What Happens When You Have to SOAP or Scramble into Residency

Co-Authored by Megan Jenkins-Turner, DO aka @curleysurgeon

Not matching can feel like a heavy setback.

Last year was the largest Match to date, with over 47,000 applicants. More than 9,500 people did not match. I was once one of them. Since graduating medical school years ago, I have met some of the most wonderful, high-achieving, brilliant physicians who also did not match.

Not matching can feel like a judgment of your worth. It is not. It is an unfortunate outcome inside a constrained system. There are more qualified applicants than there are residency positions, and spots are not growing at the same pace as medical school seats. So, if you don't match, then what comes next? SOAP week can feel like a maze. Let’s walk through it together chronologically.

Monday: Emails go out designating whether or not you have matched. For those who are SOAP-eligible and unmatched, the List of Unfilled Programs becomes available in the NRMP’s R3 system under the SOAP tab.

You may feel pressure to match into any specialty with open positions. Be careful: fear makes urgency feel like clarity. I watched several surgical applicants pivot into primary care out of panic. Some later regretted it. One completed a family medicine residency only to restart general surgery because it was what he wanted all along. Your career is long. Make decisions that align with who you are, not just with what is available this week.

At the same time, do not dismiss preliminary or transitional years entirely. There are roughly 1,300 preliminary spots available, and many institutions do not even open their prelim positions until SOAP. More than 5,000 prelim and transitional spots exist each year. If you pursue that route, choose carefully. Programs that routinely convert prelim residents to categorical positions offer a very different trajectory than those that rarely do.

Now is the time to tighten your ERAS application. Update your personal statement if it needs broader framing. Secure new or revised letters of recommendation if appropriate. Refine your CV. Clean and clear matters. These revised documents will be resubmitted via ERAS to align with your SOAP application. Keep in mind that you can apply to more than one specialty during SOAP, if you choose.

Call your mentors. Tell them exactly what happened. Ask directly for help. You need advocates making phone calls and sending emails on your behalf. This is not the time to be reserved or shy. Your medical school will likely reach out and assign you a SOAP advisor. Use those resources if they support you and your goals.

At this stage, you can prepare and submit applications to unfilled programs, but you cannot initiate contact until programs reach out.

Tuesday and Wednesday: Clear your schedule. You may need to step away from your current rotation for a few days. Interviews can come through ERAS messages, email, text, or phone at any hour. In my experience, phone calls are the most common method of contact from programs. A friend once stepped out of the shower to take one. I once pulled off the highway while driving. Stay reachable.

As programs begin reviewing applications, the pace shifts quickly. This phase is fast and unpredictable. Programs may contact you soon after receiving your application, and interviews can happen with very little notice. Some will be brief and conversational. Others may be more formal and structured. Answer unknown numbers. Check your messages often. Keep your phone charged. Have your CV, personal statement, and any requested documents organized and ready to send within minutes. Important: have a concise answer to the question “Why do you think you didn’t match?” Keep your answer brief and focus on how you will improve.

Thursday: SOAP proceeds through multiple structured offer rounds. Programs submit ranked preference lists. Applicants do not rank; you either receive an offer or you do not. If you receive one, you must decide quickly.

If you receive an offer that aligns with your long-term goals, accept it confidently. It does not matter if it came in the first round or the last. When July 1 arrives, no one asks, or even has to know you SOAP’d or which round you matched in.

If you do not receive an offer early, do not interpret that as final. The list of unfilled programs updates between rounds. Things shift rapidly. If the structured rounds conclude without a position, the process transitions into open contact. Programs and applicants can now reach out directly.

Friday: Match Day.

If Match Day does not go your way, prepare for the Scramble. Unmatched applicants still have access to the open position list, although it is not always perfectly up to date. This phase can feel even less structured, and many institutions offer very little guidance.

Combine your entire ERAS application into one concise PDF so it can be sent within minutes. Sign up for ResidentSwap.org. Create or reactivate a Twitter/X account. Many unexpected openings are shared there first by program coordinators and residents. For those interested in surgery positions, monitor APDS Open Positions website for open positions you can apply to outside the match several times a day.  I obtained my position through this website via a phone call interview at 8 pm!  Additionally, monitor hashtags like #SOAP2026 and #Scramble2026. Email programs directly. From this point forward, you are often communicating with program coordinators rather than through the ERAS or NRMP system.

There is usually an initial rush immediately after Match Day. Another wave often appears around late spring as contracts and visas shift, and even occasional openings surface in mid to late summer.

If you do not secure a position during the early Scramble, the process is not over. Openings continue to appear throughout the year. I obtained my general surgery position outside the match on July 14th and started residency a month later. I was able to make up for this time and still graduate with my medical school cohort by limiting the vacation I took throughout 5 years of residency; anything is possible! 

Keep monitoring online platforms and program websites. At the same time, begin preparing intentionally for the next Match. Speak with a trusted advisor in the specialty you actually want to pursue, ideally someone who has recently participated in the Match. Talk to current residents. You will need honest feedback about perceived weaknesses and a concrete plan to address them.

For some, that means a dedicated research year. Research positions exist across the country, many beginning in July or August. Choose strategically, ideally at an institution that promotes from within or produces meaningful publications and strong letters. Some are unpaid or modestly paid, so plan accordingly. Align your strategy with your long-term goal.

This season will be uncomfortable. It may be one of the hardest stretches of your training. But you are not alone, and you are not deficient. There are more qualified applicants than there are open positions.

Gather the people who love you. Protect your sense of worth. The road may not look the way you imagined, but it is still very possible to arrive exactly where you are meant to be.

If you need help navigating this, reach out to us.

No one should walk this week alone.