Residency SOAP process

Step 1

Breathe. Take 5 minutes to 1 hour to feel whatever you need. Sadness. Anger. Frustration. Grab some water, a snack, and a fun beverage of your choice…because we have work to do.

Having to SOAP does not mean you have failed. It simply means you need to assess why you might not have matched, adjust your application, and proceed forward. For example, did you write a purpose statement that was too long, non-specific, or maybe had the wrong specialty in it? Did you apply to back up programs and give the vibe that you really didn’t want them? Or maybe you forgot to get your token and your application went unread for 3 months because of it. (All things I’ve either personally done or seen done by other students). So breathe, this is a speed bump, meant to make you reflect, not fail.

Step 2

Create a folder on your computer that will hold everything you need to apply to residencies. This includes letters of recommendation, your transcript, copies of your level/step scores, and an UPDATED version of your CV.

You technically should have this already, but if you don’t or if it needs updating, this is the time to do it. You want everything in one, easily accessible, place. This week will be chaos enough, don’t add to it by frantically searching for all of your papers.

Step 3

Decide what your boundaries are for SOAPing. Are you willing to travel across the country for a specialty you never wanted? Are you willing to accept a transition year knowing you will have to do Match next year? What about the cost of living?

Here is the hard part: you may feel forced into accepting a position you never really wanted. Truth is, you CAN turn down offers. You CAN end up unmatched at the end of all of this if you don’t find something you want. Know that it makes the Scramble process a bit difficult, and that if you choose something you didn’t want, it’s easier to switch programs than to go unmatched for a year. It is possible to match after a gap year—I am living proof of that. It’s just harder because you are a year removed from school, and programs want fresh minds that still have their medical school knowledge in the front. The next week/year/three years will be hard no matter what path you choose. You get to pick which hard you are and are not ok with.

Step 4

Narrow down your 44 choices by the requirements from step 3. Think about both reach and safety options. Remember, they need to fill the spots with good people, so you have the chance to be EXACTLY what they are looking for

This can seem like a daunting task, but if you are certain you will not move from New York to Oregon for a program, you can cross all of Oregon programs off from your list. Or if you cannot afford to live in a big city on a resident’s salary, and are willing to go to a smaller program with less fellowships, you have another way to whittle it down to 44. Once you start getting close to that magic number, you can start to look at other things important to you: how close to family is it, do they offer housing stipends, etc. Everyone has different preferences, so make sure you are ok with any of the programs you are applying to.

Step 5

APPLY TO 44 PROGRAMS ONLY. Why? Will sending out that last 1 application help you? Maybe, maybe not. BUT if you run into a situation where if you had just applied to this ONE program after you had one conversation, you’d be in…always good to save an extra…it happens. Trust me.

Why 44 choices? Well, the truth is, sending out that last application is much less likely to yield a position than saving it for a “we want you now” position. What does that mean? Well if you happen to be on clinical rotations, and hear the program you are rotating with has an open position, you can quickly apply knowing that the hard part of knowing who applicants are, is done with. Remember, the NRMP strictly prohibits anyone reaching out to the program on your behalf IF the program does not initiate contact with you or your representative first. This does NOT prohibit you or your friends sharing the struggles of SOAP with the programs and how your wonderful friend would also love their program. Please make sure you are reading and following ALL NRMP SOAP rules beforehand.

Reminder, after each round of SOAP matches, you CAN continue applying IF you have not met the 45-application cap…this means as programs don’t fill, you might be able to snag a spot. There is little time for interviews as the rounds go quickly, so this is a huge gamble. I do not recommend this method, but it is an option.

Step 6

Write skeleton letters of interest for each specialty. It should have a place where you will personally address the program director, specifically mention the program and its attributes you like, AND why you want this specialty NOW if you didn’t apply to it during Match.

One of the most common questions I got during SOAP was “what did you initially want to do” and “are you really going to be happy in THIS specialty/program”. I have seen SOAPing students have the mentality of “this program needs me, so I don’t have to try”…you couldn’t be more wrong. Programs are willing to take a middle of the pack learner who wants to work hard and be a part of the team over an arrogant “top of the class” jerk who thinks they are better than everyone else. Be humble yet confident.

Step 7

Start customizing your letters to each program. LABEL EACH ONE. Use names, exactly details you like, and then the generic “why I want to be in this specialty” portion of the letter. I use the names of each program for titling the letters.

This is where your support people can really shine! Is it overkill? Maybe. But this is SOAP, you have to put your best foot forward each and every time. These programs have hundreds of applicants frantically searching for a spot…just like in dating, both parties want to find someone that wants to be there. Plus, it gives your support people a way to feel like they are helping, even if it’s in a small way.

Step 8

Submit your applications. Seems silly to add this in there, but don’t forget to hit submit in the chaos of the week. Small misses can be the deciding factor in the SOAP process.

Step 9

Set up your interview spot. Somewhere quiet, with a backdrop (in case of video interviews). Plenty of chargers for ALL of your devices. A friend/family member to act as secretary if you have a call while on a video interview or vice versa. A notebook for questions. A spare device to Google the programs if you forgot which one they are. Stock questions ready.

You will have multiple programs calling, emailing, messaging in rapid fire. Put on a nice top. Wash your face. Drink a strong cup of coffee. Because you need to be ready at a moment’s notice. And yes, these interviews can happen late into the night.

Step 10

Mentally prepare for the questions that are going to be asked…it will feel like rapid fire and overwhelming.

I have found there is a little less of the dancing around the truth in these interviews. Programs don’t want to waste time talking to someone ultimately not interested in them. So be polite and direct.

Step 11

Know that between 20-25% of applicants go unmatched each year. This week is just one of many. You can and will get through this. Motivate MD has joined me in the mission to help applicants get through Match, SOAP, and Scramble. We’ve created a guide and checklist that you can download here. Please email us with any questions you have. [email protected] 

Written by Dr. Johnson is a PGY2 currently who has shared her story of going unmatched for a year and going through the SOAP twice. We will be posting her story very soon.