SOAP 2022

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Good luck to everyone on Monday! But just in case, we're starting this thread now for anyone who does find themselves going through the SOAP process. Hopefully we can all support each other through this stressful time.

If anyone who has gone through this process in the past (or helped someone go through this process) and has some tips, please feel free to share!

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What are the implications for categorical IM applicants who enter SOAP and apply for prelim IM positions? Is applying to prelim IM an option?
 
What are the implications for categorical IM applicants who enter SOAP and apply for prelim IM positions? Is applying to prelim IM an option?
There are historically relatively few prelim medicine positions (compared to surg pre-lims).
I have observed that PD's have a preference for those who have matched into an advanced position (e.g. Neuro, Anesthesia...) as opposed to the entirely unmatched. This may be because those with advanced positions don't need to re-apply during their intern year and the program need not fear that the intern will subsequently go unmatched (thus causing increased surveillance from their accreditation body).
 
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Good luck to everyone on Monday! But just in case, we're starting this thread now for anyone who does find themselves going through the SOAP process. Hopefully we can all support each other through this stressful time.

If anyone who has gone through this process in the past (or helped someone go through this process) and has some tips, please feel free to share!
Nooo you beat me to opening it for this year
 
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I SOAPED last year into a TY matched this year applied to 3 different specialties all PGY-1 positions as my goal was to not move. If you need support or advice here to help. I still have PTSD from it but I got through it.
 
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when was the first time people received interview/contact on soap? I believe programs are able to see our applications 8am on Tuesday(today).
 
someone has been received phone interviews. I am still waiting...
 
lol. nothing for me either! it is depressing. More depressing is there is not a lot of traffic or supports here either.
 
There wasn't a ton of traffic here last year either, but if you go to some of the earlier year threads it really seemed like interviews went all the way into the evening on Tuesday. So I would not give up hope at this point!
 
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I am guessing sdn traffic got eaten by reddit and the such and all that’s left are old timers.
 
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Yeah, I think more people have moved to reddit to discuss SOAP. In any case, I'm a failed 2014 SOAper and successful 2015 Matcher, and I'm here for anyone who needs advice or support.
 
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I was an anesthesiology resident and used up 3 year of funding. Now I want to apply for IM, I got a preliminary interview with a chief resident in an IM program and was told that it could be an issue for me regardless where I apply to. Is there a way to get around it??
 
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Happy to read essays! I am a pretty decent writer and editor. You can send them to my inbox. I won't guarantee that I'll get through all of them so sorry if I don't respond to all the requests. It's safe to assume that if I reply, I'll follow through and give you a few edits/suggestions so you're not left in the dark waiting for the deadline. Lastly, just to be transparent, I will say this time around I am being a bit choosy with demographics. I prefer helping US medical students (MDs/DOs, don't care) and foreign IMGs as opposed to Caribbean students.
 
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I am guessing sdn traffic got eaten by reddit and the such and all that’s left are old timers.
Myself included. Reddit was the best way to do this last year and I already signed up under a burner account there. Also, of note, for those who choose to take on this task, note that you may mostly be contacted by Caribbean IMGs who applied surgery/psych and now are "settling" for FM.
 
There are historically relatively few prelim medicine positions.
I have observed that PD's have a preference for those who have matched into an advanced position (e.g. Neuro, Anesthesia...) as opposed to the entirely unmatched. This may be because those with advanced positions don't need to re-apply during their intern year and the program need not fear that the intern will subsequently go unmatched (thus causing increased surveillance from their accreditation body).

I don't know the numbers or have historical perspective as an admin, but I think some schools with residencies who do offer prelim medicine without an advanced spot try to reserve the spots for their own students especially those who did not match something else to:

1.) Improve match rate.
2.) Known students, known quantities and personal connections play a part. Vice versa for students as they know the system and culture and it's a win-win and usually a safe match. If they were applying something competitive, that tends to correlate with more honors/higher step scores and while personality is a huge factor, more often than not their skills will translate well to IM.
3.) Know some of those students will convert to categorical medicine and they'd be happy to have them at a place with current IMG>>AMG where any US MD (albeit decent person) on the match list is a plus.
 
