Just as an FYI for guys who unfortunately don't match in SOAP, my understanding is that there is a system for hiring residents outside of the match. There are off-cycle positions (most certainly in IM) that are not advertised. Bronx-Lebanon hospital ctr in NYC hires ~1 IM resident/month off-cycle. Due to being off-cycle, these guys can't apply for fellowships, but hospitalist gigs are very much open to them. These positions are usually taken up by IMGs, but there is no reason why a PD would not choose an AMG over an IMG for an off-cycle spot. I only know about Bronx-Lebanon and know someone there that was recruited off-cycle after not finding a position in the scramble two years ago, but I am sure that there are programs, esp in NYC, that have a considerable number of off-cycle positions. While some of these places are not ideal - training wise, they do give you the opportunity to to sit for boards at the end of the day. I don't really know how to find the positions (i.e. what is the off-cycle alternative to FREIDA), but If I were you, I would email a lot of PCs in large, community hospital programs right after the match and ask about off-cycle positions. Hope this helps a bit.