Medicine From The Trenches

Experiences from medical school, residency and beyond.

The Post-Match “Supplemental Offer & Acceptance Program (SOAP)

Introduction

In previous years, a process known as “The Scramble” existed for:

  • People who were unmatched on the Monday of Match Week
  • Unfilled residency programs
  • People who matched to an advanced position but not a first-year residency position.

The Scramble was also utilized as a primary residency application process for people who didn’t want to go though the Electronic Residency Application Service (ERAS) who often submitted their application materials via fax to programs who didn’t fill (from the list provided on the Monday of Match Week) or even contacted those programs via phone or e-mail. The Scramble does not exist any longer and programs who participate in the Match cannot accept applications outside ERAS. In short, the SOAP process is a different entity with hazards and plenty of opportunities for mistakes on the part of applicants.

SOAP is NOT “The Scramble”

Programs that participated in the Match are no longer allowed to interact with applicants outside of ERAS as this would be a violation of the Match participation agreement. This means that all applications to unfilled programs (those programs that are on the unfilled list) have to be submitted via ERAS. For programs, this means that e-mails, fax machines and phone lines are not jammed with people attempting to submit application materials. Frequently in previous years, many applicants (IMGs, FMGs in particular) could pay for a mass fax service to fax applications to every program on the unfilled list as soon as the Scramble opened which often jammed machines. Most residency programs were only interested in filling with desirable applicants who may not have matched (by mistake usually) and were not able to screen for those applicants because their fax machines, e-mails and phone lines were jammed.

SOAP should not be your primary residency application

If you are seeking a residency position in the United States, you need to meet the deadlines for ERAS with your application materials. In short, you need to submit your application materials (to your medical school if you are an American grad or to ERAS if your are an FMG/IMG) and participate in the regular Match.  If you are an applicant with problems such as failures on any of the USMLE Steps or failures in medical school coursework, do not make the mistake of believing that unfilled programs are desperate and will take a chance on you rather than remain unfilled. First, there are far more applicants in the regular match than ever before. Many people who will find themselves unmatched either overestimated their competitiveness for a program or were just below the cutoff for a program to rank. If a program interviewed you but you didn’t make the cutoff for them or you didn’t rank them at all, you have a better shot at securing a position in that program through SOAP than an applicant who didn’t interview at all. Programs would rather take an applicant that they have seen and interviewed rather than just a person on paper (which is why trying to use the SOAP rather than the Match is a poor strategy).

You are limited to an absolute maximum of 45 programs in the SOAP

In the SOAP, your maximum is 45 programs. You can apply to 30 programs during the first cycle (Monday) and 10 programs during the second cycle (Wednesday) and 5 programs on the third cycle (Thursday).  Applications do not roll over so that if you don’t get a match by the third day the start of the second cycle, you are likely not going to find much out there. There are more applicants who will be unmatched (because there are more people participating) thus the positions will go quickly because programs can review applications to chose the most desirable candidates with the SOAP system.

If you have problems that prevented you from getting any interviews in the regular Match season or you didn’t get enough interviews to find a Match, then you are going to be less likely to find a position in the SOAP. This means that you won’t have a position for residency. If this happens (you know if you have academic or USMLE/COMLEX problems), have a contingency plan in place. This means that rather than sitting around wishing, hoping and praying while your classmates and colleagues are going on interviews, you need to be looking at alternatives to residency that will enable you to earn a living and alternatives that will enhance your chances of getting a position in the next Match.

Strategies to enhance your chances of getting a PGY-1 position

If you know that you are a weaker candidate (failure on USMLE/COMLEX Step I, failure in medical school coursework, dismissal from medical school and readmission), then don’t apply to the more competitive specialties. Don’t apply to university-based specialties in the lesser competitive specialties and apply to more rather than less programs. If you have academic problems, you are likely not going to match in Radiology, Opthalmology, Dermatology, Emergency Medicine, Radiation Oncology or Anesthesiology. You are likely not going to match in university-based programs in Surgery or any of the surgical specialties, Psychiatry, Pathology, OB-GYN,Neurology, Physical Medicine and Rehabilitation, Family Medicine or Internal Medicine. In short, community-based programs in Family Medicine and Internal Medicine may be your best options.Do not believe that if there are unfilled positions in programs that are university-based or competitive, that you are going to snag one of those positions in the SOAP. A majority of those programs would rather go unfilled than fill with a less desirable applicant (in spite of what you hear, those programs are not desperate enough to take any applicant just to fill).

If you are an IMG/FMG, you have to meet the requirements for application which means that your USMLE Scores likely will have to be higher than those for American grads and you can’t have any USMLE failures. There are also cutoffs in terms of year of graduation from medical school for many programs. In short, you need to look at the application requirements for any residency program that you apply to and make sure that you are eligible (better yet, that you exceed) those application requirements.