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I don't know the numbers or have historically perspective as an admin, but I think some schools who do offer prelim medicine without an advanced spot try to reserve the spots for their own students those who did not match something else to.

1.) Improve match rate.
2.) Known students, known quantities and personal connections play a part.
3.) Know some of those students will convert to categorical medicine and they'd be happy to have them at a place with current IMG>>AMG where any US MD on the match list is a plus.
Sadly, SOAPers have no way of knowing which spots have been reserved for (potential) internal candidates.
For this reason, the number of spots is inflated and participants waste precious resources (of their 45 picks).
 
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I SOAPED last year into a TY matched this year applied to 3 different specialties all PGY-1 positions as my goal was to not move. If you need support or advice here to help. I still have PTSD from it but I got through it.
Hi, I am interested in DR. I have applied this cycle as a DO student and landed 22 TY and 16 DR interviews and ranked all of them. Despite the confidence in my numbers, I went completely unmatched. (And yes I can relate to your PTSD because of it). Currently I am SOAPing and I was just wondering how you made it thru the 2nd time around. How did you improve your application? what is your work on? Anything you say can help and thank you in advance.
 
this is a re-post: hoping someone would answer my question.

I was an anesthesiology resident and used up 3 year of funding. Now I want to apply for IM, I got a preliminary interview with a chief resident in an IM program and was told that it could be an issue for me regardless where I apply to. Is there a way to get around it?
 
I was an anesthesiology resident and used up 3 year of funding. Now I want to apply for IM, I got a preliminary interview with a chief resident in an IM program and was told that it could be an issue for me regardless where I apply to. Is there a way to get around it??
Not exactly, but it may not matter at some programs.

If you trained in Anesthesia, your Initial Residency Period (IRP) is 4 years, as anesthesia has a PGY-1 (either a prelim or a CBY) followed by 3 years of core anesthesia training. So you get 4 full years of funding. Since you completed 3 years, you have one year left (this assumes that you're counting your PGY-1 in your statement "I used 3 years of funding").

Since IM is 3 years, you'll be short by 2 years of funding. However, this isn't as bad as it seems. Institutions are paid by Medicare for training residents. They get two different payments - DME (Direct) and IME (Indirect). Once any resident gets beyond their IRP, the institution gets 50% of the DME and 100% of the IME. The details are complicated, but in many institutions the IME is much bigger than the DME. Hence, "reduced" funding is often 80-85% of full funding. All fellowships are reimbursed at this lower rate -- so any program with fellows is already dealing with this.
In addition, all programs are capped at the maximum number of residents they get reimbursed for. Many programs are over this "cap", having decided that training more residents was a good decision anyway. In that case, any place that is over their cap isn't going to get paid anything for some number of their residents, and they could just put you in that group and then there would be no financial impact to them at all.

In summary, this can be a problem at smaller programs that are highly dependent on their CMS funding. Many larger programs will simply not care, it may make no difference at all or be a rounding error in their budgets. Last, all of this CMS money doesn't go to programs at all -- it goes to the institution. So in the end it makes little difference to a PD.

If you want to read all about GME funding, read the report here: Medicare’ Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know
 
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Not exactly, but it may not matter at some programs.

If you trained in Anesthesia, your Initial Residency Period (IRP) is 4 years, as anesthesia has a PGY-1 (either a prelim or a CBY) followed by 3 years of core anesthesia training. So you get 4 full years of funding. Since you completed 3 years, you have one year left (this assumes that you're counting your PGY-1 in your statement "I used 3 years of funding").

Since IM is 3 years, you'll be short by 2 years of funding. However, this isn't as bad as it seems. Institutions are paid by Medicare for training residents. They get two different payments - DME (Direct) and IME (Indirect). Once any resident gets beyond their IRP, the institution gets 50% of the DME and 100% of the IME. The details are complicated, but in many institutions the IME is much bigger than the DME. Hence, "reduced" funding is often 80-85% of full funding. All fellowships are reimbursed at this lower rate -- so any program with fellows is already dealing with this.
In addition, all programs are capped at the maximum number of residents they get reimbursed for. Many programs are over this "cap", having decided that training more residents was a good decision anyway. In that case, any place that is over their cap isn't going to get paid anything for some number of their residents, and they could just put you in that group and then there would be no financial impact to them at all.

