I didn't Match my first cycle. I remember opening the email, it was a literal ton of bricks dropped on my shoulders and each Facebook post I saw from my friends and classmates weighed me down even more. It was not fun. I was upset, I felt like a failure, but I knew this wasn't the defining moment for what I was capable of. I've decided to share my journey, provide encouragement, and offer advice to those who may be going through the same or similar challenges. Spoiler alert: your life doesn't end on an Unmatched Day. You're already looking for help and that's a step in the right direction, keep reading to see how I went from Unmatched to Matched and what I recommend to get there.

Okay, let's get into it

For the non-medical or maybe the premeds or young med students that aren't quite keen on the Match schedule activities, I've outlined them here so you can stay on track with us:

Before Monday: Applicants have been interviewing with programs and forming a Rank-List based on their preference of where they'd like to attend which was submitted a week ago
Monday: An email goes out from the National Resident Matching Program (NRMP) telling applicants whether or not they Matched to a position. For unmatched, today begins the Supplemental Offers and Acceptance Program (SOAP) which involves applying for positions that went unfilled. These spots may be in the applicants desired specialty or they may not
Tuesday: Programs participating in SOAP may extend interviews to unmatched applicants
Wednesday: SOAP interviews continue
Thursday: 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: Matched applicants are revealed to the programs they matched to and vice versa. SOAP officially is over and the remaining unfilled programs list is available to those who remain unmatched

I've created this survival guide based on my experiences going unmatched and going through the SOAP and then going through ERAS process a second time. I include in this guide everything I wish I knew and things I wish every med student knew before Match Week. I've counseled with literally thousands of medical students who all were interested in knowing how to defeat unmatched day and I strive to answer all of their questions here. I hate to spoil the ending but I ended up matching into a Prelim spot, and then matching into a proper Advanced Position after putting out a much better application my second time around. Now, lets find out how I did it and how you can too.

Before Monday

There are steps you can take before Monday that can make Match Week go a bit easier. The first thing you should do is find out where you stand compared to peers who applied to the specialty or specialties that you applied to. I recommend you use the NRMP match data to assess your probability of matching to determine how aggressive you need to be during this preparation process.

I knew my odds of matching were slimmer than ideal based on information provided by the NRMP when cross-referencing my number of interviews with my peers. Here, take a look. I had 7 interviews, and as a DO that correlates to around a 70% chance.

If your probability of matching is <60% you should be seriously prepared to go unmatched, but the following tips will help anyone prepare. You should decide if..

• there is a specialty you can prepare an application for prior to unmatched day
• there is possibility of reapplying during an intern year (Transitional Year, Prelim year, etc..)
• you'd rather do a year of research while reapplying
• you'd rather delay graduation and reapply as a med student

I strongly recommend finding a support network and a mentor or advisor to talk to if you even remotely think you may go unmatched. There are things you can do in advance in anticipation of facing the SOAP or learning of being unmatched.

I think everyone should have the following things ready at least a couple weeks prior to Monday Morning:

• Have an action plan for what you will do if you go unmatched
• Discuss this action plan with the following 3 people:
  • your advisor and/or mentor
  • your family
  • your peers*
• If you know you will transition an application to a different specialty, you can start outlining a Personal Statement or getting Letters of Recommendation,
• Begin looking at specialties that go unfilled and consider if you'd fit into these spots

Monday

This is it. Today's the day you find out if you Matched. For some, this day is just another day with a tiny bit of anxiety, and for others, its a day they've been dreading for weeks as their interview numbers were far lower than they would have wanted (hint, its me). It doesn't matter. The email will still come and the Schrödinger's "Match"-Box will unveil itself to you and the multiverse collapses onto the path you were ultimately meant to take.

Anybody who has been through the match process can tell you that this email arrives a couple minutes early. Having gone through the process twice, I can almost assure you the email will come early. However, if you’ve made it this far in your medical education, you are no stranger to anxiously awaiting email results. By now you’ve received news from various medical schools, board exams, interview invites; your inbox is a war zone and today is no different.

From here, things could go a couple of directions. For example, if you applied to a position that begins the following year (Advanced position) your email may say that you partially matched and the email will disclose to you whether you matched into a preliminary position or only to the advanced position. The email will then also disclose the ZIP Code of where you partially matched so that you have a general idea of where you will be going.