The best resource for estimating your competitiveness for a particular specialty is to look at the previous years  National Residency Matching Program ( NRMP) reports for those specialties. You can look at the characteristics for matched and unmatched individuals to see where you fit. With a greater number of medical school graduates (most American medical schools increased their class sizes) and the number of residency positions staying static, there are fewer positions out there to be filled. There will be fewer position in the SOAP and the competition for those positions will be greater. Since the competition in the SOAP is greater, it is best to avoid having to use that system all together if possible.

If you know that you are a weaker candidate, apply for preliminary (not transitional) positions in either Internal Medicine or Surgery. You will stand a better chance of getting a preliminary position (more available) and you will have a job where you can demonstrate your clinical abilities for one year before you re-enter the Match for the next year. If you do a good job in your preliminary year, score high on the in-training exams and perform at a high level clinically, you may be able to secure a categorical second-year position in the same program where you do your preliminary position or you may position yourself to become more competitive for another specialty at another institution. The upside to this strategy is that you will not be relying on the SOAP as a primary means of residency application but the downside is that you have to be ready to perform extremely well in your preliminary position without exception. In short, getting into a preliminary position can be a huge asset if you are ready to work hard and prove yourself but can be a huge liability if you are not ready for clinical residency and perform poorly.

Things that generally DO NOT enhance your chances of matching

Doing graduate degree work if you do not match will generally not help your chances of matching. If you can complete a graduate degree (such as an MPH), you may enhance your chances but most graduate degree programs close their application submission dates before you know whether or not you have matched. If you anticipate that you are not going to match, then apply for graduate school long before Match Week or you will find that you can’t get into graduate school. Additionally, you need to complete your degree before the clinical year starts after the next Match. This means that you have to be able to ensure on your next ERAS application, that you will complete all of your degree requirements by the start of your PGY-1 year. Again, if you know that you have a high change of not matching, get your graduate school application done ahead of time or better year, delay entering the match and just apply for graduate school outright (can’t do a Ph.D) but plan on spending no more than one year away from clinical medicine.

Hanging out and “schmoozing” with residency attendings if you are not in their residency program is generally a waste of time. Doing additional observerships (IMG/FMG) generally will not help you if you have done enough before you applied. Working in “research” will generally not help you unless you already have an advanced degree (MS or Ph.D)  or you are able to produce a major paper or article for a national or international peer-reviewed journal. When I say produce, I mean first author not just run a few experiments  or enter data. If you can get yourself on a major clinical research project where you are actually gathering some clinical experience, you can use this to enhance yourself for residency but you face stiff competition for these types of projects and you need an unrestricted license to practice medicine (difficult to obtain without a passing score on USMLE Step 3 + 1-2 years of residency training).

Summary

Making sure that you match requires a bit of strategy and planning for everyone but for some applicants it will be a difficult process.

  • People who have academic and USMLE/COMLEX problems will have even more problems getting into a residency
  • It is important NOT to rely on the SOAP as a primary means to apply to residency programs because you put yourself at a distinct disadvantage in terms of the number of programs that you can apply
  • You need to make sure that you are even eligible for the SOAP in that you have to have applied to the Main Residency Match (at least one program) and are fully or partially unmatched.

Learn as much about the process as possible as soon as possible. The decisions that you make in the residency application process can profoundly affect your career in medicine. Educate yourself about all aspects of the process as there is little room for error.

29 November, 2013 Posted by | applying for Residency, Match Day, residency, scramble, USMLE | 28 Comments

Everybody is doing better than I am doing…

Well, for most people, it’s nearing the end of the first semester of school for this particular year.  It’s a time to complete the projects, papers and assignments that are needed to complete the year strong and it’s a time to start getting organized for those final exams that are looming in the future. This is not the time for berating yourself for not performing up to the standards that you created when you began the semester. For all students, there is quite a bit of “life” in between the start and end of any semester (or any period of time) in the educational process. Over any period of time, distractions and immediate needs/problems will get in the way of your learning. How you manage those distractions/problems is something that you can change to help you in the next semester. In short, as soon as you are done with your work for this semester, take an honest appraisal of what you would like to change and keep the things that worked for you.

Every person has a tendency to compare their lives with what they perceive as the life of another person. That other person might have been your sibling as you were growing up. ( I thought my sister was smarter, more beautiful and more talented that I could ever imagine).  That other person might be someone in your class (I see that X or Y is at the top of the class and he/she doesn’t even have to study) or that other person might be someone you see on the telly or in the movies that you perceive would have a better life or greater abilities than yourself. This practice of comparison is a huge time waster because the only person that you can compare yourself to (in any way) is your previous self. Only you know how to live your life and only you know what you need to succeed in getting what you need to live your life. It’s always easy to believe that others are somehow innately “better” that you are but in reality, they can’t live your life as well as you can live your life and you can’t know what challenges them.

