From unmatched to Intern of the Year: My SOAP experience

“We are sorry, you did not match to any position.” The words every Match applicant dreads seeing.

I remember receiving this email while I was at my clinical rotation. I debated telling the resident and preceptor I was with, not excited to share what felt like the worst thing that could’ve happened. I ultimately did let them know.

My phone went off while I drove the long 30 minutes home. I barely heard it, still in shock.

Most of us don’t think it will be us. We assume it will be someone we’ve never met before. A statistic in the national Match data.

But some of us will end up not matching. I was one of them. This article isn’t a reflection on what went wrong, though part of the grieving process of not matching should include reflecting on what might have led to this occurring. In this article, I want to share what I did after I learned I didn’t match, how participating in the Supplemental Offer and Acceptance Program (SOAP) went for me, and my advice for others who don’t match.

If you go the SOAP route, after learning you didn’t match on a Monday, you’ll spend the rest of the week applying to and interviewing for residency slots that are still open. According to AACOM, 99.5% of graduating DOs were placed in residency positions in 2023. This means your odds of landing a position via SOAP are very good.

At the same time, it’s hard not to be stressed during this process. For most, the question of looming debt, other career options, and what can be done with a medical degree without residency training can create significant fear and doubt.

Strongest recommendations

If possible, well before the Match takes place, engage in some self-reflection on what you are looking for in residency and what your backup plan will be if you don’t match. 

It is unpredictable: You can never be sure what specialty may have positions and in what location. Additionally, what are you willing to do to achieve your goals? Some individuals might not be willing to compromise and may prefer a research position or preliminary spot. Others, like myself, might consider switching specialties.

If interview season starts up and you are struggling to get interviews, think about what else you might want to do if you find yourself unmatched. Have multiple backup plans. There are some specialties that are reliably in SOAP; many others are not. You can get an idea of which specialties will likely have SOAP positions by looking at the chart on page 46 of the NRMP Match report.

Finding another specialty

In the middle of my fourth year, I became hesitant about the initial specialty I applied to.  Serendipity brought me to the emergency department during the month of March, and if I had experienced emergency medicine sooner, I might have applied to that specialty first. I liked the marriage of medicine and procedures. I liked the first contact that we get with patients and being at the front end of many diagnostic mysteries.

Others are not as lucky as I was to find the specialty they were looking for all along. It is very important for anyone going through this process to rely on their support system and talk through their feelings with a trusted friend or family member.  

SOAP week

It can be hard not to feel like you’ve failed. Especially after applying to medical school and working through all the challenges of school itself, plus piling on research, working for honors on rotations and other obligations, all to acquire a residency spot in your desired specialty.

Mentors and faculty at our institutions try to prepare us for the possibility that we may not end up at our top program. However, we often do not feel fully prepared to end up without a position.

If you find out you didn’t match, your first priority will likely be getting through SOAP week and landing a position that will work for you (I share more about SOAP preparation in this article.) But once that acute period is over, reach out to friends and family you trust. Talk to them about what’s going on. Seek out help from your medical care team. Seek out a counselor if you need to.

What did I do?

I talked to my people. I was honest about what happened and found no point in not talking about it. I tweeted about it. People knew. I went back to the emergency department after the weekend and embraced my new home. I made sure I learned more about the specialty.

I went to social gatherings to keep myself attached to my friends, even though it was challenging. I felt like an outsider at times, especially with peers who had matched in the specialty I wanted. We weren’t quite sure how to talk about the fact that they were going into that specialty and I wasn’t.

If you find yourself in this scenario, I encourage you to remember that it does get better and it will be OK. Your future and your life are not defined by this moment. I ended up doing well in my program and received our “Intern of the Year” award.

There were countless times in our first few months of intern year that I thought of myself as the worst of our cohort because I hadn’t initially pursued emergency medicine. I never felt like I knew what I was doing. But most interns and new doctors feel that way, whether they matched or not. I also realized over time that I am happy with what I am doing and I ended up in the best specialty for me. In fact, if I had matched, I would not have gone into emergency medicine, where I truly feel I belong.

Related reading:

What to do if you don’t Match into residency

Matching into your top choice: 8 OMS IVs share their stories and advice