• Didn’t Match (or Fill)? Don’t Panic

    Follow These Steps to Succeed in SOAP

    (Editor's Note: This guest editorial has been updated to reflect changes for the 2022 Match season.)

    March 10, 2021, 1:40 p.m. Diana Heiman, M.D., C.A.Q.S.M.; and Frederick Chen, M.D., M.P.H. — It’s Monday of Match Week and you receive an email with the dreaded words “unmatched” or “unfilled.” Although it’s not the most direct route to residency training, the Supplemental Offer and Acceptance Program can be just as fruitful. Here’s what students and programs can do to have a successful SOAP.  

    process clipboard steps

    Your first tip is: Start before Match Week to have a contingency plan in place.

    Step 1: Shake the Feeling of Stigma 

    Your ego is probably feeling a little bruised and your identity may feel challenged. Don’t let those feelings take root. You’re in for a few stressful days, but in the end, you still have a chance to find a great match.  

    Many great residency programs don’t fill for a variety of reasons that have nothing to do with quality. Family medicine is a growing specialty with many new programs. Family medicine programs are also much more likely than programs in other specialties to be located in the communities they serve, and therefore more family medicine residency programs are not connected to large academic health systems and may be less known. These are some of the hidden gems you can uncover this week. 

    While the COVID-19 pandemic had had a strong influence on the Match process, we do know that many people applied to and interviewed at more programs than they would in a typical year. Programs are likely to have ranked more of those same applicants than in other years, resulting in more unfilled/unmatched spots. 

    But even before a pandemic threw the residency recruitment process for a loop, we saw evidence that SOAP candidates turn out to be great residents and physicians. We recently examined the SOAP experience in a network of more than 30 family medicine residencies across five states.

    We asked program directors about their experiences and about the residents who came to their programs through SOAP. We were pleased to find that the vast majority of those residents performed great in their programs. They fit in, they met the goals of the programs and almost all of them were highly recommended for future practice by their program directors. 

    What we learned is that program directors can be reassured that they will get great residents through the SOAP and that students will find wonderful programs.  

    Step 2: Figure Out Your Strategy 

    Start by taking a deep breath. Analyze why you didn’t match. Talk with mentors, your dean of students, people whose opinion you value and decide your next steps. Family medicine has a lot to offer and may meet your future practice goals even if you thought another field was what you initially wanted. 

    Why consider family medicine? Variety in ultimate practice is a key component and one of the strengths of family medicine. If you wanted emergency medicine, for example, you can still get training in many family medicine programs, especially rural ones, that prepare you to work in emergency and urgent care settings. Family medicine could be a great option for candidates who originally considered matching into obstetrics and gynecology, pediatrics and other fields. 

    Look for programs with strengths in the areas you want for your future practice. If you have restrictions on locations, this may be more challenging. Look for regional programs that meet your needs.

    Family medicine programs are not all the same. Evaluate the ones you are interested in based on their offerings. Visit the AAFP’s SOAP resources to find the AAFP Residency Directory and search programs by specific attributes, and look at the other resources there, like interview questions and application tips. 

    This is also the time to make sure you understand the SOAP process. Visit the SOAP information page from the Association of American Medical Colleges, watch the National Resident Matching Program’s SOAP video for applicants, and download the AAMC’s checklist of Electronic Residency Application System tasks for SOAP.   

    Clear your schedule for Monday and Tuesday of Match Week. You’ll need Monday to get your application updated and sent to programs, and you’ll need all day Tuesday for interviews. Make sure whatever commitments you have Wednesday and Thursday will allow you to respond to SOAP offers within the two-hour windows.  

    Step 3: Update Your Application and Apply

    Choose programs to apply to where you would be happy and have your future practice needs met. If you aren’t sure what you really want to do, choose a transitional year program to get more experience and decide. It’s extremely unfair to a program to choose it to just get experience and then jump ship. Make sure you’re honest with yourself about what you want, and be honest with the programs you are applying to, as well.  

    Send your applications early! Have them ready to go to the programs when ERAS opens for the programs Monday afternoon. The number of applicants each program receives is enormous, and you want to be in the first group reviewed. Use all of your 45 submissions right off the bat. You are unlikely to get a call from a program if you submit your application in a later round, so don’t hold any back. Programs typically aren’t calling new applicants after the first group they review; there are too many applicants to keep adding them along the way. Put most of your submissions in for your desired field, but consider putting a few in for transitional year positions because this will allow you to get experience and letters for next year’s Match. 

    Step 4: Interview 

    Programs will interview you, likely by phone first and then virtually. It will be rapid-fire because the programs are trying to see if you are a good match for them, just like you are trying to see if the program is right for you. In the SOAP, programs will ask you about what you applied to previously and why you think you didn’t Match. Make sure you are open and honest about this. The programs want to know that you have reflected and are ready to move forward on your new path. And they want someone committed to train for all three or four years in their program.   

    Follow all Match rules! Do not reach out to a program that has not contacted you, and don’t let any faculty or mentors reach out on your behalf either! This is a Match violation and will come back to haunt you. It’s also a big red flag regarding professionalism that could lead to your removal from SOAP now and in the future. Only speak with programs with whom you have applied and that have contacted you first.   

    Once a program has contacted you, feel free to ask follow-up questions even after you interview. This indicates interest, and programs are in a situation where they want to make their best offers in the first round of SOAP. Be genuine — don’t lie about your interest — but if a program knows you are interested, you will have a much better chance of getting an offer in the first round. We all want to have a first-round Match so we can celebrate! 

    Programs Should Prepare, Too 

    “Hope for the best, prepare for the worst,” is always good advice, especially leading up to the Match. Preparation may be even more important for new program directors or rural programs that have fewer applicants. Learn about the SOAP process ahead of time and have a plan. 

    Familiarize yourself with the SOAP resources from the AAMC and NRMP. 

    Programs can take some steps to prepare for SOAP just in case. That includes clearing schedules for staff and faculty, having faculty ready to do interviews and reviewing the ERAS criteria that you use to sort applicants, because you’ll get a new group of applicants through the SOAP. 

    Diana Heiman, M.D., C.A.Q.S.M. is a Residency Program Solutions consultant and vice chair for academic and faculty affairs in the Department of Family and Community Medicine at the University of Kentucky College of Medicine. Before  joining UK, she was residency director of the East Tennessee State University Johnson City Family Medicine Residency, where she participated in the SOAP process on multiple occasions and matched with excellent residents.   

    Frederick Chen, M.D., M.P.H., is director of the WWAMI Family Medicine Residency Network, a professor in the Department of Family Medicine at the University of Washington School of Medicine and chief of family medicine at the Harborview Medical Center in Seattle.