If you don’t match on Match Day, you find out the Monday before, not on Friday with everyone else. That early notification exists for a reason: it gives you access to the Supplemental Offer and Acceptance Program (SOAP), a compressed process that fills leftover residency spots over the course of that same week. Most unmatched applicants go through SOAP, and many secure a position. But understanding how it works, what your odds look like, and what happens if SOAP doesn’t pan out can make the difference between a productive week and a paralyzed one.
How Many Applicants Go Unmatched
In the 2026 Main Residency Match, 93.5% of U.S. MD seniors matched into a PGY-1 position, and U.S. DO seniors were close behind at 93.2%. That means roughly 6 to 7 out of every 100 U.S. medical graduates did not match on their first attempt. The numbers are steeper for international medical graduates: U.S. citizen IMGs matched at a 70% rate, while non-U.S. citizen IMGs matched at just 56.4%.
Those percentages translate to thousands of people each year entering Match Week without a position. You are not alone in this, and the system has a built-in next step.
What Happens on Monday
On the Monday of Match Week, applicants learn whether they matched or not. This is three days before the general Match Day ceremony on Friday (when matched applicants find out where they’re going). If you’re fully unmatched or only partially matched, you become eligible for SOAP, which begins almost immediately.
At 11 a.m. ET on Monday, the list of unfilled programs becomes visible through the NRMP’s R3 system. From that moment through Thursday evening, you can apply to up to 45 programs total through ERAS. Once you hit that 45-application cap, you cannot add more until SOAP officially ends Thursday at 9 p.m. ET. This means you need to be strategic about where you send those applications rather than blanketing every open spot.
How SOAP Works
SOAP operates in rounds. Programs review the applications they receive, conduct brief interviews (often by phone), and then extend offers through the NRMP system. If you receive an offer, you have a limited window to accept or reject it. Rejected offers go back into the pool for the next round. This cycle repeats over the course of the week.
There are strict communication rules during SOAP. You cannot contact a program until that program contacts you first, and programs can only reach out to applicants whose applications they’ve already received. Programs are also prohibited from asking you, verbally or in writing, whether you’d accept an offer before one is formally extended. Violating these rules can result in a match violation, so resist the urge to cold-call or email program directors directly.
Types of Positions Available in SOAP
Not every SOAP position is a full residency. The spots that go unfilled tend to fall into a few categories, and understanding the differences matters.
- Categorical positions offer the complete residency training needed for board certification in a specialty. These are the most desirable SOAP spots and often the most competitive.
- Preliminary positions provide one to two years of training, typically as a stepping stone before entering an advanced specialty program. They don’t lead to board certification on their own.
- Transitional year programs are a type of preliminary training that rotates through multiple specialties over one year. They’re useful for building clinical experience while you prepare to reapply.
If your goal is a competitive specialty, accepting a preliminary or transitional year position keeps you in the clinical pipeline and strengthens your application for the next cycle. Many reapplicants take this route intentionally.
If SOAP Doesn’t Work
After SOAP concludes on Thursday evening, any positions still unfilled become available outside the Match system. At that point, programs can recruit applicants directly without going through NRMP. This post-SOAP period is less structured, and finding open spots requires actively reaching out to programs, checking online listings, and working your network.
If you don’t secure a position through SOAP or the post-SOAP scramble, you still have options for the year ahead. The two most common paths for reapplicants are completing a research fellowship or taking a preliminary year of residency. Both keep you connected to medicine and give you new material for your application. A smaller number of applicants pursue other routes: earning an additional degree, completing clinical work abroad, or combining a preliminary year with research.
Reapplying the Following Year
Most unmatched applicants reapply in the next Match cycle. The gap year is an opportunity to address whatever weakened your initial application. If your board scores were the issue, retaking exams is one path. If you lacked research, a fellowship year fills that gap. If you applied too narrowly to a single competitive specialty, broadening your list or adding a backup specialty improves your odds significantly.
Strong letters of recommendation from the physicians you work with during your gap year can reshape how programs see you. Program directors understand that not matching doesn’t define a candidate. What matters is how you used the time in between.
Careers Outside Residency
A smaller group of medical graduates decide not to reapply at all. An MD or DO degree opens doors beyond clinical practice. Common nonclinical paths include pharmaceutical consulting, medical device and health technology companies, health insurance and utilization management, regulatory agencies, public health, medical education, and hospital administration. Medical writing is another option, though it tends to pay less than industry roles.
These aren’t consolation prizes. Some physicians who initially planned to practice find that nonclinical work aligns better with their interests. Others use nonclinical roles as a bridge while they decide whether to reenter the Match. The degree retains its value regardless of whether you complete residency, though practicing medicine independently requires finishing training and obtaining a license.
The Emotional Side
Not matching feels like a public failure in a profession where your peers all seem to be moving forward. The Monday notification, followed by a frantic week of SOAP applications, is one of the most stressful experiences in medical training. It helps to know a few things going in: the timeline is survivable, thousands of people go through it every year, and your career is not over.
Lean on your medical school’s advising office during SOAP week. Most schools have dedicated staff who help unmatched students identify programs, prepare for phone interviews, and navigate the application cap strategically. This is not a process you need to manage alone, and the people who do best in SOAP tend to be the ones who accept help quickly and stay focused on the mechanics rather than spiraling into self-blame.