In summary, this can be a problem at smaller programs that are highly dependent on their CMS funding. Many larger programs will simply not care, it may make no difference at all or be a rounding error in their budgets. Last, all of this CMS money doesn't go to programs at all -- it goes to the institution. So in the end it makes little difference to a PD.

If you want to read all about GME funding, read the report here: Medicare’ Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know
I am really appreciative of your input. I felt so distraught when I did not get any interviews during the soap. Now I know if I re-apply next year with better LORs and research experience, I could still have a good chance to match. Would you say if I applied to university programs, I would have a better chance to get interviews for next year?
 
Good luck to everyone on Monday! But just in case, we're starting this thread now for anyone who does find themselves going through the SOAP process. Hopefully we can all support each other through this stressful time.

If anyone who has gone through this process in the past (or helped someone go through this process) and has some tips, please feel free to share!
HI have partially matched which is great. I have completed a preliminary year before. I wrote to the ACGME who said i did not have to repeat my preliminary year but on the nrmp it says I am SOAP eligible for preliminary/transitional programs. I am confused do I apply for the preliminary programs? I do not want to lose my advanced training program.
 
HI have partially matched which is great. I have completed a preliminary year before. I wrote to the ACGME who said i did not have to repeat my preliminary year but on the nrmp it says I am SOAP eligible for preliminary/transitional programs. I am confused do I apply for the preliminary programs? I do not want to lose my advanced training program.
It is completely your choice. If you have already completed a prelim year that satisfies your advanced year, then you can either try to get another prelim year, or you can just work for a year doing anything you want. Or, you can sit on a beach for a year. You won't lose your advanced spot.

Be certain your prior prelim year meets necessary criteria. Neuro needs an IM prelim year. GS prelims usually won't be accepted, and TY's it depends upon how much IM time was in it. Derm and Rads are much more flexible.
 
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It is completely your choice. If you have already completed a prelim year that satisfies your advanced year, then you can either try to get another prelim year, or you can just work for a year doing anything you want. Or, you can sit on a beach for a year. You won't lose your advanced spot.

Be certain your prior prelim year meets necessary criteria. Neuro needs an IM prelim year. GS prelims usually won't be accepted, and TY's it depends upon how much IM time was in it. Derm and Rads are much more flexible.
I wrote to radiation oncology ACGME and they said i didnt have to repeat. I did a IM prelim year. But then nrmp said i am soap eligible for prelim years. I didn't get that, does the nrmp know that you have already done a prelim year?
 
I am really appreciative of your input. I felt so distraught when I did not get any interviews during the soap. Now I know if I re-apply next year with better LORs and research experience, I could still have a good chance to match. Would you say if I applied to university programs, I would have a better chance to get interviews for next year?
In general, bigger programs will have less reliance on CMS funding, especially programs with lots of fellowships. These are often (but not always) university based programs.

But, much depends upon why you left your anesthesia spot. If you had performance problems, it's going to be much more difficult to get univ based programs to consider your application.

Also, I forgot to mention that the other class of programs that probably won't consider you are new programs -- programs that are just starting need to build up their resident classes. At some point after starting, the number of CMS FTE's in the program becomes their cap -- which then becomes very difficult to change. If you have less than full funding and you're in the program when that happens, they will be "locked out" of your funding forever.
 
I wrote to radiation oncology ACGME and they said i didnt have to repeat. I did a IM prelim year. But then nrmp said i am soap eligible for prelim years. I didn't get that, does the nrmp know that you have already done a prelim year?
It's actually the ABR that decides if your prelim year counts, not the ACGME. Regardless, an IM prelim is fine for Rad Onc so no issues there.

