Fourth-year medical students are now just a few days away — March 16 — from learning whether they made residency matches.

And while the vast majority of medical students will rejoice, a smaller number will work through the pain of rejection — and the scramble to find a program that did not fill its quota.

This is the process called SOAP, or the Supplemental Offer and Acceptance Program. SOAP is not a separate match program, and students do not have to submit new rank order lists.

The SOAP process moves quickly. Students who don’t match don’t have much time to ponder what-could-have-been.

At 10 AM on March 16, medical students learn by email and within the National Resident Matching Program (NRMP)’s system whether they matched. For those who didn’t, the NRMP’s system gives them a list of unfilled programs that they are eligible to apply for.

Then, at 11 AM, students can begin those applications, which often means writing a new personal statement and obtaining new letters of recommendation.

At 8 AM on March 17, programs can begin reviewing the applications from students who didn’t Match. Program directors reach out to applicants they are interested in, but applicants cannot approach the programs after they apply.

For 2 days, programs review applications and interview potential candidates. On Thursday, March 19, four rounds of offers begin at 9 AM and end at 8 PM. And even then, some students may not have matched.

SOAP is not a clean, easy process. Even though it does help medical students and programs find a match, many advisers, residency programs, and students have said they do all they can to avoid it.

That is why many medical school advisers — as well as students who have gone through SOAP and helped other students go through it — advise medical students to have a “SOAP buddy,” or close friends and families on standby in case you don’t match.

“It’s hard to watch,” said Janice Cousin, MD, a psychiatry resident at the University of Chicago, Chicago, who graduated from Meharry Medical College in Nashville, Tennessee, last year. She felt fortunate to match, but she felt sad for those who did not. And she recognized how difficult the process is because students almost immediately begin re-doing their personal statements and preparing new applications.

“When you don’t match, you don’t have time to grieve, you don’t know what to do,” Cousin said.

That’s why medical school advisers urge students to be prepared by having friends and family on standby — and to utilize the academic services staff at their medical schools. Emotions run high, and demands are great. Students cannot do this alone.

“It’s not our first time going through Match, so we understand the process a little bit,” said Laurie Archbald-Pannone, MD, assistant dean of students at the University of Virginia School of Medicine, Charlottesville, Virginia. 

Still, it’s “complicated, and it moves fast,” Archbald-Pannone said.

Some students may “partially match,” and they, too, will need to go through SOAP. A partial match can happen if the student applied for a preliminary program, such as a 1-year training opportunity, and then an advanced program after that.

In some cases, a student may match to one program but not the other — that’s partially matched. Those who didn’t match and those who partially matched are eligible for SOAP, provided that they registered for Match and will complete their medical degrees this spring.

Because the process starts so soon after hearing bad news, it is especially difficult, advisers said.

“You’re doing that while you’ve been stabbed in the chest,” said Emily Rose, MD, assistant dean of student advising at the Keck School of Medicine at the University of Southern California, Los Angeles. That’s why USC medical school advisers block out the whole day to help students who did not match, she said.

“It’s painful, it’s emotional, and it’s devastating,” Rose said. “But you have to get it together and start applying again.”

Keck has a therapist on call to help, Rose said.

Even the best of students can fail to match, advisers said. That’s important for students to realize, they said, because it can help diminish some of the sting of not matching.

Hilit F. Mechaber, MD, senior associate dean for student affairs at the Miller School of Medicine at the University of Miami, Miami, said her school works hard to normalize not matching. Students should not feel ashamed or stigmatized, she said.

“We spend a lot of time educating on SOAP,” Mechaber said. “We want that to feel like it’s not failure.”

Sometimes, not matching is simply about the numbers, the advisers said. Top students can be competing for very limited residency spots in highly desirable specialties, such as surgery. There simply might not be enough slots to accommodate an especially high number of medical students who, in any given year, ranked a program highly.

“You can be a fantastically strong candidate, but the residency program may be really tight,” Rose said.

At 11 AM, when students can see the lists of programs with available slots for which they are eligible, they may be surprised. Those slots may not be in the specialty that a student wished for. They may be in geographical locations that students do not want to go.

That in turn means considering another specialty that a student had not planned for or especially wanted.

This must happen in time for next step — the 9 AM review on March 17 by the programs that had unfilled slots.

“You’re picking through the sales rack,” Rose said. “And there’s no guarantee they’ll get a match, and it very likely won’t be in a specialty of their first choice.”

After students have applied to new programs, they are not permitted to contact the program. Family members, friends, “people who know someone,” faculty, advisers — basically, everyone — are also forbidden to contact the programs.

Program directors and others looking to fill their open slots are moving quickly. They must consider the best matches for slots they had hoped to fill. While not feeling the same stress and disorienting emotions that the students may be experiencing, the program directors are time-pressed, hurrying to extend offers within 2 days.

On March 19 at 9 AM the first of four rounds of offers go out to unmatched students. Students have 2 hours to accept or reject an offer. After an hour, a new round of offers goes out to unmatched applicants.

The majority of offers are filled in the first round, but the list is updated after each round until SOAP ends at 8 PM.

While the process is demanding and tiring, it’s a necessary part of helping students and programs find matches, the experts said. Some students may end up taking a research year instead of matching to a program they do not want and going through Match the following year.

Some students may make compromises on their specialty and decide to switch paths. Because students are making big decisions about their future, experts strongly advise the students to lean on medical school advisers for help.

“Do you take the leftovers, do you switch specialties, do you take a preliminary position?” said Diane M. Howell, MD, a professor of pediatrics and the interim assistant dean for student affairs at the University of Florida College of Medicine, Gainesville, Florida. “It’s hard. And a lot of people don’t make good decisions when they’re under pressure.”

But people do make it through — and end up happy with the results. SOAP and the entire Match process can be important steps in helping make strong physicians, the advisers said. Physicians help patients deal with setbacks and challenges every day, she said, so they too need to be able to deal with them.

“So often, you think, you plan, there are things you think you wanted, then you have to re-direct,” said Rose. “Life has hiccups.”