How to help a family member or friend through the SOAP

Introduction

You've just found out a family member or friend is struggling with the US Residency Match. I'm here to help you understand what's going on, what they might be going through, and how you can help them. This article has a sister-article designed for the applicant themselves. That sister article goes more in depth into the nuance of the application process and may be too much information to read if you aren't involved directly in the Electronic Residency Application Service (ERAS) process. Don't worry, I'll help you digest this whole thing regardless.

I'll get you up to speed, work through some terms and definitions, familiarize you with the Match process, and help you understand what happens from here. I intend to make this article digestible for non-medical readers, and I'll assume you know little to nothing about the US Residency Match process so everyone is on the same page.

I went Unmatched my 4th year of medical school and used the SOAP* process to Match into a Preliminary Intern Program called a Transitional Year. From there, I was able to reapply to my desired specialty and successfully Matched the year after. Going Unmatched was one of the hardest things I've gone through, but like all things, I used that burden to bounce back better than before.

You can use the Table of Contents to quickly jump around if needed.

What is The Match?

Every year, 4th year US Medical Students apply for residency positions in the specialty of their choice. For most, this process begins in September of their 4th year, or final year of medical school and involves submitting applications to programs around the country that they'd like to attend. Those programs then receive the applications and they extend interviews to the applicants and formulate a Rank-Order-List (ROL) of the applicants in the order they'd prefer to have at their institution. Applicants also make a ROL of the programs they interviewed with and sort them likewise. Both applicants and residencies submit these ROLs to the National Residency Matching Program (NRMP) which uses a Nobel Prize winning algorithm to match applicants to residency positions based on each others preferences.

The NRMP goes more in-depth on how this process works if you're interested, but all you need to know is that not all positions get filled, and not all applicants get Matched to a residency program. Once the algorithm has processed both side's Rank Order Lists (ROLs), the system informs either side IF they have matched but does not tell them where just yet. This big IF comes in the form of an email the Monday before Match Day. If the algorithm did NOT match the applicant, it will inform them they have not been Matched and will allow them to enter the Supplemental Offer and Acceptance Program (SOAP); a process by which those that are unmatched will be allowed to "Scramble" into unfilled positions. This process begins almost immediately after receiving that dreadful news on Monday. From there, the process of interviewing and attempting to Match with unfilled programs takes place, and this continues until Match Day. All applicants during the ERAS cycle will be informed WHERE they Match on Match Day. Here are some takeaways:

• Applicants must only include programs they interviewed with on their Rank Order List (ROL).
• Applicants will not be Matched to a program that is not included in their ROL.
• Some Applicants must Match to Preliminary and Advanced positions and can be Partially-Unmatched if one of these does not occur.
• Applicants are not required to SOAP into the unfilled positions.
• Unfilled positions may or may not be in the applicants desired specialty of practice.

Okay, that was a lot to take in. Your family member, friend, or classmate may have found out they went Unmatched and they may currently be navigating this process. You can send them the sister-article to this one that is designed for applicants who are navigating the ERAS/NRMP process directly. Now that we have some of the terms out of the way, here's an overview of the schedule for SOAP week.

Before Monday (Sept - Mar): Applicants have been interviewing with programs and forming a Rank Order List based on their preference of where they'd like to attend
Monday (Mar 17th): NRMP tells applicants IF they Matched to a position. For unmatched, today begins SOAP which involves applying for unfilled positions.
Tuesday (Mar 18th): Residency programs participating in SOAP may extend interviews to unmatched applicants
Wednesday (Mar 19th): SOAP interviews continue
Thursday (Mar 20th): Programs will have 4 rounds to extend offers to unmatched applicants based on the number of spots they have unfilled. Unmatched applicants who receive 1 or more offers may accept 1 offer and are now considered Matched
Friday (Mar 21st): Match Day. NRMP tell applicants WHERE they Matched. SOAP officially is over and the remaining unfilled programs list is available to those who remain unmatched

What is SOAP?

As described above, the Supplemental Offer and Acceptance Program (SOAP) is the process by which Unmatched applicants attempt to Match to unfilled residency positions. Previously, this was called "The Scramble" but the medical community has decided to stick with the politically correct abbreviation "SOAP" (pronounced like the cleaning product). The term is also used as an action word, such as "He will attempt to SOAP into a program", or "She SOAPed into her residency spot", or "They are SOAPing this week".