The NRMP doesn't know if you completed a prelim year. They know if you matched to one last year (which if you got a spot after the match, they wouldn't know at all). For all they know, you dropped out. In any case, the NRMP is just telling you that you can apply for prelims if you want. It's now up to you whether you want to complete another prelim year (which would use another year of your funding, but there's nothing your advanced program could do about that) or take a gap year.
 
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I might talk to my program director regarding this -the only problem is SOAP is going on so I am not sure if I am allowed to talk to my PD. I have an idea which program it is as i only interviewed at one program in that particular city.
this is the person from acgme i wrote to who checked for me- who said no need.

Senior Accreditation Administrator for Anesthesiology, Radiation Oncology, and Transitional Year.- at the ACGME

Also I had previously done a neuro residency but left and didn't finish the program as i wanted to pursue another area. SO how many years of funding are we given









 
Reddit was the best way to do this last year and I already signed up under a burner account there.
Out of curiosity, could you explain this? I am firmly in "old fogie" land at this point, but to me I've felt that when Reddit gets super busy the threads become almost impossible to follow because a new post gets stuck at the bottom of a thread without any upvotes... but maybe I'm doing it wrong :shrug:
 
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I might talk to my program director regarding this -the only problem is SOAP is going on so I am not sure if I am allowed to talk to my PD. I have an idea which program it is as i only interviewed at one program in that particular city.
this is the person from acgme i wrote to who checked for me- who said no need.

Senior Accreditation Administrator for Anesthesiology, Radiation Oncology, and Transitional Year.- at the ACGME
You're (understandably) overthinking this. If you completed an ACGME approved PGY1 year in IM, GS or a TY (and probably Peds or OB/Gyn), then you're fine from the perspective of an advanced Rad Onc position. NRMP is telling your that you're SOAP eligible simply because all it knows is that you matched advanced and not prelim THIS YEAR.
Also I had previously done a neuro residency but left and didn't finish the program as i wanted to pursue another area. SO how many years of funding are we given
The technically precise answer is "the total length of your originally matched residency training program". Which for neurology is 4 years.

The more relevant answer is that it doesn't matter now. You're matched and that program is stuck with you now.

@NotAProgDirector summarizes the funding story beautifully right up here (for what must be the 57,000th time on SDN...I don't know how he has the patience) if you want to read more.
 
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I was not promoted from pgy2 to pgy3 in IM. Now I figured they have used my 2 years of funding. Could you help me assess if its possible to continue IM, or starting FM or transfer to pgy2 FM in terms of financial limitation due to funding? Thank you!
 
In general, bigger programs will have less reliance on CMS funding, especially programs with lots of fellowships. These are often (but not always) university based programs.

But, much depends upon why you left your anesthesia spot. If you had performance problems, it's going to be much more difficult to get univ based programs to consider your application.

Also, I forgot to mention that the other class of programs that probably won't consider you are new programs -- programs that are just starting need to build up their resident classes. At some point after starting, the number of CMS FTE's in the program becomes their cap -- which then becomes very difficult to change. If you have less than full funding and you're in the program when that happens, they will be "locked out" of your funding forever.
Thank you so much!
 
I was not promoted from pgy2 to pgy3 in IM. Now I figured they have used my 2 years of funding. Could you help me assess if its possible to continue IM, or starting FM or transfer to pgy2 FM in terms of financial limitation due to funding? Thank you!
You are correct you have used two years of funding. You have one year of full funding left, and then unlimited years of partial funding.

It may be possible to continue in IM or switch to FM. You were not promoted, so there must have been performance issues. Whether or not you can find a program willing to consider you with those performance issues is unknown. IM programs may consider you but probably only for a PGY-2 spot -- if your prior program felt you were unready to promote to a PGY-3 I doubt a new program will give you a PGY-3 spot. And if your prior program terminated you it suggests they didn't think that more time would fix the issue. So, at best, you'd need an IM PGY-2 position or an FM PGY-1 position (I am unsure whether FM would consider you for PGY-2).