OR. The email could tell you that you fully matched, which is what all applicants hope for.

Now, the reasoning for writing this is for this final example which consists of receiving the news that the algorithm did not match you to a position. The email will explicitly tell you “unfortunately, you did not match“. I've listed 3 steps to take as soon as this email presents itself.

1: Cope with the initial shock

You've been chewed up and spit out by the medical education system. You deserve to be upset. It means that you're invested in the work you put in. You'll be tempted to hide from your friends and family and delay sharing the news, and that's okay too, at least for a little while. Take some time and clear your head, you're gonna need to be in a better state of mind when you try to decide where you want to go from here. It's important to allow yourself to feel and process these emotions.

Once you've faced the facts and are starting to engage with the thinking portions of your conscious, you can start the reflection and self-assessment step. You should know your application strengths and weaknesses in and out by now, especially if you got to this post before Monday. Was the specialty you applied to too competitive? Did you have red flags on your application that would make Program Directors remove you from their rank list? Did you apply to enough programs within your reasonable-attainable-reach?

I reasoned that the following were likely causes of my short interview list, and some of these may apply to you too:

• Board Scores were average and below average
• Research and Publication count were below average
• I was not at a Top 40 NIH Funded Medical School

If you're not sure why your application was under-appreciated, you should talk to an advisor, a mentor, or someone you trust. This brings me to the next section.

2: Seeking Support and Guidance

The sooner you meet with your advisor, or a mentor, or your support network, the better. Open up to them and tell them about what you plan to do and use their guidance to strengthen your course. It's important to heed good counsel early on. Take advise from those who have been through something similar or are very knowledgeable about the consequences of each choice. When I went unmatched, I found comfort in talking to other unmatched med students on Reddit/Discord and taking advise from those who had previously gone unmatched.

Once you've started forming an action plan, it's time to decide what direction you can confidently steer this ship. From here there are multiple options, and depending on when in the process you're reading this post, you may have more or less options available.

1. Join the SOAP Process and apply for internships and prepare to reapply to a specialty while in your first year of residency
2. Join the SOAP Process and reapply to the original specialty(ies) you applied to (if there are any available spots)
3. Join the SOAP Process and apply for a different, albeit maybe more attainable specialty among the open spots
4. Abandon the SOAP Process and delay graduation
5. Take time off to do research or other projects and reapply
6. Quit entirely and try something else

After reviewing my application and my options I decided to go with option #1 and SOAP into a transitional year residency and reapply. This is not the best case for everyone, I was primarily applying for a specialty that required an Internship Year anyways, and figured this would be the best option for me. If your applying for Categorical positions that start in year 1 (Family Medicine, Orthopedics, Internal Med, etc..) it may be best to take a research year or delay graduation, that decision is up to you and it should be appropriately vetted.

3: Putting your plan into action

Maybe you've decided you want to reapply, it's time to start building a plan and putting it into action. Hopefully by now you have a few goals you'd like to attain: SOAP-ing into a spot, obtaining a research position, or maybe delaying graduation and making the most of it. You should start outlining your goals and work backwards from where you want to end up.

Nobody expects you to cover all of this in one day, its really not very possible. I can't stress enough, prepare before Monday even if you think you're a shoe-in. Once I started combing through my options prior to Monday, I knew I would likely be aiming for a Transitional Year and a reapplication the following cycle. If you've decided that you would want to SOAP into a different specialty, having Letters of Recommendation and a prefabbed Personal Statement ready will make Monday all the more easy.

Sending in SOAP Applications

You'll be given a list of unfilled programs that you qualify to attend (If you matched a prelim year you will only see Advanced positions or vice-versa). From here, you should tweak your action plan based on what's available and what you deem yourself competitive for. Maybe you were torn between a backup application in Family, Internal, or Emergency Medicine and seeing available programs in your hometown pushes you over the edge to something else. Again, coming up with a plan before Monday will help you to avoid making rash emotional decisions based on what's available.

Spend today writing personal statements, maybe getting backup Letters of Recommendation if making a large enough jump to a different specialty (If you have letters for Psychiatry and are switching to Family Med for example, many Program Directors wont mind and will appreciate you sticking to your interests, just be sure to justify your switch in your NEW personal statement).

