SOAP Stress - Realistic expectations and specialities available?

[deleted804629]

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[mvenus929]

One of my classmates applied initially to Ortho, I think, then applied to Anesthesia as back-up because he wasn't get a lot of ortho interviews. Ultimately, he made the bold decision to rank 'no match' (he was couples matching) and SOAP into whatever was available where his partner matched. He ultimately matched into IM.

 

[gyngyn]

Last year, the categorical positions were mostly in Anesthesia, Family Medicine, Internal Medicine, Radiology and Pathology.
There were a few spots in Neurology, ObG and Peds, very few in Psych and PM&R. Three were only 2 unfilled Surgery spots.
The bulk of the open spots were Surg-Prelims.

 

[AdmiralChz]

Yeah, a solid US graduate would have opportunities during SOAP. In Anesthesiology, some of the larger (>20 per year) will have one or two open spots. When this happens at my program we typically fill with fairy high-level applicants who fell through very competitive subspecialty matches.

But honestly, do what you can to match through the regular match. Your options become much much more limited, often in less desirable locations.

There are an absolute TON of open surgical prelim spots all over the country. Usually those are filled by less competitive IMGs.

 

[NotAProgDirector]

http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdf

Table 18 and 19, Page 46. All SOAP spots are listed, with outcomes.

Also, this has a bunch of SOAP data in it: http://www.ahme.org/wp-content/uploads/2016/05/T13_NRMP-Update_Signer_Thu_05-19-16_GRAND-SALON-F.pdf

 

[gutonc]

Are we really doing the SOAP thread before interview season even starts?

Bottom line, do whatever it takes to not be in SOAP. Apply broadly, add a backup specialty or 2, accept every invitation you get and rank them all.

 

[deleted804629]

Are we really doing the SOAP thread before interview season even starts?

Bottom line, do whatever it takes to not be in SOAP. Apply broadly, add a backup specialty or 2, accept every invitation you get and rank them all.

.

 

[DrBowtie]

I generally agree, and never really thought I would even be considering SOAPing, but the reality of my situation is that I am only going to rank 2-3 very competitive categorical programs and I am gathering information on various back-up plans.

....which begs the question of why that is the case so early in the season? Send out some back up specialty apps like yesterday.

 

[gutonc]

I generally agree, and never really thought I would even be considering SOAPing, but the reality of my situation is that I am only going to rank 2-3 very competitive categorical programs and I am gathering information on various back-up plans.

Then you are a complete idiot and deserve the pain you bring on yourself.

You either want to be a surgeon, or you don't. Sh** or get off the pot.

 

[ThoracicGuy]

I generally agree, and never really thought I would even be considering SOAPing, but the reality of my situation is that I am only going to rank 2-3 very competitive categorical programs and I am gathering information on various back-up plans.

So what happens when you don't match? SOAP into a spot that's still outside your geographic restrictions? If you SOAP, there's no reason to expect that you'll then match to one of your 2-3 very competitive programs. I think you need to be realistic about going through with the match. Yes, you mention having childcare issues, but there are residents out there now that don't have any family nearby with young children and they still manage. It won't necessarily be easy, but it all depends on how much you want to be a surgeon.

 

[deleted804629]

Then you are a complete idiot and deserve the pain you bring on yourself.

You either want to be a surgeon, or you don't. Sh** or get off the pot.

 

[deleted804629]

So what happens when you don't match? SOAP into a spot that's still outside your geographic restrictions? If you SOAP, there's no reason to expect that you'll then match to one of your 2-3 very competitive programs. I think you need to be realistic about going through with the match. Yes, you mention having childcare issues, but there are residents out there now that don't have any family nearby with young children and they still manage. It won't necessarily be easy, but it all depends on how much you want to be a surgeon.

 

[ThoracicGuy]

My significant other is locked into a region for residency too (one of the areas where I would be happy to match). Are there functionally single parents of infants in general surgery without any family support around and making it work? If so, I would actually love to hear from them. I'm a realist and not going to waste my time or a program's time by applying to and ranking them if I can't make it work.

To clarify somewhat: I don't expect to be able to match at those same short list of surgery programs nor any surgery program outside the match. I have other back-up plans in place too. My question was more to see what the categorical options were in the SOAP to explore that hypothetical back-up plan (for example, a rads, path, psych, or family residency somewhere random since those hours are less demanding than general surgery). I wasn't sure how a surgery candidate, even a fairly strong one, would fair applying to these other categorical programs without LORs or 4th year rotations in the specialties. Hence, my original post.

Having your SO locked in for residency makes this much tougher to do. Single parents of infants in general surgery? Probably has been done. I imagine has been a nightmare for them, though. There may be some places that offer free childcare onsite depending on the hospital. Maybe there's a way to look for that to add more places? If your SO can't move, then you'd otherwise either have to rely on a family member moving with you or hiring childcare (probably with family help) to be there for your child.

