Hi Everyone,
When I was a PGY3 applying to fellowship, I got a cold call from a PD, asking where I planned to rank his program. I was rounding at the VA that day and caught off guard. His program was my third choice, and I blubbered something about how happy I’d be to train with them and hung up as soon as I could.
Decades later, these uncomfortable discussions still happen. Many applicants believe, or are led to believe, that they must write “first choice letters” to match at their favorite program. But why should letters matter? Shouldn’t programs just rank candidates based on clinical performance, letters of recommendation, and academic potential? Would a program seeking the best fellows really penalize applicants because they didn’t commit?
Commitment letters warp the Match. Trainees have asked me if they should send a “first choice” letter to their second choice program because they thought their true first choice was out of reach. Even worse, some trainees say programs have told them—explicitly or implicitly—that they need to reveal their preferences to have a realistic chance of matching, which leads applicants to worry that if they don’t get their first choice, they won’t match at all. Though going unmatched is extremely unlikely, the fear is real.
NRMP rules are clear: Programs are not allowed to ask candidates to reveal their preferences. When programs break this rule, you have to ask what other rules they’re breaking. Regardless, the intent is clear: programs are pushing candidates to commit, even if they’d prefer to go elsewhere.
Our residency follows the rules: we tell all applicants that we do not consider letters of intent when creating our lists. Some candidates still tell us, but their letters don’t influence our decisions.
Some of you may choose to write letters anyway, and the truth is the NRMP permits you to share your interest voluntarily, but not “for the purposes of influencing or ascertaining program’s ranking intentions.” If you’re thinking of writing a letter, here’s my advice:
- If a program tells you not to reveal your intentions, believe them. They are following the rules, which is good.
- If you choose to tell a program you’re ranking them “first” or “number one,” consider this a solemn commitment. Programs won’t forget what you told them, particularly if they rank you to match and you go somewhere else.
- Avoid sketchy language. Don’t tell programs you’re ranking them “highly” or “at the top” of your list. You might as well say you’re not ranking them number one. It’s better to say nothing at all.
- Feel free to explain why you’re attracted to their program. Be specific. Did you learn something at your interview? Is there a research mentor you hope to work with? Special clinical offerings you’re excited about? Does their mission resonate with yours? Do you have big news to share, like a newly published article? Did your partner just take a position at the same hospital? This is important and helpful information to share.
Ideally, all programs would explicitly tell candidates not to write letters of intent- and all candidates would believe them. Someday, when that finally happens, candidates and programs will simply declare their intentions on their certified rank lists, which is the only place they belong. When that happens, the Match will work as it should.
If you’d like to discuss your own situation and plans, let me know. I’m available to talk.
Enjoy your Sunday, everyone. After a bike ride, I’ll be working on the interview slide show (our first residency interview day is Friday), and I’ll be gearing up to watch Game 6 of the NLCS tonight. Let’s Go Mets!
Mark
What I’m reading and listening to:
- The Farm Art Festival Where You Can See Tractors Do Ballet by my daughter Isabella
- Reviving Humility in Physicians
- Hitler's People: The Faces of the Third Reich by Richard J. Evans
- College Officials Must Condemn On-Campus Support for Hamas Violence by Erwin Chemerinsky