For most applicants, the requirement to SOAP falls as a dreadful surprise, and they may be as confused as you are about where to go or what to do from here. I'm here to help alleviate the stress, help you (and them) form an action plan, and navigate the SOAP process with poise and precision. There are strategies to come out the other side successful, but like all things, it depends on the goals of the applicant. Here are a few things they may be considering at this time.

• Do I change specialties to something that may be less competitive?
• Do I prioritize location over prestige?
• Do I delay graduation? Or take a gap year?
• Do I try to become partially Matched into a Preliminary spot so that I can reapply next year?

There's no right answer. Careful planning and consideration before the SOAP arrives can help alleviate some of the weight and stress of making these decisions, but like I mentioned before, the SOAP may fall as a surprise. If you're reading this before the SOAP process has started, its important you and the applicant grapple with some of these questions ahead of time; and it's likely they've at least considered some of these questions.

I decided that applying to a Preliminary spot such as a Transitional Year program was the best plan of action for my specific case. This allowed me to complete my intern year and reapply the following year. This plan may not work for everyone, but it is a well vetted plan for certain specialties. Remind your applicant to discuss their options with their academic advisors, mentors, or peers.

Why didn't they Match?

The exact reasons why an applicant might not match are likely unknown, however, there may be multifactorial reasons contributing here. I'll briefly discuss a few points here that may be to blame.

The most common factor among unmatched applicants is a ROL that is too short. If an applicant was not offered many interviews, or keeps programs off of their ROL, this decreases the number of places for the algorithm to satisfy their placement. Every specialty is different and there's no threshold number of interviews to try and obtain. What's more, the components that build a robust application are not easy to polish and certain Residency Program Directors may use metrics from these applications to filter out applicants from interviews. These are not things that can be improved overnight, and now that Match Week is here, the current focus of the applicant is not on improving these metrics and that should be understood.

Additionally, the reason or reasons contributing to going unmatched should be reserved for a discussion following the SOAP activities. Do NOT lecture an applicant on the metrics of their application at this time. Instead, I'll give you instruction for helping them navigate the emotional rollercoaster that is SOAP week.

It is, however, important to come to face with the reality of any factors that may have contributed to going Unmatched, not for the sake of improving them overnight, but so that the applicant can address them in SOAP Interviews if needed.

I knew around January that my interview numbers were below average and therefore my likelihood of going unmatched was higher. I started formulating a mental plan in case I didn't Match. Not all applicants will be clued in ahead of time like I was.

How can I help?

This may be one of the worst weeks of their life, and it's important to come to terms with that. Support them in any way that you can, and offer to help where they ask and often for things they won't ask for. Here's the reality of what will unfold over the coming days.

• Long hours revising and submitting new applications
• Rewriting personal statements
• Sitting by the phone/email hours on end waiting for interviews that may or may not come
• Inability to fall asleep

And I'll list a few of the things they may be feeling. I've been through the process and a lot of these hit me pretty hard as well.

• Feelings of inadequacy
• Wishing it would all just disappear
• Desire for isolation from classmates, family, friends
• Feeling haunted by other's Match success stories on social media
• Feeling like I let myself, and my family down

Depending on your relationship to the applicant, and your capacity to assist in some of the above items, even simple things like the following may help tremendously:

• Preparing or arranging meals
• Offering to watch the email inbox while they take a nap
• Screening phone calls
• Proof-reading Personal Statements
• Helping with mock Interviews
• Not being judgmental

I was worried if I tried to take a nap or cook dinner that I might miss an interview invite. These invites are first come first serve and sometimes the best thing to do is just sit waiting and ready. This was very exhausting, but luckily friends and family helped by preparing meals and watching the inbox. Most of my interviews had no warning, they would call and hold the interview over the phone right then and there.

Is there any hope?

I don't think I'd be writing these articles if there wasn't. I went Unmatched and SOAPed into a preliminary internship called a Transitional Year. This gave me the ability to knock out my Intern year, improve areas of my application that needed work, and send out a much better application my second time around. I got to move to the beach for a year, and I got to meet a bunch of other people who went Unmatched as well. I submitted my improved application, and broadened the specialty that I applied to and haven't looked back since. I Matched into my top pick and will likely be an even better doctor because of these trials.

I couldn't have done it alone. I had a lot of help from family, friends, and classmates, and they were the inspiration for turning something as treacherous as Match Week into something much better. I hope that you read this and are motivated to help as much as you can.