As for applying to other programs as a SOAP candidate, you wouldn't really need letters in those programs. They know you didn't match in what you were wanting, so they don't expect those letters. Path and Psych would likely have less hours overall, but don't be surprised that many places don't have close to 80 hours. Also, with the ACGME intern rules, that makes weekends much harder for you unless you get to a surgery program that is outside those restrictions.

I don't envy your situation.

 

[gutonc]

The solution to this issue (geographic limitation) is not to plan for the SOAP though. It's to apply across specialties that you'd be happy doing, in order to avoid the SOAP. Because in the SOAP, you're going to to have a much bigger problem staying in one place than you will in the Match.

 

[AdmiralChz]

The solution to this issue (geographic limitation) is not to plan for the SOAP though. It's to apply across specialties that you'd be happy doing, in order to avoid the SOAP. Because in the SOAP, you're going to to have a much bigger problem staying in one place than you will in the Match.

Couldn't agree more. If you are that concerned (confident?) that you won't match, SOAP is a huge risk since there is no way to guarantee open spots in any specialty in a given area - and even then, no way to guarantee you would or could match at remaining spots - SOAP is comprised of some very high-level competitive applicants who fell through Ortho/ENT/etc so it could be tough, especially if you already applied to them in the regular match.

You are in a tough spot, but clearly you are a little against the grain here since you are much more geographically limited rather than specialty interest - it could be really tough to convey your sincere interest in specialties outside of gen surg (never mind LORs or PS). If you are this concerned on your chances, I would suggest adding specialties with very low competitiveness with a mix of community-based programs - particularly in FM, Psych. Otherwise do everything you can to convey your interest to gen surg programs in the area.

 

[deleted804629]

Couldn't agree more. If you are that concerned (confident?) that you won't match, SOAP is a huge risk since there is no way to guarantee open spots in any specialty in a given area - and even then, no way to guarantee you would or could match at remaining spots - SOAP is comprised of some very high-level competitive applicants who fell through Ortho/ENT/etc so it could be tough, especially if you already applied to them in the regular match.

You are in a tough spot, but clearly you are a little against the grain here since you are much more geographically limited rather than specialty interest - it could be really tough to convey your sincere interest in specialties outside of gen surg (never mind LORs or PS). If you are this concerned on your chances, I would suggest adding specialties with very low competitiveness with a mix of community-based programs - particularly in FM, Psych. Otherwise do everything you can to convey your interest to gen surg programs in the ar

 

[IMPD]

I generally agree, and never really thought I would even be considering SOAPing, but the reality of my situation is that I am only going to rank 2-3 very competitive categorical programs and I am gathering information on various back-up plans.

I think about 100-200 AMGs take this approach every year for varied reasons.

#1. It's the BMW appraoach to the Match -"The Best or Nothing". They'd rather do a research year, or some such other filler experience and go back in the Match next year for their gold ring program if they don't get it the first time around. Usually (but not always) taken by overall above-average applicants who will undoubtedly match *somewhere* in *something*.

Downsides: No road map on how to do this. Possibly will end up at much worse program than if you interviewed and ranked some backups. Terrible uncertainty.

#2. They are over-estimating their competitiveness. They believe themselves to be in the "above" to "highly above" group and turn out not to be.

Downsides: Lack of insight makes them terrible advice-takers from people who could give them an honest appraisal.

#3. They don't really want to do medicine. This sort of high-risk maneuver is seen occasionally in people who are looking for a way out.

Downsides: None, really. Leaving medicine is painful and there is no graceful way to do this.

 

[NotAProgDirector]

So, from the details on this thread, it appears that you are in a relationship with a resident, have a very young child, and are interested in GS or one of the surgical specialties, and the question is how to proceed. The primary plan is to match in your desired specialty in your desired location. That goes without saying. The real question is what to do / how to plan if that doesn't happen. And I see several possibilities:

1. SOAP into whatever is geographically available. This gives you the appearance of some choice, but will require a relatively quick career altering decision.

2. Apply to a categorical residency program in another field in your geo location. If you do this, you'll need to contact the program directly and explain the situation. Your best chance of this working is at the same institution where your SO is. Explain the situation, and they are likely to consider interviewing you even though you're actually applying to another field.

3. Apply to Prelim GS in your geo location. These spots are usually easy to get, but still better to get in the match rather than in SOAP. It's a one year spot, allows you to apply again the next year in your desired field, perhaps starting at the PGY-2 level (depends upon field and a million other things). Perhaps your SO is done by then and the geo loc issue is resolved?

4. Apply to your desired field in other locations, and if you match there, your SO moves. This all depends upon his/her field. In IM, it's relatively easy to move at the PGY-2 or PGY-3 level if your performance is good, especially for a reason like this. In other fields, especially the surgical ones, not so much. But don't discount this option -- you would need to focus on locations with lots of programs.

 

[themockjock]

Ultimately, he made the bold decision to rank 'no match' (he was couples matching) and SOAP into whatever was available where his partner matched. He ultimately matched into IM.

Marriages come and go, but specialty choice is forever. Poor guy.