Hi everyone,
Maybe it’s a sign of progress (or too early to tell), but fewer residents this year have asked me about sending “commitment letters” to fellowships, promising to rank them number one.
You shouldn’t have to write such letters. We tell internship candidates not to send them, and, though some send them anyway, the letters don’t impact our decisions. Most internal medicine programs follow the same policy. Unfortunately, at the fellowship level, many candidates feel pressured to reveal their plans, though the NRMP rules are clear:
Program directors and other recruitment team members…must not request an applicant disclose ranking preferences…
and programs
must not solicit or require post-interview communication for the purposes of influencing applicants’ ranking preferences.
Pressure to disclose decisions warps the Match’s premise—that applicants should rank programs by preference. Nevertheless, and I say this because it happens, some trainees consider committing to their second or third choices because they believe their first choice is out of reach, thus sabotaging their chance to match at their favorite program.
It’s easy to see why programs would pressure candidates to commit, since doing so makes it more likely the candidate will match with them. But such pressure is unfair and puts candidates in an untenable position. Consider this scenario: Fellowship A does not expect commitment letters, while Fellowship B expects candidates to reveal their preferences if they wish to match. The candidate who prefers Fellowship A now has a dilemma: if they don’t commit to B and don’t match at A, they may not match at either. So, should they take a risk and rank A over B (with no letter), or should they commit to B and rank it first, even though B is their second choice?
When residents ask how to handle this situation, I give one consistent answer: rank your first choice first. I also advise them to avoid programs that violate NRMP rules. Finally, I remind them that they can show their interest, if they wish, while also following NRMP rules:
Applicants may freely express their interest in a program, but they must not request a program director or any member of the recruitment team to disclose program ranking preferences or intentions.
You may share what excites you about a fellowship, or how you hope to contribute, but don’t expect that writing a letter will influence ranking decisions at programs that are following the rules. Thoughtful programs should understand that many applicants, who are just as qualified and excited, are abiding by the NRMP advisory to limit post-interview communications.
If you’re an applicant navigating these currents, here’s the bottom line: rank the programs you love first. You are exceptional candidates, and years of experience tell me that many outstanding programs will rank you to match—whether you send a letter or not. Just keep it simple and let the Match algorithm work its magic.
Enjoy your Sunday, everyone. I’ll be driving down to New Jersey to visit my mom.
Mark
What I’m reading:
- What Makes Men in Groups Behave So Badly? By Kate Manne
- What New York City Will Lose When It Ends Carriage Rides By Mary Haverstick
- First-of-Its-Kind Vaccine Ushers in New Hope for Cancer Patients By Nina Agrawal
- The Increasingly Long Drive to Give Birth in Rural America By Sophie Jager
- New Haven’s final East Coast Greenway link is open. Now cyclists can ride 27 miles to Southington By Kylie Clifton
- Goodspeed marks ‘Annie’-versary with a new staging 50 years after its world premiere By Christopher Arnott
- The Grace We Seek but Have Forgotten By Lydia Sohn
- Lord of Misrule By Jaimy Gordon