The annual medical residency application cycle culminates in the National Resident Matching Program (NRMP) Main Residency Match, which pairs graduating medical students with training programs across the country. This highly anticipated event, often referred to simply as “The Match,” determines the next step in a physician’s career by assigning applicants to residency positions based on a confidential preference-ranking algorithm. When an applicant fails to secure a residency position through this main process, a structured secondary pathway becomes immediately available. This safety net, which operates during Match Week, is the Supplemental Offer and Acceptance Program.
Defining the Supplemental Offer and Acceptance Program
The Supplemental Offer and Acceptance Program, or SOAP, is a process designed to fill residency positions that remain vacant after the NRMP’s primary matching algorithm has been completed. Administered by the NRMP, SOAP ensures that both residency programs and applicants have a fair, regulated method for finding a match outside of the main cycle. This system replaced the previous, less-organized “Scramble.”
SOAP’s core function is to provide a structured environment for the last-minute placement of eligible applicants into available training slots. The process takes place over four days, beginning on the Monday of Match Week when applicants learn their initial match status. Programs that did not fill all their available positions through the main Match can choose to participate, listing their remaining vacancies within the NRMP’s Registration, Ranking, and Results (R3) system.
The binding commitment that characterizes the Main Residency Match also applies to positions secured through SOAP. Accepting an offer constitutes a legal and professional obligation to enter that residency program. This mechanism is a final opportunity within the current cycle to secure a required training slot.
Eligibility and Requirements for Participation
Participation in SOAP requires applicants to have already engaged with the main matching process. To be eligible, an applicant must have registered for the NRMP Main Residency Match and have been either fully unmatched or partially matched after the initial algorithm runs. A partially matched applicant is one who secured a position, such as a preliminary year, but not the advanced specialty spot they desired.
A further requirement is that the applicant must be eligible to enter graduate medical education by July 1st of the Match year. This eligibility is verified either by the applicant’s medical school or by the Educational Commission for Foreign Medical Graduates (ECFMG) for international medical graduates. Applicants who withdrew from the main Match, or who failed to certify their rank order list, are not permitted to participate in the SOAP process.
Residency programs that participate in the main Match but have unfilled positions are also eligible to use SOAP to recruit applicants. These programs must have indicated their intent to participate in SOAP within the R3 system. The documentation required for SOAP applications generally consists of the materials already submitted for the main Match through the Electronic Residency Application Service (ERAS).
Navigating the Application Process
The SOAP application timeline takes place from Monday through Thursday of Match Week. On Monday morning, eligible applicants gain access to the List of Unfilled Programs within the R3 system, which details the specialty and location of every available residency position participating in SOAP. Applicants must then use the ERAS system to submit applications to the programs they are interested in.
Applicants are permitted to submit a maximum of 45 applications throughout the entire SOAP period. A strict policy dictates that applicants and their representatives, including medical school officials, cannot initiate contact with any SOAP-participating program. All communication, including interviews, must be initiated by the residency program after they have reviewed an application.
Programs review applications and conduct brief interviews, typically via telephone or video, on Tuesday and Wednesday of Match Week. The process culminates on Thursday with a series of timed Offer Rounds, usually four in number, where programs extend offers to applicants they wish to recruit. Each offer round lasts for two hours, and applicants must accept or reject any received offer within that specific window.
All offers and acceptances must be processed through the NRMP’s R3 system. If an applicant rejects an offer, that position may be offered to the next preferred candidate in a subsequent round. The rapid nature of these rounds demands that applicants remain constantly available to respond to time-sensitive offers.
Post-SOAP Scenarios
The SOAP process officially concludes on Thursday evening, and all matches made are announced on Friday, alongside the results of the Main Residency Match. Applicants who successfully secure a residency position through SOAP will then proceed with the standard onboarding process, including contract signing and preparing for the start of their training. The commitment made means the applicant is obligated to train at that institution.
For applicants who remain fully unmatched after the conclusion of SOAP, the options shift toward preparing for the next application cycle. They are then free to seek out any remaining unfilled positions that did not participate in SOAP, or positions that became available after the process ended, without the NRMP’s communication restrictions. A common strategy involves securing a preliminary or transitional year position, which provides a year of general medical training to strengthen their application for the following year.
Many unmatched candidates dedicate the intervening year to improving their credentials, which may include taking USMLE Step 3, pursuing research fellowships, or gaining clinical experience in a non-accredited capacity. These steps are aimed at making their application more competitive for the following Match cycle.