“We are sorry, you did not match to any position.”

That sentence alone is enough to crush someone who has spent over a decade chasing the dream of becoming a physician. But what came next was a blur of rushed decisions, emotional exhaustion, and the pressure to uproot my life—without knowing if the choice was right for me or my family.

I entered SOAP, the Supplemental Offer and Acceptance Program—advertised as a second chance, but in reality, it feels more like a pressure cooker. Within hours, unmatched students are expected to gather new letters of recommendation, draft new personal statements, and apply to programs they haven’t visited in specialties they likely never considered.

In theory, SOAP offers choice, but that choice is an illusion. Offers come in timed rounds, and because there is no guarantee you will receive another in the next round, applicants are often advised to accept whatever comes first—whether or not it is the right fit. Yes, I was “fortunate” to receive multiple offers during SOAP. But what does “fortunate” even mean when you have just two hours to make a life-altering decision? There is no time for second interviews or opportunities to speak with current residents. No ability to truly compare programs or specialties, or consider what is best for your future, your training, or your family.

And so, I said yes. Because I was terrified to say no.

What the NRMP does not tell you is that accepting that offer is not like accepting any other job. It is a binding legal contract. There is no time to process and no chance to back out. If you are having second thoughts? Too bad. If you are pregnant, caring for a newborn, grieving the loss of a loved one, or struggling with your health? Still too bad.

There is a quiet weight in relocating your entire family for a path you are not even sure is yours. After accepting the SOAP offer, we had to adapt quickly. My husband began dismantling the business he had spent years building. We searched for a new home—our third move in four years—and broke the news to our daughter’s beloved daycare that she would not be returning. We had to find new prenatal care as I entered my third trimester, hire new childcare for our toddler, and rebuild a support system in our new and unfamiliar city.

We paid thousands in upfront rent, and thousands more to move across state lines. And perhaps the most difficult part is the uncertainty: I do not even know if I will like this specialty or this program. But I am bound—because I had two hours. Because I was desperate. Because the system is designed to trap you in that desperation and call it “gratefulness.”

How is this OK?

Physician assistants and nurse practitioners can change specialties with relative ease. If they try something and realize it does not fit, they can pivot. Explore. Rebuild. But we—the doctors who trained for over a decade and have poured our lives into this field—are bound by a rigid, antiquated system that leaves no room for humanity.

No room for grief. No room for change. Just a click, a contract, and the immediate unraveling of the life we had worked so hard to build.

There is a process to request a waiver or deferral from the NRMP. On paper. But in practice? It is nearly impossible. I scoured forums, legal sites, and physician groups, yet I could not find a single case—not one—where someone successfully obtained a waiver for health issues, pregnancy, or family hardship. The pathway that exists is opaque and utterly inaccessible, leaving applicants facing a future that feels like a question mark.

I know what some will say: “At least you matched.” But being coerced into a major life decision under duress is not a privilege—it is a failure of the system. I want to be clear: I am grateful to have a residency spot. I love medicine. I have worked too hard and sacrificed too much not to. But gratitude does not erase injustice.

We desperately need reform.

• The NRMP must build in real time for applicants to evaluate all offers.
• Programs must offer meaningful interviews—not just ten-minute introductions.
• The waiver and deferral process must be transparent, accessible, and realistic for those facing major life changes.

We are not just data points to be sorted by an algorithm. We are mothers, fathers, partners, and caregivers. We have lives, families, and roots. Right now, SOAP does not reflect that reality. It demands rushed decisions and punishes vulnerability.

Medicine asks everything of us. And still, we give more.

But the system has to meet us halfway.

Because right now, it is not just broken.

It is failing the physicians at the heart of the profession.

Nicolette V. S. Sewall is a resident physician.