Menu Icon Search
Close Search

Using “SOAP” to Clean Up the Scramble

Created October 24, 2010 by Michelle A. Finkel, MD
Share

 

In response to persistent concerns about the “Scramble,” the two-day process when unmatched residency applicants vie for unfilled residency positions, the National Residency Match Program (NRMP) and the Association of American Medical Colleges (AAMC) have announced significant Match Week changes to start in 2012, thus affecting next year’s residency applicants. The new system, called the Supplemental Offer and Acceptance Program (SOAP), is an attempt to improve the Scramble after repeated complaints about disorganization and lack of transparency. SOAP will overhaul the Match Week calendar, so all applicants – both unmatched and, indirectly, matched candidates – will be affected by the reforms.

Why Change?

Two issues prompted SOAP: First, the increasingly competitive nature of getting a residency position has made the Scramble a bad method of handling a worsening problem. Second, applicants and residency administrators have had considerable concerns about the Scramble’s integrity, organization and professionalism.

Escalating Competition

The competition to obtain a residency slot has amplified. According to the NRMP, last year was the largest Match in history: 30,543 applicants participated, vying for one of 22,809 first-year and 2,711 second-year residency positions. The competition is more intense for unmatched applicants: In the past nine years, the number of unfilled PGY-1 residency positions has declined from 2288 in 2001 to 1060 in 2010. Yet, in 2010, nearly 13,000 applicants participated in the Scramble. These numbers and the subsequent competition involved in matching applicants to unfilled positions mandated a streamlined system, which the current Scramble is not.

Criticisms of the Scramble’s Process

The Scramble has been fraught with problems based on the system’s lack of stewardship – leaving little applicant or residency program accountability – and its dizzying schedule. Currently, the Scramble works as follows:

On Day 1 applicant matched and unmatched information is posted to the NRMP web site at noon EST.

On Day 2 the NRMP’s Dynamic List of Unfilled Programs, an index of all residencies that have unfilled slots, is released at noon EST. After looking at the list, unmatched candidates start to submit applications. Many unfilled programs accept applications through both ERAS, the official system, as well as through external means, including direct faxes and phone calls. This dual system leads to a chaotic process: Many applicants submit through ERAS, while simultaneously, frenetically faxing and calling programs.

On Day 4 the Scramble ends. Match results are available at 1pm.

Although the Scramble is technically a two-day process, the NRMP has documented that the majority of unfilled residency slots are taken within the first few hours on Day 2. If an unmatched applicant is fortunate enough to be offered a slot, she or he doesn’t have a lot of time to consider it, forcing candidates to make career-changing decisions rapidly, often within a matter of minutes.

What Precisely are the SOAP Changes?

SOAP would launch several changes in the current system: First, the NRMP will take stewardship of the process. Previously, no organization was responsible for filling unmatched positions, causing confusion and a lack of accountability.

Next, unmatched applicant and unfilled residency program information will be released simultaneously. Previously, candidates found out they were unmatched a day before the NRMP’s Dynamic List of Unfilled Programs was released. Candidates might spend Day 1 collecting friends or finding companies to help send massive numbers of faxes the next day to unfilled programs. With SOAP, that planning day will be eliminated, alleviating some pre-process anxiety.

Third, all participating applicants will be required to use ERAS, obviating the outside, unofficial means that heightened the Scramble’s chaos. All residencies will be forbidden from accepting applications through means other than SOAP: No phone, fax, email or personal contacts will be permitted.

Fourth, the NRMP’s web-based system, often called R3 – for registration, ranking and results – will now allow unfilled programs to submit a preference list for their empty slots. (Although residencies cannot fill their slots outside of this system during Match Week, they can opt to leave their slots unfilled.) A residency’s unfilled slots will be offered to applicants in order of preference until all positions are filled or the list is exhausted – rather than the seemingly haphazard approach used now. Applicants will have to accept or reject an offer within a specific time frame or lose the offer. When an applicant accepts, the R3 program will automatically establish an electronic commitment between the applicant and the program, and the unfilled slot will be removed from the Dynamic List of Unfilled Programs.

Fifth, to ensure more integrity is afforded to SOAP compared to the Scramble, SOAP will be covered by the Match Participation Agreement, and applicant and program participants will be penalized for infractions.

Sixth, because the R3 program will now create a binding commitment between applicants and unfilled programs, the NRMP will ensure applicants using SOAP are eligible: The week prior to Match Week, medical school deans and the ECFMG will be required to re-certify the status of their students through the R3 system. Ineligible students will be notified the week prior to Match Week and will not have access to the Dynamic List of Unfilled Programs.

The table below offers a comparison of the current and proposed Match Week schedule:

Day Current Schedule Proposed Schedule
Monday Before Match Week NRMP sends re-certification requests to Deans.
Wednesday Before Match Week 12 pm: ECFMG and Dean’s re-certification information complete.
Friday Before Match Week 12 pm: NRMP informs all applicants, regardless of matched status, if they are SOAP eligible.
Match Week: Monday 12 pm: Applicants find out if they matched. 12 pm: Applicants find out if they matched and programs find out if they filled; Dynamic List of Unfilled Positions posts; ERAS opens for SOAP.Unmatched applicants begin using ERAS to submit to unfilled programs. Programs begin interviewing but cannot offer slots yet.
Match Week: Tuesday 11:30am: Programs find out if they filled.12 pm: Dynamic List of Unfilled Positions posts.