Follow this paragraph outline for you Personal Statement:

1. Why Medicine: Basically same as before
2. Why the specialty you're applying to: You will need adjustments here
3. What makes you think you're qualified or good for this specialty: Again, changes may be needed
4. Why this program specifically: If changing specialties, use this paragraph to address what you originally applied for and why you think this new specialty is still in your wheelhouse

You only get 45 spots to apply to during the SOAP and they are free, and you can't apply to anymore than that. The jury is still out if there's any advantage to saving a few of your application spots open in case you change your mind again, but from my perspective, that just means your application isn't getting into the hands of unfilled residencies and that's counter-intuitive. However, the following anecdote may persuade you one way or another:

Another student at my school was interested in surgery and immediately spent all her applications on Prelim-Surgery spots. She heard nothing back. She did not apply to any Transitional Year programs which can also be used to get into some surgical specialties. She wished she had saved a few spots so she could broaden her application to some TY programs.

In the above example, the student's plan was initially sound. However, upon hearing nothing, she wished that she had vetted her application plan in advance in order to get across the desks of some Transitional Year Program Directors. I don't think there is anything she could have done to avoid this, other than "Planning for Anything and Everything" which unfortunately is just not possible during the SOAP. Like this story, your mileage during SOAP week may vary, and if it helps you sleep better saving a few spots, then do it.

Once you've sent your applications in with your new personal statements, the waiting game begins.

Tuesday

It's time to hurry up and wait. Tuesday was one of the days I'll remember most. You can't do anything: except wait. Your phone is on loud, maybe you're ambitious and wearing a suit for any early morning interview invites or cold calls. Usually they don't come.

Program Directors get access to the applications on Tuesday morning and for a lot of them, they are taking time from working to pour through dozens, if not hundreds of applications. They usually recruit their residents, coordinators, and other faculty to help digest the workload and you may get your interview invite from someone other than the Program Director telling you that you'll get a call at any moment and to be ready. In some other cases, you may get an email from a coordinator asking you to quickly sign up for an interview time. These types of things are DEFINITELY first-come-first-serve and your entire job today is to NOT miss out on these opportunities.

I spent the day on Discord chatting with other unmatched applicants and we embraced the anxiety and emotions together. This really helped me. I was skeptical of the advice they offered, but it was nice knowing I wasn't alone. Be ready to screen all phone calls and emails. You thought you hated scam callers before? Just wait.

If you don't have someone to cook meals for you, DoorDash or UberEats may be the best option. There's also a guy on reddit who has a pizza fund each year, maybe he'll keep it going.

You'll keep at this basically for the rest of the day. Because Monday is so hectic, today may be a good day to freshen up on your interview skills and do a few mock interviews with family, friends, and other students if needed. You should be ready to answer the following questions confidentially.

• Why do you think you went unmatched and what changes can you make to better your application?
• What specialty did you originally apply for and why do you think you'll be competitive for what you're applying to now?
• If you're applying for a prelim year and plan to reapply next year, what specialty will you apply to on your second attempt?
• Why did you not apply to us during the match? (If broadening your application during SOAP)
• Why should we make you an offer?

If you didn't get any interview invites today, don't completely panic yet. Wednesday is the day most people will receive an interview.

Wednesday

If you’re gonna get interview invites during SOAP, today is likely the day you’ll get them. Stay diligent and be ready to sound confident. Today is all about staying on your toes. If you didn't schedule any interviews on Tuesday, you may get cold-called today or you may hear nothing at all, I'm just giving it to you straight. Be ready to answer the questions I listed in the Tuesday section, and have a few questions of your own to throw back at the interviewer. It really helps to have these scribbled down somewhere in case you get called without warning. Or, just reference back here:

• What/who is your program looking for specifically?
• What are some characteristics of one of your best residents that make them so great?
• What are some expected changes happening with the program, and how did those changes get put in motion?
• What activities, events, or resources do the residents have access to for wellbeing?
• What are the didactics, board prep, and education fund like?
• Where do most graduates go after finishing here?
• What access do residents have to procedures, skills labs, feedback, and evaluations?

