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Failing to match is simply an opportunity to reroute your success.
There are a multitude of reasons why applicants do not match—not enough interviews, a highly competitive specialty, mistake with rank order lists, last-minute decision change, etc. Regardless of the reason, don’t spend valuable time dwelling on “what could have been.” Your attention should be focused on how to move forward.
Some applicants apply to ultra-competitive specialties with mediocre applications and have considered their “backup plan”—usually a research fellowship or securing a one-year position [e.g. preliminary medicine/surgery or transitional year] to strengthen their application to re-apply.
For applicants that are surprised by their match result, the Supplemental Offer and Acceptance Program [SOAP] offers a second chance to secure a residency position. Here are some tips to help you turn your results, whatever they may be, into an opportunity for growth:
Navigating the SOAP
First off, you must be SOAP-eligible in order to participate. Everyone who is SOAP-eligible receives an email confirming this the Friday prior to Match Week. At 11AM EST on the Monday of Match Week, the list of unfilled programs is available to applicants. U.S. seniors usually receive a call from their medical school to assist through the process.
You will have until 2PM EST to submit up to 45 applications. At 3PM EST, programs have access to the applications and begin the “interviewing” process, which can mean a phone call, video, or in-person [if local] interview. There are three Offer rounds—12PM EST & 3PM EST on the Wednesday and 9PM EST on the Thursday of Match Week. The offers are based off of the program’s rank list
If you are extended an offer during the first round and decline it, you will not be offered the spot again. After the last offer round, the remaining unfilled spots from both SOAP and non-SOAP programs are released. At this point, applicants can start to reach out to programs directly. During the SOAP process, it is a violation to contact programs outside of ERAS—don’t do it!
Advice for U.S. seniors
Many unmatched applicants can secure a position through SOAP. It may not be in your initial specialty or desired location. However, starting at a program offers the best option for switching specialties or re-applying the following year. Or you may find that you enjoy the specialty you matched at and complete the program!
Advice for IMGs
Even as a U.S. IMG [e.g. U.S. citizen at a Caribbean medical school], SOAP can be a frustrating process unless you already have a relationship with a program. Non-U.S. IMGs have even fewer resources to navigate the system, which can make it hard to optimize one’s strategy for securing a spot.
If your goal as an IMG is to practice medicine in the U.S. regardless of specialty, then applying to preliminary medicine/surgery, as well as open categorical primary care specialties, may be your best option. Showing that you’re a strong resident in a one-year position will probably open more doors for re-application the following year.
Next steps after the SOAP
If you remain unmatched after the SOAP, you can use the list of unfilled spots to reach out to programs directly. There are typically very few programs left at this point and most programs will have either filled the spot by the time you’ve reached out to them or decide to leave it unfilled. At this point, it doesn’t hurt to reach out to any program you’d be open to training at. Although, the number of offers extended at this point are minimal.
Unmatched applicants after Match Week will need to reflect upon deficiencies in their application in order to determine the best path for re-application. Certain aspects cannot be changed—clinical grades and USMLE scores—but letters of recommendation, research, and networking are all areas that can be improved upon.
You may consider another advanced degree [e.g. MPH, MBA]. However, this also generally confers more debt. Reach out to mentors and ask for frank feedback on your application. It’s important to reflect upon your application and move forward.
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