What Happens If You Don’t Match Into a Residency Program

What Happens If You Don’t Match Into a Residency Program

Not matching into residency can be scary, overwhelming, and disappointing, but there are many options available to continue your career in medicine. This article will discuss The Match process, the SOAP, and other options available if you fail to match.


What Happens If You Don’t Match Into a Residency Program
Nicolette Natale


February 21, 2023

What is The Match?

The National Resident Matching Program (NRMP), better known as “The Match” has been in place since 1952. The Match is the method used to place medical students into residency training programs.

In the past, there was a separate match for osteopathic medical students and allopathic medical students. In 2020, the two match programs were merged, and there is now one graduate medical education accreditation system that all U.S. medical students use to apply for residency positions.

Applying to Residency: How Does The Match Work?

Applying for The Match is a long, tedious process that is a culmination of all the hard work that medical students put in throughout medical school. Residency applications are submitted through the Electronic Residency Application Service (ERAS), which streamlines the residency application process. Applications open in June, and are submitted in mid-September of each year. Candidates are evaluated on various factors, including board scores, research publications, Medical School Performance Evaluations (MSPEs), letters of recommendation, medical school ranking, and grades. After submission, interested programs will contact selected applicants for an interview. Interviews typically occur from October through February and are currently virtual due to the COVID pandemic.

After the interviews are completed, the applicant and the residency program will create and submit a Rank Order List (ROL). For students, the ROL will include programs that the applicant interviewed with in descending order from the most preferred position to the least. Similarly, residency programs will rank applicants that they interviewed in order of preference. The ROL is submitted through the NRMP. Once the ROL is submitted, the resident will enter a binding contract with the program they match to. The NRMP uses a computer algorithm to match applicant and residency lists. In March, the status of The Match will be sent to applicants on a Monday, which will notify applicants whether they successfully matched. The applicant will find out which program they matched into on that Friday. If at the end of interview season you recognize you have a short rank list, typically fewer than 5-10 total ranks, it is possible you may go unmatched. If this is the case, preparing for the Supplemental Offer and Acceptance Program (SOAP) is a smart decision.

How many people do not match?

In the 2022 Match, 36,277 PGY-1 residency positions were offered, and 8474 applicants went unmatched. According to the NRMP data, 92.9% of US MDs and 91.3% of US DOs matched into a PGY-1 position. After The Match, there were 12,836 unmatched applicants and 766 programs with 2,358 open positions. This means that even those who enter the SOAP may go unmatched. Programs can decide whether they would like to participate in the SOAP if they have unfilled positions or elect other ways to fill open spots. 

What Is the Residency SOAP? How Does the SOAP Process Work? How Do I Prepare?

For those who receive the dreaded email stating that they have failed to match, many options are still available. Take a deep breath, and know that you are not alone.

Many students feel embarrassed and lost after failing to match, which is a completely normal response. Now is the time to reach out to your support system and your medical school’s department of clinical education to assist you in the next steps in the coming week. The clinical education team has previously helped many students with this process and can offer essential guidance and resources.

The first step is to enter the SOAP. The SOAP was created in 2012, and it is the way applicants who fail to match can apply to unfilled residency positions. The clinical education department of your college of medicine can assist in the SOAP process. During Match week, there are three SOAP rounds in which unmatched applicants and residency programs can link up. Unmatched applicants will use ERAS to apply to unfilled residency positions. So, if you are in danger of going unmatched, it is a great idea to prepare letters of recommendation and personal statements to use for your applications in the SOAP process. This is especially important for those who will be applying to different specialties than what they had initially applied to, and they may need to rewrite a personal statement tailored to that specialty.

During the SOAP, programs can interview unmatched applicants who apply for their open positions. They then will create a new ROL through the NRMP. The NRMP will offer positions to applicants in the order of the program’s preference through a series of rounds. If the position remains unfilled, it can be reoffered in the following rounds if an offer is rejected by an applicant or expires. This process can be very stressful for applicants, so it is essential to reach out for assistance from mentors, clinical education, and friends during this week. All unfilled residency positions are typically filled by the end of the week.

What If I Fail to SOAP Into a Residency Position? 

If you fail to SOAP, don’t panic! There are still options available.

Stay in contact with your medical school’s clinical education department, as they will likely be able to guide you in the reapplication process if that is what you decide to do the following year. In the meantime, finding a position that can help strengthen your application is an excellent choice for continuing toward becoming a licensed physician. Options include finding a clinical research position, working as a medical scribe, or working as a medical school instructor. 

Finding a research position for the year is a common decision for those who fail to match, especially in more competitive specialties that value research experiences, such as Dermatology, Orthopedic Surgery, and Ophthalmology. A research position is a great way to boost your resume with publications, make connections within your field of interest, and make an income while you prepare to reapply to The Match. This can also allow you to attend conferences to present your research and make connections in the field. Reach out to residency programs you are interested in and ask about research positions they may have available for the year. Be on the hunt for research job postings on jobs boards, as sometimes they will post there.

Another option is to reach out to program directors at residency programs personally. Sending a quick email to explain your current situation may open a pathway for a position. Let them know that if a position opens up, you would be eager to have the opportunity to interview for the spot. Life happens; people decide medicine isn’t the right field for them, they leave for personal reasons or serious illness, and positions open up. If programs are already aware that you are looking for a position, you will be first in their mind if one does become available. Websites like ResidentSwap.org are great places to check for open PGY1 positions should they become available.

Final Steps and Reaching Out for Support

Lastly, and most importantly, reach out for help! Not matching happens to many people, and knowing you are not alone is hopefully comforting. There are many people who can support you through this process strategically and emotionally. Reach out to your colleagues, favorite attendings, friends, and family who can help support you through the process. Although it might not be easy, it is a challenge that many have overcome before you and one that you can overcome yourself.

Life and medicine can be a bumpy ride, but as long as you keep your eye on the prize, finding a residency position after failing to match is a very achievable goal!

Further Reading

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