail to Match into a competitive specialty, then consider withdrawing from the Match, taking a year or two to pursue a research year, continuing to pay tuition, and re-applying to ERAS and the NRMP Match again as a fourth-year medical student (MD or DO senior). Your chances of Matching are, on average, higher as a MS4 than Matching as a PGY1. Most people cannot afford this career path, but a significant number of applicants committed to Matching into their specialty of choice choose this route.

3. You are not planning on staying in medicine or pursing residency training

There are a nonzero number of medical school graduates who choose not to pursue training in direct patient care. These people work in industry, become consultants, teach, etc. instead of becoming board-certified physicians. Typically, it’s not a good idea to pursue alternative medical careers without completing a residency, but it’s possible.

4. You are going to try to get into a residency program outside the NRMP Match.

Before I begin, let me clarify that I do not recommend this route unless you are fairly certain you will match the following application cycle or if you are dead set on a competitive specialty. 

That being said, believe it or not, people break match agreements. Breaking a match agreement within 45 days of the start date specified in your Match agreement will make you ineligible to participate in the NRMP Match for 1 to 3 years, but it won’t stop you from stepping into an open residency spot outside the Match. If you’d like to learn more about this, check out my other guide discussing swapping residency programs. The NRMP may make it seem like you are an indentured servant if you’ve Matched, but Unmatched medical students do have options even after breaking a match agreement. Take a look at the NRMP’s Match Participation Agreements to learn more.

*As an aside, you may not be meant to Match! I tried to SOAP and still did not Match. And yet, I found my calling in pediatrics and matched at my #1 program following my second time applying and interviewing.

If you are planning to apply for residency matching, and need some extra help deciding whether or not to withdraw from the NRMP Match, Elite Medical Prep is here to help! For more information about our residency advising program, please schedule a consultation call using our contact form.