The funding issue is likely the smaller of the problems. You only have one year of full funding left, so anything beyond that (which will be 1-2 years at a minimum) will have reduced funding. As above, some programs will care and some will not. In general, bigger programs will often care less -- but with your problematic history you may be looking at smaller community programs.

Bottom line is that there is no way to be certain, and all you can do is apply and see what happens. There isn't anything you can do to change the funding issue. You can't volunteer to take a lower salary, etc.
 
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Out of curiosity, could you explain this? I am firmly in "old fogie" land at this point, but to me I've felt that when Reddit gets super busy the threads become almost impossible to follow because a new post gets stuck at the bottom of a thread without any upvotes... but maybe I'm doing it wrong :shrug:
You need to change the sort order. Most reddit threads are sorted by "Best" or "Top" by default (so the most-upvoted posts appear at the top of the page, immediately below the original post).

A thread about a current event (like an ongoing football game, or SOAP) should be sorted by "New." If you sort by "New", you will see the newest posts and their replies at the top of the page, immediately under the OP.

This link will take you to the current SOAP thread over there. I've changed the URL to force it to display the old reddit style (which is, imho, more readable) and to force the sort order to "New."
 
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Out of curiosity, could you explain this? I am firmly in "old fogie" land at this point, but to me I've felt that when Reddit gets super busy the threads become almost impossible to follow because a new post gets stuck at the bottom of a thread without any upvotes... but maybe I'm doing it wrong :shrug:
There’s a list of people listed by Reddit username who help with essay editing and advice for soap stuff. I’ve been in tough places before and I’m ok/good at editing so the thread’s pretty rewarding for me. You can specify field you’re in and stuff like that so people can message you directly based off things in common. I think people who soap’ed likely get great satisfaction out of doing this.
 
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You are correct you have used two years of funding. You have one year of full funding left, and then unlimited years of partial funding.

It may be possible to continue in IM or switch to FM. You were not promoted, so there must have been performance issues. Whether or not you can find a program willing to consider you with those performance issues is unknown. IM programs may consider you but probably only for a PGY-2 spot -- if your prior program felt you were unready to promote to a PGY-3 I doubt a new program will give you a PGY-3 spot. And if your prior program terminated you it suggests they didn't think that more time would fix the issue. So, at best, you'd need an IM PGY-2 position or an FM PGY-1 position (I am unsure whether FM would consider you for PGY-2).

The funding issue is likely the smaller of the problems. You only have one year of full funding left, so anything beyond that (which will be 1-2 years at a minimum) will have reduced funding. As above, some programs will care and some will not. In general, bigger programs will often care less -- but with your problematic history you may be looking at smaller community programs.

Bottom line is that there is no way to be certain, and all you can do is apply and see what happens. There isn't anything you can do to change the funding issue. You can't volunteer to take a lower salary, etc.
This exactly OP. Think about what you want to do. Regarding IM, you won’t find a PGY-3 because you wouldn’t be given PGY-2 credit while simultaneously not being able to progress to PGY-3. Honestly finding a PGY-2 start will be difficult too but you are considering this at an opportune time, but if worst comes to worst and your heart is set on IM, you may want to consider just doing ERAS over and looking for PGY-1 in IM, FM, or even something different altogether etc. I know it’s hard. I honestly think the part that hits home the most here is that you have to ultimately apply and see what happens and not to listen to others speculate about what your chances are (including my thoughts above) because at the end of the day, the sample size for this sort of this is super small and each one of these cases is unique. Wishing you the best and PM if you want more specific advice to your situation. Also, echo what APD says above that funding is not so much of the concern as much as is what you’re going to tell programs to convince them to give them to give you another shot.
 
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You are correct you have used two years of funding. You have one year of full funding left, and then unlimited years of partial funding.

It may be possible to continue in IM or switch to FM. You were not promoted, so there must have been performance issues. Whether or not you can find a program willing to consider you with those performance issues is unknown. IM programs may consider you but probably only for a PGY-2 spot -- if your prior program felt you were unready to promote to a PGY-3 I doubt a new program will give you a PGY-3 spot. And if your prior program terminated you it suggests they didn't think that more time would fix the issue. So, at best, you'd need an IM PGY-2 position or an FM PGY-1 position (I am unsure whether FM would consider you for PGY-2).