A few people will get a lot of interviews, and a lot of people will get a few interviews. The program directors, and the faculty that are helping them are doing their best to flip through tons of applications and are left to a lot of the same devices as during the regular application cycle. They see high board scores and tons of publications, they extend interviews. They see someone who has rotated with them before, they extend an interview. This leaves off a lot of the applicants who are just as deserving of those spots. Unfortunately, there isn't much you can do about this until after SOAP has ended. Be diligent, and make the best impression that you can should you get extended an interview.

If you decide to turn to Reddit or Discord during SOAP week, don't get discouraged when others are getting more interviews than you. Every program reviews their applicants differently, and every specialty has a different approach as well. There's no rhyme or reason to any of it.

This was also the day that the Discord channel saw a lot of residents from the participating programs pop into the group chats helping and giving information to those that had questions. This humanized the process and was also very reassuring to applicants that this process is just as stressful for the programs at times.

Letter of Intent to Accept Offer

Tomorrow is when programs will extend offers. You should send an email to the programs you interviewed with and tell them you intend to accept on offer if they extend one; these are called Letter(s) of Intent (LOIs). This LOI will ensure the program knows you're willing to accept, and they should keep you on their list of people who they should extend an offer to.

Keep the LOI short, sweet, and professional. Quickly mention some things you noted during your interview that attract you to their program. In bold AND with underline say something like the following:

If offered a position on Thursday, I would unequivocally accept.

If you had multiple interviews, do NOT mention that you have other options open in an attempt to convince them to make you an offer earlier than they may have planned. This will only backfire. Program Directors during match week are most interested in finding quality residents to fill their positions, and they will likely be turned off by an applicant who could potentially waste their offer. Because the Program Directors can only offer positions for the number of spots they have available, they could go unfilled in early rounds due to their offers being overlooked by applicants who pick other sites. Because of this, the Program Directors may remove you from their list if they think you're on the fence.

Once you've sent out your LOIs, you should keep your head up and your inboxes refreshing. Tomorrow is still not the end.

Thursday

Today is a big day if you received interviews. Today is the day the programs will offer spots during Rounds; a series of offers that begins at 9am ET and runs through 4 iterations until 9pm ET. Most positions will fill during the rounds, and most unmatched applicants will become Matched.

If you did not receive any interviews or correspondence during the week up to this point, there likely won't be much for you to do today. Interviews may still come in, from residents and other faculty that aren't actively participating in Rounds, but its not common. Keep your phone alive, and keep your hopes up, there's still plenty of options to match outside of SOAP once this hell-week ends.

Each Round will consist of unfilled programs offering unmatched applicants spots to their program. Lets run a scenario really quick so you better understand. Because some applicants will receive multiple offers, not all spots get filled in each Round.

If a program has three openings, they will be able to make three offers in Round 1. If they fill two of those spots in Round 1 they will have one spot to fill in Rounds 2-4 until it fills.

With this information in mind, you can see that each Round will decrease in the number of available positions being extended. Counterintuitively, not all programs actively try to fill their positions and not all unmatched applicants will accept positions. For reasons that are somewhat ambiguous to residents, the programs may leave open positions alone for a less panic-induced matching cycle that exists outside of SOAP. These programs can be contacted AFTER the SOAP week activities have ended and they may offer you a spot during this time after they've had their own time to thoroughly browse your application. Not all programs believe that SOAP is the answer to matching the unmatched; but more on that later in the article.

Before the Rounds - 7:00am ET

Programs are allowed to reach out to you prior to a Round to inform you they plan on offering you a spot, because, they want to know if you'll accept it. If multiple residencies have reached out to you before the Rounds to ask if you'll accept, always say YES, even if you have another program in mind (they may not offer you anything). That's right, you should always accept an offer when extended one. If you're extended multiple offers in the same Round, pick the one that fits you best. Once you've accepted an offer you are now Matched and are excused from the remainder of SOAP activities, congratulations 🎉 . If you're applying for an advanced position AND an intern position and only fill one of the spots, you can continue through the Rounds to attempt to become fully Matched.

Have your email open and your phone ready. Emails will arrive right on the hour.