Unmatched applicants submit to unfilled programs using ERAS and outside methods.

Programs continue to interview unmatched candidates and start creating their preference list in R3.
Match Week: Wednesday 2 pm: Programs receive a roster of their match applicants. 11:30 am: Deadline for unmatched programs’ preference lists.12 pm: Offers to unmatched applicants begin through R3.

Offers are made every 3 hours. Programs may continue interviewing and adding names to the bottom of their preference list.

Match Week: Thursday 1 pm: Applicants find out where they matched (Match Day). 2 pm: Programs receive a roster of their match applicants.Offers to unmatched applicants continue to be made every 3 hours.
Match Week: Friday 1 pm: Applicants find out where they matched (Match Day).5 pm: ERAS SOAP mode ends.

Offers to unmatched applicants continue to be made every 3 hours until 5p. Dynamic List of Unfilled Positions posted thru May 1.

 

How and Whom Does SOAP Help?

SOAP eliminates many of the problems that plagued the Scramble. Because of the NRMP’s leadership and the inclusion of the Match Participation Agreement, the process should be more explicit and professional. Furthermore, the use of ERAS exclusively should avoid the chaos and inequalities that the Scramble posed.

Those who traditionally have more difficulty matching to U.S. allopathic residency slots – IMGs and osteopathic medical students – are likely beneficiaries of these improvements. However, unmatched U.S. allopathic medical graduates should, of course, also be positively affected. Even matched applicants will see changes because of the new schedule: Previously, Match Day fell on Day 4, and it will now fall on Day 5 of the Match Week.

Taking suggestions

SOAP was initiated in 2008 by a task force consisting of medical school student affairs deans, program directors, and recent U.S and international medical school graduates. From now through April 1, 2011 the task force will solicit comments from NRMP and AAMC constituents regarding SOAP:  The NRMP Executive Director will accept suggestions at [email protected]. In May, the NRMP is slated to adopt SOAP at its May 2011 meeting.

For those applicants and residency administrators who have been through the Scramble or those who may need to go through it in the future, SOAP is viewed with optimistic anticipation. As with most new processes, especially those based on technology, there may be some glitches, but the changes will likely be an improvement over the current very broken system.

Dr. Finkel, formerly an Assistant Residency Director and faculty member at Harvard Medical School, founded Insider Medical Admissions to level the admissions playing field by offering elite advising services for applicants to residency, medical school, fellowship, post-baccalaureate programs and dental schools. Check out Dr. Finkel’s latest entries at the Insider blog.

 

// Share //

// Recent Articles //

  • The Year of Privilege, Part 2

  • Posted May 29, 2017 by Brent Schnipke
  • In my last article, I wrote about my perspective on the third year of medical school and how it has evolved over the course of this year. Medical education is unfortunately sparse with free time, which makes it difficult to reflect; writing these posts has been one way for me to slow down and process...VIEW >
  • Do You Recognize the Classical Clinical Triad in This Emergency Case?

  • Posted May 26, 2017 by Figure 1
  • A 35-year-old female, G0P0, presents to the emergency department with lower abdominal pain and vaginal spotting. Her last menstrual period was nine weeks ago. She was treated for a chlamydial cervical infection in the past, and has never taken oral contraceptives. On abdominal examination, no mass is detected, however, there is moderate tenderness in the...VIEW >
  • You Can Buy That on Amazon?

  • Posted May 26, 2017 by The Short Coat Podcast
  • All work and no play…is not what we do. Sometimes you’re having so much fun that the time flies by and you forget that you have other important things to do.  That’s what happened on this week’s show, in which Dave brings Aditi Patel, Aline Sandouk, Kylie Miller and Irene Morcuende along for a trip...VIEW >
  • Considering Rejection: Lessons Learned From an ESL Classroom

  • Posted May 25, 2017 by Nicole Hawkins
  • I was seated on a child-sized plastic chair along a wall in the classroom when the teacher summoned me to the front of the room. She handed me a sheet of stickers and, in broken English that was heavily accented, indicated that my task was to watch the approximately twenty children in front of me...VIEW >
  • My Own Little Ice Age

  • Posted May 24, 2017 by Miguel Galán de Juanai
  • Reposted with permission from here. I can finally say I’m in my last year of medical school. It has been a bumpy ride, but only one clerkship, a research project and an OSCE separate me from graduating. I remember receiving my acceptance letter eight years ago. Thinking back to those days, neither vocation nor sentiment...VIEW >
  • What is Cirrhosis?

  • Posted May 23, 2017 by Open Osmosis
  • What is cirrhosis? Cirrhosis is a disease where the liver becomes scarred over time from chronic inflammation and liver cell damage. Cirrhosis can be caused by a variety of diseases, with alcohol abuse and viral hepatitis being some of the most common. This video discusses the cellular mechanism behind fibrotic tissue generation and the pathophysiology...VIEW >
  • Medical, +1 MORE
  • Q&A with Dr. Jennifer Villwock, ENT

  • Posted May 22, 2017 by Rafid Rahman
  • Dr. Jennifer A. Villwock is the current Rhinology and Skull Base Fellow at the University of Kansas Medical Center. After graduating in 2011 from the Michigan State College of Human Medicine, she completed her ENT residency at the State University of New York (SUNY) Upstate Medical University. Dr. Villwock is active in the American Academy...VIEW >

// Forums //