The funding issue is likely the smaller of the problems. You only have one year of full funding left, so anything beyond that (which will be 1-2 years at a minimum) will have reduced funding. As above, some programs will care and some will not. In general, bigger programs will often care less -- but with your problematic history you may be looking at smaller community programs.

Bottom line is that there is no way to be certain, and all you can do is apply and see what happens. There isn't anything you can do to change the funding issue. You can't volunteer to take a lower salary, etc.
Yea I get it now. Thanks for the thorough reply. Now I can at least continue the potential conversation if it goes in that direction. I guess it was foolish to think people would even consider interviewing me. I honestly thought the subjective aspects of evaluating performance would give me a chance to advocate for myself. Not that it matters, but the initial plan was for me to repeat pgy2, and a few days after I was brought in again now with GME present stating otherwise.

What really gets me is that they continued to let me run my service as the pgy3 senior resident, admitter duties, long call, night call etc, while knowing that they had already made the decision the month prior. If my performance is that bad to the extent I was not promoted, then why was I allowed to continue to run my hospitalist service, supervise interns, med students, reverse denied claims via peer-to-peer calls, and so on stating patient safety or something to that nature. It's just a tough pill to swallow. To this day I am still being asked by my former coworkers what happened. Apologize for the rant, I'll try to get some shut-eye, thanks again for your feedback, it is surprisingly difficult to get any clear information in these unique situations.
 
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This exactly OP. Think about what you want to do. Regarding IM, you won’t find a PGY-3 because you wouldn’t be given PGY-2 credit while simultaneously not being able to progress to PGY-3. Honestly finding a PGY-2 start will be difficult too but you are considering this at an opportune time, but if worst comes to worst and your heart is set on IM, you may want to consider just doing ERAS over and looking for PGY-1 in IM, FM, or even something different altogether etc. I know it’s hard. I honestly think the part that hits home the most here is that you have to ultimately apply and see what happens and not to listen to others speculate about what your chances are (including my thoughts above) because at the end of the day, the sample size for this sort of this is super small and each one of these cases is unique. Wishing you the best and PM if you want more specific advice to your situation. Also, echo what APD says above that funding is not so much of the concern as much as is what you’re going to tell programs to convince you to give them to give you another shot.
Thanks for the honest response. I likely will take you up on that offer and DM for specific questions. I was able to participate in soap. It would be appropriate to say the silence was deafening. It is really tough to think about everything I did and sacrificed for this to be the end result. Ultimately what really hurts is that I needed someone to stick out their neck for me and no one was willing to do so. I thought the relationships I formed, my innate ability in raising HCAHPS scores, and being an all-around good-natured human being would have given me the benefit of the doubt.
 
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Hi guys! I usually post around SOAP week to remind everyone it is still possible to match!

Anyone who didn't match, do not be discouraged! My husband did not match last year, and also did not find a program in SOAP. But he fortunately found a program 2 week after match. There are still a lot of positions and programs that will open up over the next few months before June. Be positive and don't give up! You have to be diligent and keep an active look out for programs. He would check eras EVERY SINGLE DAY for new programs that showed up and also signed up for and would check freida, needaresident.com, residencyswap and whatever else he could find. He eventually found an FM position that worked out and started in June just like he wanted. DO NOT GIVE UP! You made it this far, keep pushing forward.
 
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Hello,

I have a friend who must SOAP for fellowship. Is it similar to residency SOAP and if so what exactly must he do? Documents? Any help would be appreciated!
 
There is no SOAP for fellowships. All results are released simultaneously to applicants and programs. They would contact programs directly to inquire about open positions.

What field is this? I assume we are talking about IM fellowships.
 
There is no SOAP for fellowships. All results are released simultaneously to applicants and programs. They would contact programs directly to inquire about open positions.

What field is this? I assume we are talking about IM fellowships.
Anesthesia - pain management
 
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