We apologize, but you have not qualified for any positions.
That statement alone can devastate someone who has dedicated more than ten years pursuing the aspiration of becoming a physician. However, what followed was a whirlwind of hasty choices, emotional fatigue, and the obligation to upheave my life—without clarity on whether this decision was right for me or my family.
I entered SOAP, the Supplemental Offer and Acceptance Program—marketed as a second opportunity, but in truth, it resembles a pressure cooker. Within hours, students without matches are expected to collect new letters of recommendation, create new personal statements, and apply to programs they haven’t visited in specialties they likely never contemplated.
In theory, SOAP provides options, but that option is a mirage. Offers arrive in timed rounds, and with no assurance of receiving another in the subsequent round, candidates are often recommended to accept whatever arrives first—regardless of fit. Yes, I was “fortunate” to receive numerous offers during SOAP. But what does “fortunate” even signify when you have just two hours to make a life-changing choice? There’s no time for second interviews or chances to converse with current residents. No opportunity to genuinely compare programs or specialties, or to evaluate what’s best for your future, your training, or your family.
And so, I said yes. Because I was afraid to say no.
What the NRMP fails to convey is that accepting that offer is unlike accepting any other job. It is a binding legal agreement. There is no time to reflect and no possibility to withdraw. If you have second thoughts? Too bad. If you are pregnant, caring for a newborn, mourning the loss of a loved one, or dealing with health issues? Still too bad.
There is a heavy burden in relocating your entire family for a trajectory you are not even sure belongs to you. After accepting the SOAP offer, we had to adapt rapidly. My husband began dismantling the business he had spent years developing. We searched for a new home—our third relocation in four years—and informed our daughter’s cherished daycare that she would not be returning. We needed to secure new prenatal care as I entered my third trimester, hire new childcare for our toddler, and establish a support system in our new and unfamiliar city.
We spent thousands in upfront rent, and thousands more moving across state lines. And perhaps the most challenging aspect is the uncertainty: I do not even know if I will enjoy this specialty or this program. But I am bound—because I had two hours. Because I was desperate. Because the system is set up to trap you in that desperation and label it “gratefulness.”
How is this acceptable?
Physician assistants and nurse practitioners can switch specialties with relative ease. If they try something and find it unsatisfactory, they can pivot. Explore. Rebuild. But we—the doctors who trained for over a decade and poured our lives into this profession—are constrained by a rigid, outdated system that allows no space for humanity.
No space for grief. No space for change. Just a click, a contract, and the immediate disintegration of the life we have labored so hard to construct.
There exists a process to apply for a waiver or deferral from the NRMP. On paper. But in practice? It is nearly unfeasible. I searched through forums, legal websites, and physician groups, yet I couldn’t uncover a single instance—not one—where someone successfully acquired a waiver for health issues, pregnancy, or family hardship. The pathway that exists is unclear and utterly inaccessible, leaving applicants confronting a future that feels like a vast unknown.
I know what some might say: “At least you matched.” But being pressured into a significant life decision under stress is not a privilege—it is a failure of the system. I want to emphasize: I am thankful to have a residency position. I love medicine. I have worked too hard and sacrificed too much not to. But gratitude does not negate injustice.
We urgently need reform.
– The NRMP must provide real time for applicants to assess all offers.
– Programs must conduct substantial interviews—not merely ten-minute introductions.
– The waiver and deferral process must be clear, accessible, and realistic for those facing major life transitions.
We are not mere data points to be sorted by an algorithm. We are mothers, fathers, partners, and caregivers. We have lives, families, and roots. Currently, SOAP does not reflect that reality. It demands hasty choices and penalizes vulnerability.
Medicine demands everything from us. And still, we give more.
But the system must meet us halfway.
Because right now, it is not just broken.
It is failing the physicians at the core of the profession.
*Nicolette V. S. Sewall is a resident physician.*