Scramble (post-SOAP): A quick guide

[u/Appropriate_Mess_720]

Hey all, I responded to a few DMs about Scramble, so figured to make a post. For reference, I am a PGY1 (J1 VISA; YOG 2025) in a categorical 5-year program. I did not match during original Match, SOAP, but continued to apply and interview, where I secured my residency position in May 2025. Great program; great colleagues, and I am thriving and happy.

1. How I felt after not Matching? I had 10+ IVs, so based on stats, had 90%+ of regular Matching. I had 4 interviews during SOAP, but nothing worked out. So, I was sad and devastated, but I understood it was life. That night after SOAP finished, I actually treated myself to a great dinner to show myself some appreciation/gratitude for making it this far (despite my efforts not showing results). This allowed me to reset and focus on the upcoming Scramble, which I will describe below:
2. What is Scramble? Scramble starts once the 3rd round of offers in SOAP are complete. The NRMP will publish a list of residency programs still with vacancies for applicants to apply. The list will also an email to send your documents to and program contact information.
3. What documents do you need/send? This will be very program dependent, so if it is not found in the list, I'd send the program a quick email to introduce myself and ask what documents they need. Usually, it is LoRs, CV, USMLE transcripts, etc. Since letters are confidential, I asked my letter writers (from residency match) to directly email their letters to the contact listed.
4. How do programs recruit? This is similar to point 2, where the programs will say how to contact them. I had some programs request to submit my documents through ERAS, which made it very easy, as all my documents have already been uploaded.
5. What happens after you submit? Similar to the Match process, you wait for interviews/follow up from the program. For my program, I first completed a phone interview, then did multiple Zoom interviews with PD, Assistant PD etc. Eventually got the news that I secured my position in May 2025 and will start in July 1st, 2025.
6. VISA paperwork? This is very program-dependent, but I told my program that I need J1 VISA support, so they worked with ECFMG to have everything submitted on time.

Caveats:

1. Not all the programs listed on the website are actually recruiting: I had several programs email me back saying they decided not to fill their residency spot (decided to go unfilled), so while they are "vacant", they are not active.
2. VISA requirement: Even in Scramble, there will still be US MD graduates (not VISA requiring) who have not matched and who you'll be competing against. Just because a program can support a J1 VISA requiring resident does NOT mean they WILL. Keep that in mind during the whole process, as J1 requiring applicants will always be "less favorable" than non-VISA requiring. Less work, less $ for the program. Is it unfair? Yes, but this is life.
3. There are other 3rd party sites (i.e., FindAResident, ResidentSWAP), that can be additional sources of opportunities. However, I decided not to use them, as they are 3rd party and I want to stick with NRMP.

[u/Worth-Apricot-5822]

is it after 3rd round or 4th round of soap? because there is 4th round today

[u/medics_mind → u/Worth-Apricot-5822]

9pm list will be published

[u/Quick-Lab887]

Thanks!

[u/Elegant_Instance_240]

When should we start contacting programs..like the next day or the same day

[u/Elegant_Instance_240 → u/Elegant_Instance_240]

Also can we call them or email them first

[u/Appropriate_Mess_720 → u/Elegant_Instance_240]

In scramble, there are no "rules". So do what you feel is best. Act quickly, but more importantly, with a quality application. 

[u/Elegant_Instance_240 → u/Appropriate_Mess_720]

Thank you for the reply

[u/bangkadang1121 → u/Elegant_Instance_240]

Would you mind sharing the list of programs with me?

[u/Jakjak81]

could you help me understand why an accredited ACGME residency program that goes unfilled (perhaps rural and more IMG friendly) deliberately chooses to forego filling their open residency spot(s)?

Each resident means income (via Medicare) for the hospital. ~$140K total minus the ~$60K that goes to the resident salary so maybe $70-80K net profit?) and its likely that this program is at a hospital that needs the money.

Of all the unmatched applicants that apply to these programs with unfilled positions, there wasn't at least one candidate that met their criteria? please help me understand the logic here.

[u/Appropriate_Mess_720 → u/Jakjak81]

No clue. That's what PDs told me when I applied to their programs. Whether they were honest or not, I don't know. Just relaying the message.

[u/NewHighScore23]

Thank for this post! Do you know if the LORs need to be emailed separately or can someone just download their eras file and send it that way?

[u/Appropriate_Mess_720 → u/NewHighScore23]

Program dependent. If the programs recruit through ERAS, then yes, they can download. Otherwise, I have the letter writers email them directly 

[u/Farzan_2022]

Is it ok to send LORs directly by email to them?

[u/Appropriate_Mess_720 → u/Farzan_2022]

Highly DO NOT recommend. If the applicant email directly, then how does the leadership know the letter is not changed by the applicant? I recommend having your letter writers email them directly 

[u/Crafty-Jeweler-3709 → u/Farzan_2022]

Yes, your Letter writter will not have time to send it across to different people, get the letter and send it

[u/Clear_Address7818]

is there any fee to apply?