The stress of school, especially medical school or any professional school, can send many students into behaviors that they would not even consider if academic stressors were not present. Assignments, tests and projects seem to be endless. The time that you thought you would have at the beginning of the semester, at this point, seems to have evaporated faster than dry ice. You find that you feel overwhelmed and rushed to complete things often feeling less satisfied that you have been able to give your work your best efforts. When this happens, stop and take a minute to prioritize the upcoming tasks. This is a good time to make a very simple list of the things that have to been done immediately and the things that can wait until you have a bit more time. This is also a good time to pencil in at least 30 minutes of time daily to just reward yourself for keeping up with your semester/academic tests as best you can. That daily 30-minute reward should be something affirming (not self-destructive) that you can keep coming back to when you need to take a short retreat.

Why is it so easy to believe that everyone else is doing better that you are doing at this minute? This happens because you project your feelings of inadequacy into your thoughts about others as you compare yourself to them. You are no more inadequate than the next person in your class but you may be making decisions that are not productive in terms of getting your academic work under control. Just allowing distractions to eat up your preparation time for study and completion of projects can be counter-productive to doing  your best work. If something is so distracting that you can’t concentrate on things that you need to be working on, then take that daily 30-minute reward time and use it to indulge in your favorite distraction (social media for example) as a reward instead of “beating up” on yourself for procrastinating on Facebook.  This means that you use your Facebook time as a reward for getting your other work accomplished rather than something that takes you away from what you need to do. In short, make a better decision not to deprive yourself of indulgences but to limit the amount of time that you participate in them.

Another thing that you can do in this minute, is to replace your belief that you are somehow inferior to others with the affirmation that they would have no idea of how to live your life. Only you can live the life that you are living. You were born with all of the tools that you need to make a success of what you would like to be successful in. All skills can be mastered if you put yourself in a position to master them and take each step needed toward a goal on a daily basis. Success is more of a habit rather than something that is “conferred” on a few “lucky souls”. Success in little daily tasks always adds up to overall success in the “big” items. If you attempt to “rush” or “short-cut” your way through your academics/projects, then you WILL run out of time to do your best work. Objective and thoughtful planning, with daily adjustments, works better than waiting until the last minute because you have the idea that “working under pressure” will spur you to work better. Adding pressure to an already stressful situation adds more stress and does little to get your tasks accomplished. Remember, people who are stressed tend to exhibit behaviors that add to stress rather than relieve it.

The other problem with constantly comparing yourself to others is that under stress, you always believe the negative thoughts first. In stressful situations, it’s aways easy to believe that you will “never” understand all of this or that you will NEVER get everything done that you need to get completed. In reality, if any student in the past was able to get the work completed, you will be able to get the work completed. You have all of the tools do your best under any circumstances. There is no other human out there that can life your life better than you can live your life.  You make a list of what needs to be done and you plan how you will do it. This doesn’t apply to anyone except you because only you can figure out what you need (and how much time you need) to complete your list. Yes, it’s true that there are only 24 hours in each day (and you have to sleep) but look objectively at your priority items on your list and do the most important items first. This is how we triage patients (we treat the sickest patients first and take care of the less acute patients in turn). If you don’t get everything completed, then you examine how you would change things and take action so that you get the most out of your academics.

Finally, telling yourself that you have “passion” for something is not the same as putting yourself in a position for being successful with something. Passion does not overcome or offset daily work toward a long-term goal. If you seek a long-term goal, realize that these long-term goals are reached by taking regular/daily small steps toward them. There is a path toward a goal and the steps along that path are the challenges that you have to meet. Meet and greet each challenge with the idea that you will figure out what each challenge requires and get the job done in your unique manner.

Put comparison terms out of your mind and replace them with action terms such as ” I can” and ” I will” do what I need to do along with asking for assistance at the first sign of trouble. Asking for guidance or assistance is not a sign of weakness but a sign of logical and careful evaluation of that you need for success. If you needed to lift a car, would you keep struggling alone or would you enlist the assistance of 10 others to help you lift that car? Anyone can lend you a hand along the way because most people are willing to help others if asked. You just need to be able to swallow your ego, ask for assistance if you need it and affirm that you will live your life, taking care of your needs without comparison to others and what they are or are not doing. In reality, those people that you believe are so much better than yourself are more like you than you would believe and have the same challenges that you have. In the end, you are equal to them and better in living your life.

7 November, 2013 Posted by | academics, organization | | 2 Comments