Round 1 - 9:00 am ET

Emails for me didn't come. I got zero offers in Round 1 despite having 4 SOAP interviews. This is evidence that I was not an above average applicant that somehow slipped through the cracks and went unmatched. I was further down the list for the program directors, but that's why these offers come in four Rounds. Once the Round starts you'll see your offers (if any) and you'll have plenty of time (the Round ends after 2 hours) to accept them, don't rush into anything. You can call programs and ask them questions if you still have any, but if you only get 1 offer you should accept it, if your goal is to be matched (if you're delaying graduation and reapplying next year, you should weigh your options with your advisor).

Remember, programs cannot extend offers to more than the number of spots available, so wait the full 2 hours to accept your offer if needed. No one can slide in and take that spot from you. If the program has 1 unfilled spot, you are their ONLY offer and they have to wait all 2 hours if needed to know whether or not you're going to accept it. If you have multiple offers you should talk to your family, friends, advisor, mentors, or whoever you confide in about which program might be the best for you.

Once it gets closer to 11:00 am ET you should accept one of the offers. Once you click accept you are officially Matched and you can close your laptop and sleep for as long as you want, hell week has ended! If you do not accept any offers you will still be unmatched and you will be able to continue in later Rounds but I do not recommend this, unless you have goals beyond matching.

Between Rounds 1 and 2

If you are still unmatched when the round ends, you will see an updated list of open positions in the R3 system. You should check on your interviews and see if the positions you interviewed for are still available. If they have been filled you will likely not get any offers from programs you did not interview with, but you may still have some last minute interviews as programs lose their top prospects to Round 1, its important to stay diligent.

If you see your interview spots are still corresponding to available positions, keep your email tab wide open, keep the phone alive and wait to see if the programs call you before the Round to offer you a spot. The later Rounds of the day will progress very similarly to Round 1, but will consist of only the remaining unfilled positions from the previous Round(s).

My Experience with the Rounds

I went into Thursday having received 4 SOAP interviews. I heard radio silence going into Round 1, I got zero offers and no follow up. Just before Round 2 however, I received a phone call from one of my interviews that said they were going to extend me an offer in Round 2. I told them I was going to accept the position, and I was excited to be working with them very soon.

Right at 12:00pm ET I got an email from soap@nrmp.org with 3 Offers enclosed. The 3 offers were from 3 of the programs that I had SOAP Interviewed with, including the program that took the time to call me. I immediately called my family to tell them I got offers and told them which program I was planning to accept.

I accepted the offer that was best for me. I was now Matched 🎉. I could feel the weight lifted off my shoulders. I still felt defeated, like I had accomplished something, but not the thing I had set out to accomplish. It was a weird feeling, I was going to be a Resident nonetheless.

Two hours after I Matched in Round 2, I received another Interview Invite which I promptly declined; informing them I had Matched. Hopefully one of my fellow SOAPers got that spot.

Some people Match on a Friday, some of us Match on a Thursday.

Friday

You've made it to Match day. The day most med students and pre-meds always dreamed of reaching. You probably never expected to go through what you went through, but you made it out the other side. A lot of you matched, a lot of you may still be unmatched (and I'll talk about some options for you below). You probably feel defeated, but take your match and be proud of it! You're still going to be as good of a doctor as you want to be! You should celebrate with your friends and family and especially celebrate with your fellow unmatched folks who fought through SOAP week.

Today is a tough day for a multitude of reasons, one of the big ones being all the social media posts from your classmates and friends who find out where they're going. If you matched during SOAP week, you already knew where you were going a whole day ahead of them. Its important to take in and feel all the emotions you might have, today is a day you'll still remember for a long, long time. I spent Match Day avoiding the parties and celebrations and I definitely regret doing that. I was tired, I was depressed, I was defeated by the whole process, and that made me miss out on a lot of the exciting parts of Match Week that I could have cherished with my fellow classmates. If you aren't up for the parties, though, you now know where you're headed and can start researching everything about where you'll be moving in the coming weeks; that was exciting for me because I Matched at the beach!

Take your time going back to rotations. Listen to your school's guidance on when you're required to go back to your duties, but take as much time as you can to process everything that happened this week.

I'm still Unmatched, now what?