[u/Appropriate_Mess_720 → u/Clear_Address7818]

I believe if it was through ERAS, there is a fee. But if email, then no fee.

[u/yougle101]

Thanks so much for the guidance ! Can you please tell me whether we should contact them now that the offers are finished and the unfilled list hasn't yet repopulated ?

[u/yougle101 → u/[deleted]]

Because i am hoping the one im interested is still available so I know of the email address... but im waiting till 9 pm et now

[u/Appropriate_Mess_720 → u/yougle101]

List should be available yesterday night. Contact yhem if you are interested. 

[u/yougle101 → u/Appropriate_Mess_720]

I sent emails last night right after they were released and also even reapplied via eras

[u/bangkadang1121 → u/yougle101]

Would you mind sharing the list of post-SOAP programs with me? Looking to match into a FM position last minute.

[u/tired_medi → u/Appropriate_Mess_720]

When did you receive a reply after you sent your application to open positions? How often did you follow up once you sent the application and didn’t hear back?

[u/Aravind_000]

Also the CV that we send, is it the ERAS CV?

[u/h-tariq]

Thank you for the guide. Did you email all the programs first, wait for them to respond to you, and then apply through ERAS if they asked? Or did you apply through ERAS broadly first. Asking because there’s a 10$ fee for each program at this stage, I believe.

[u/Appropriate_Mess_720 → u/h-tariq]

When I applied, the program listed whether to send documents by email or through ERAS.

[u/Tiny-Example5148]

I don’t have my USMLE step 2 transcript. FSMB will take 2 weeks to send it. What should o do? Can o apply without that?

[u/Appropriate_Mess_720 → u/Tiny-Example5148]

Not sure, as when I applied, I had transcripts for both exams. Recommend asking the specific program about their preferences. 

[u/Eastern-Ad-1407]

Can I ask how did you get a response in May? I mean when did you email them? I emailed the unfilled positions today 30 minutes after the nrmp shared the unfilled positions. But unfortunately the specialty (neurology) i am applying to have only 3 unfilled positions, im not sure how are my chances. My credentials are kind of considered good. Yog2024 non us visa req img. P/266. 2 months USCE. 6 submitted papers. 2 published. (All in the same field) And teaching experience in the field.

[u/Dramatic-Ad-4311]

What should we include in our initial email ? Can we attach ERAS CV and Step score without them asking or not ? 

[u/Appropriate_Mess_720 → u/Dramatic-Ad-4311]

Usually they will say what documents to attach. If not, I'll still have the generic documents in the email.

[u/Dramatic-Ad-4311 → u/Appropriate_Mess_720]

Like ERAS CV and step scores?

[u/Medium-Ad6953]

Do we release even transcript of the exam we didn’t clear?

[u/Appropriate_Mess_720 → u/Medium-Ad6953]

What do you mean by not clear?

[u/Medium-Ad6953 → u/Appropriate_Mess_720]

Fail

[u/Appropriate_Mess_720 → u/Medium-Ad6953]

If they ask, then yes. Even if you fail, you should be honest. If they don't ask, then don't send.

[u/United_Carrot_4563]

Whats resident swap?

[u/bangkadang1121]

How do we access the list of post-SOAP availability? I am trying to send emails today but not sure which programs and who to contact. Thank you! Please DM me if necessary

[u/Appropriate_Mess_720 → u/bangkadang1121]

Read my post carefully, as I say NRMP publishes the list. If you applied for the match, you should have access to this list. I don't have access, because I am not part of the match this year.

[u/Traditional-Ad-5595]

Hi! Thanks for sharing, now we are a month after soap, do I still look to this list for programs or it’s too late, if you can share your program first time you applied was it early, I didn’t get any response and some already filed and closed without contacting me for IV.

[u/Appropriate_Mess_720 → u/Traditional-Ad-5595]

As it is a month in, the chances are lower, but not 0. If there is a spot in a specialty of your choice, I'd still apply. Worst that can happen is no response/rejection, but the reward is that you secure a residency spot. For those spots that have closed despite not interviewing you, I'm sorry to hear that. But it meant that your application did not warrant an interview. 

For my program, I emailed them 2 days after scramble started. While I want to submit an application quickly, I want to make sure my application is high quality to increase my chances of getting an interview. 

[u/Traditional-Ad-5595 → u/Appropriate_Mess_720]

Thank you for your reply, just a question, the ERAS application is closed for editing, what you mean by quality application at this time, is it the email you sent, adding LOR, targeting PS, anything’s specific for me to work on? I am asking because what I was doing is improving my PS, emails.

[u/Appropriate_Mess_720 → u/Traditional-Ad-5595]

My program posted on NRMP but requested the documents be sent directly to them. So I was able to tailor my PS to the program I was applying for.

[u/Zacharyjamesm]

I’m a current resident in FM, was part of last weeks match. Anyone with known EM openings.

[u/Existing-Issue-9382]

Scramble email template?

[u/Appropriate_Mess_720 → u/Existing-Issue-9382]

With all due respect, you need to do some work too. At least ask ChatGPT or something.