Monday of Match Week can bring disappointing news for some medical students participating in the 2023 Main Residency Match. A small percentage of residency applicants will find out on that date that they did not match. While time and space are limited, there is hope for those students who do not match.

The Supplemental Offer and Acceptance Program (SOAP) is a vehicle through which eligible unmatched applicants in the Main Residency Match apply for and are offered positions that were not filled when the matching algorithm was initially processed. On Monday morning of Match Week, all applicants will receive an email notification informing them whether they have matched, and if they have not matched, whether they are eligible for SOAP. SOAP is a service of the National Resident Matching Program (NRMP). 

In 2023, SOAP runs March 13–16. As has been the case during the last two application cycles, a fourth offer round has been added to SOAP. The rationale behind that decision, according to the NRMP, is that there has been an increase in the number of unfilled positions remaining after the SOAP process.

FREIDA™, the AMA Residency & Fellowship Database^® (registration required), enables unmatched students to research residencies from more than 13,000 programs both during and following SOAP. Access is free, but extra benefits—such as a dashboard that helps users save, rank and keep notes on each program—are available to AMA members.  

Two veterans of the Match process offered guidance for medical students who may have to enter SOAP. Here are some of the most relevant nuggets of advice.  

Christopher Libby, MD, MPH, an emergency medicine physician at Cedars-Sinai in Los Angeles: As an applicant, you have to decide whether the specialty you aspired to match into is something you will try for again or whether you will be happy in something else as well. You can’t begin to form a strategy if you don’t answer that first. 

So, if you are at risk of not matching, ask yourself a couple of questions … 

What is the weakness in my application? Most, not all, U.S. applicants who did not match have a weakness in their application. If it is a board score or some disciplinary action, then some competitive specialties may not be realistic, especially in the SOAP. 

Do a modified SWOT (strengths, weaknesses, opportunities, threats) analysis. What are the strengths of practicing this specialty? What are the weaknesses that I would not enjoy ... [i.e.] what about this clinically would I not like? What are the opportunities available in the specialty that would appeal to what I liked about emergency medicine? What are the threats to the other aspects of my life based on this specialty? 

Do you plan to reapply to the specialty you didn't match in? If you are going to try for your specialty again, you may choose to do a preliminary year and reapply or to delay graduation depending on what your weakness is. 

Nicole Deiorio, MD, professor and associate dean, student affairs in undergraduate medical education at Virginia Commonwealth University: I definitely recommend a student take the first offer they receive, rather than wait for the second round. The availability of openings goes down dramatically for the second round, so it doesn't make [strategic] sense to "hold out for something better."

In general, I also recommend applicants use all 45 applications in the first round [of SOAP], although this should be discussed on a case-by-case basis with an adviser.