Every applicant is different, and every specialty is different. Some specialties send a greater percentage of their applicants to the SOAP Gulag, these are the facts. If you know why you went unmatched, you should evaluate if those reasons contributed to staying unmatched during SOAP week. Perhaps you have changes to the application that need to be made in order to land in the specialty you applied to. Unfortunately the advise at this juncture becomes very bespoke. I highly recommend reaching out to your school, your advisors, your mentors, your family for guidance on what to do next.

Once all the Rounds have concluded, a list of unfilled positions will be sent to those who remain unmatched. You can begin contacting these programs off of this list to see if they will interview with you or not. You can email them all the highlights of your application including:

• Headshot photo
• Your ERAS application pdf
• A pdf stitched together that includes all of your board scores
  • Check google for a way to do this if you aren't sure
• A cover letter that explains why a Program Director should even read through your application
  • Note: this is different than your Personal Statement
• Your updated personal statement
• Your Letters of Recommendation (LORs) (If you have them)

Be sure that if you send an email to a program you include everything in that single email. Make it easy for them to digest your information. Some programs may elect to avoid participating in SOAP activities and hold a more practical "Job Interview" style process at the conclusion of SOAP. This gives the programs more time to read applications, weigh their options, and schedule interviews. This process can take time and likely won't happen overnight. Get your information to these programs promptly so they can add you to whatever list they use to find interviewees.

The SOAP paired me with an Intern spot called a Transitional Year but I was still unmatched for an Advanced Position or a specialty. Once SOAP concluded I was able to reach out to open spots in my specialty of choice and ask if they'd be willing to interview me. I had multiple programs say they would look over my application and would get back to me, and a few did. Ultimately, going through the Match a second time was much better for matching to a position and happened to work out well for me, your milage may vary.

If you are changing specialties, it may be important to get new LORs and rewrite your personal statements, you may find benefit doing this before emailing your application to the Program Directors. Talk about this in your Cover Letter so they know you're making strides towards the new specialty you're applying.

Conclusion

You've made it to the end of the article. Whether you're reading this ahead of Unmatched week, or during, I hope your keeping your head high and your wits about you. This is not a reflection of your accomplishments, it’s a pot-hole on the road to your final destination. You still have the ability to be the best doctor you want to be regardless of how this week goes or how it went. There are resources available to you to help you navigate whatever trail the SOAP takes you down. Here's a bit more from my personal anecdote to help motivate you, and to prove that what may seem like the end of the road may just be the beginning.

I was a below average applicant to an above average specialty. I had below average interview numbers, and I subsequently did not match. I decided to tighten my helmet and take SOAP week head-on. I used all of my available applications on Transitional Year programs with the idea that I would apply again during my intern year into my original specialty, but also into other fields that I was interested in. I received 3 SOAP Interviews, and I got zero offers during Round 1. I ultimately got all 3 of those positions offered to me during Round 2 and I was then Matched to a Transitional Year program at a site I had no clue even existed. Luckily this site was at the beach, and I was going to make the most of that. During my intern year, I broadened my applications and sent out a much better application. The following year, I successfully matched to my top pick and haven't looked back since.

I hope this article helps you in some way, or that you share it with someone who may need some of this advice. Each year, I spend my time during Match Week on Reddit and Discord helping those going unmatched and once you've gone through this process we'd love to have your help. I'll include the link to our discord server below. I've included some key resources below that may further help your adventure.

Discord

Join the SOAPHOPE 2026 Discord Server!

Check out the SOAPHOPE 2026 community on Discord - hang out with 4104 other members and enjoy free voice and text chat.

Discord

Sources

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 16th): NRMP tells applicants IF they Matched to a position. For unmatched, today begins SOAP which involves applying for unfilled positions.
Tuesday (Mar 17th): Residency programs participating in SOAP may extend interviews to unmatched applicants
Wednesday (Mar 18th): SOAP interviews continue
Thursday (Mar 19th): 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 20th): 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.

The Monday before Match Day is a chaotic day for 4th year medical students. Many students wait anxiously by their email to find out if they've Matched to a residency position, ultimately knowing if they haven't they'll have to rapid fire applications to unfilled spots before Friday. This can be the worst day of someone's life and certainly one of the most challenging weeks. At the culmination of years of effort, the application process has failed the applicant and they're tasked with scrounging together the pieces to keep their careers alive. It's really not fun.

But, you're likely reading this article because you did Match and you have a weight of guilt about you that's begging you to offer some assistance to your close friends, classmates, or internet strangers. Even if this is as far as you get, thank you for at least checking in. I've decided to write this article to help you help those who didn't Match based on my experience going unmatched, working with literally thousands of other students who also didn't match, and seeing the difference a community can make during this terrible week. Use this article as a field guide and feel free to jump around using the Table of Contents.

Where do I start?

First off, congratulations 🎉 on your Match. You should realize that Matching is not a congruency between being a good doctor; the people you are helping will be as good of doctors as they want to be. Recognize that the Match algorithm is not perfect and is designed to prefer having unmatched applicants rather than blankly assigning them to open positions. This gives the applicants the ability to steer the ship towards whichever land they choose.

Before you can help someone through the SOAP process, you should familiarize yourself with how this whole thing shakes down. If you're interested, I have a sister-article to this one that goes much more in-depth on the nuance of SOAPing, but if you're familiar with the ERAS and NRMP process you should feel right at home reading that article. If you're a non-medical person trying to help out, I recommend you read this article instead, geared much more for family and friends who are not directly familiar with the Match process. Or, you can stay right here and I'll briefly run through it:

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 16th): NRMP tells applicants IF they Matched to a position. For unmatched, today begins SOAP which involves applying for unfilled positions.
Tuesday (Mar 17th): Residency programs participating in SOAP may extend interviews to unmatched applicants
Wednesday (Mar 18th): SOAP interviews continue
Thursday (Mar 19th): 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 20th): 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

Get in the right mindset

You need to realize that those who went unmatched could have been 1 spot below you on the program's Rank-Order-List (ROL) and the remainder of their application may be no different than yours. Those who go unmatched are often shocked and surprised to hear they didn't match, while some may have had an inkling for a few months as they maybe didn't receive as many interviews as their peers. Whatever the case, its time to help our peers back up to their feet so they can march ahead.

How can I help?

The most important thing you can do for someone who didn't match is listen to them and hear what they have to say. I'd recommend avoiding opening the firehose of advice on them. My advice to you depends on your relationship with them:

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. Most of my interviews had no warning, they would call and hold the interview over the phone right then and there.

I know them personally, and I'm in close proximity

• Offer to bring them food, snacks, and water
• Watch their email/phone while they take a nap
• *Help them sort through available programs and make a list of places to apply to

After I found out I didn’t match, one of my close friends from medical school offered to go on a walk with me and let me vent about the whole process, run ideas by them, and let them know about my plans for getting matched. They ran and grabbed tacos and allowed me to focus on getting my SOAP tasks done.

I know them personally, I'm not very close in proximity right now

• Allow them to open up and vent about this process, they likely want to get some frustration out
• Let them run ideas by you, they may be deciding whether or not to change career paths, specialties, locations, etc. and want to see a plan from another angle

Family members were checking on hospital sites for SOAP Interviews that I had received, helping me vet the locations and come up with a course of action. It was nice knowing I had people to help me through this, even if they weren’t in the same room. I maybe could have done this without them, but it would have been much harder.

I don't know them personally

• Unmatched individuals have a laundry list of tasks dropped on them all at once, you could try helping them by proofreading personal statements, practicing interviewing with a stranger, and listening to their situation

I was amazed by how many people who didn’t know me personally offered to help me. They offered to read my personal statements, help me practice interviewing, or even just lend an ear if I wanted to talk. Additionally, I met other med students who had matched into the field I had applied to, and they were a great resource for checking aspects of my application that I had questions about.

Where can I find people who need help?

A great place to start is by checking in with your local classmates, if you have a shared group chat or Facebook/Discord/etc.. start by offering up your help and services and be sure to keep it anonymous by requesting they DM you. If you‘re still looking to help but aren’t finding anybody this way, don’t worry, there are other places.

You can check on Reddit and Discord, both of which usually have others offering and asking for help. The last two years, SOAPHOPE on Discord housed thousands of med students, residents, family members, etc.. all trying to get through this together. You can join the discord and offer your help here as well.

Am I actually helping?

Yes. It can, at times, seem as though your help is futile, but even the gesture itself can be enough to help those who didn’t match realize that we’re all in this together.

Again, thank you for taking the time to see what you can do to help another.