Letter of Intent

[blueridgenc]

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Hi All,

I am doing both DO and MD match. Among my DO match programs, I have received 2 letters and 1 email giving me positive indication about match. I am very interested in these programs.

I am composing a letter of intent. Is it okay to say essentially 'you are my top choice' to a particular program?

Any general advice regarding this would be great.

Thanks!

 

[HumbleMD]

Hi All,

I am doing both DO and MD match. Among my DO match programs, I have received 2 letters and 1 email giving me positive indication about match. I am very interested in these programs.

I am composing a letter of intent. Is it okay to say essentially 'you are my top choice' to a particular program?

Any general advice regarding this would be great.

Thanks!

It's pretty early - are you positive you have your final ROL? But letters of intent in residency match (I'm guessing it's the same for the DO?) are VERY different than a letter of intent from medical school.

For the match, there is your number 1 spot, and everything else. Program directors know this. If you truly know what your #1 ROL spot is (though, it's awfully early), then yes, you want to let them know that they are your #1. There's often talk that if a program knows they are your #1, they'll bump you up a bit in their ROL of applicants. This information is better conveyed by a call from your program chair, or someone in the field with connections to your #1 program, much moreso than a letter or email from you. After the call is made it is legally binding under match rules, so they'd better be your #1 on your ROL. Program directors who are lied to may try to end your career.

If it's not your #1, then a letter of "interest" is pretty useless to a PD and a waste of time.

 

[blueridgenc]

Thank you for your reply. I found it very helpful. I am doing both DO and MD match. DO match happens one month earlier than MD match.

I am done interviewing at programs that would be on my DO match list. All of these programs are either dually accrediated (DO and MD) or MD programs. But they will be on my DO match. I am planning to let only one program know that they are my top choice because that program is really my top choice in the DO match.

The only thing is - I have a top choice in MD match list too. So I am not sure if it would be considered a lie if I told that one particular program on my DO match that they are my top choice.

But as you probably know, if I match in my DO match, then I am automatically out from the MD match. I could be wrong but my guess is I will probably match thru DO match. The only way I can get into my number one choice of MD match is if they do pre-match - which is not very likely.

Thank you.

It's pretty early - are you positive you have your final ROL? But letters of intent in residency match (I'm guessing it's the same for the DO?) are VERY different than a letter of intent from medical school.

For the match, there is your number 1 spot, and everything else. Program directors know this. If you truly know what your #1 ROL spot is (though, it's awfully early), then yes, you want to let them know that they are your #1. There's often talk that if a program knows they are your #1, they'll bump you up a bit in their ROL of applicants. This information is better conveyed by a call from your program chair, or someone in the field with connections to your #1 program, much moreso than a letter or email from you. After the call is made it is legally binding under match rules, so they'd better be your #1 on your ROL. Program directors who are lied to may try to end your career.

If it's not your #1, then a letter of "interest" is pretty useless to a PD and a waste of time.

 

[DocKSV]

To piggy-back off the OP, I have already interviewed at a program that was my #1 before the IV and is still my #1. I only have a few interviews remaining, but based on their location and fellowship match rate, have no chance of approaching #1.

I will probably wait until January to write a letter of intent/interest, but I have no idea how to go about it. Is there a basic template or certain requirements for the letter? I did a google search, but it was mostly pharm resources.

 

[Cathyran]

It's pretty early - are you positive you have your final ROL? But letters of intent in residency match (I'm guessing it's the same for the DO?) are VERY different than a letter of intent from medical school.

For the match, there is your number 1 spot, and everything else. Program directors know this. If you truly know what your #1 ROL spot is (though, it's awfully early), then yes, you want to let them know that they are your #1. There's often talk that if a program knows they are your #1, they'll bump you up a bit in their ROL of applicants. This information is better conveyed by a call from your program chair, or someone in the field with connections to your #1 program, much moreso than a letter or email from you. After the call is made it is legally binding under match rules, so they'd better be your #1 on your ROL. Program directors who are lied to may try to end your career.

If it's not your #1, then a letter of "interest" is pretty useless to a PD and a waste of time.

This is good info to know. A couple questions though.

1. Is this true? Do they really bump you up a bit if they know they're your number 1 choice? Can anyone else weigh in on this?

2. How do you go about approaching your program chair/advisor to make a call for you? I haven't interacted with our chair too much, and am unsure how I could go about this?

 

[PMPMD]

This is good info to know. A couple questions though.

1. Is this true? Do they really bump you up a bit if they know they're your number 1 choice? Can anyone else weigh in on this?

Yes, programs may weigh this if they care about how far they go down their rank list. Some programs care about this more than others.

2. How do you go about approaching your program chair/advisor to make a call for you? I haven't interacted with our chair too much, and am unsure how I could go about this?

Get to know your chair or program director. Just be honest about where you want to go. It could also be an attending that has connections to the program you want to go to (they trained there).

 

[PMPMD]

It's pretty early - are you positive you have your final ROL? But letters of intent in residency match (I'm guessing it's the same for the DO?) are VERY different than a letter of intent from medical school.

For the match, there is your number 1 spot, and everything else. Program directors know this. If you truly know what your #1 ROL spot is (though, it's awfully early), then yes, you want to let them know that they are your #1. There's often talk that if a program knows they are your #1, they'll bump you up a bit in their ROL of applicants. This information is better conveyed by a call from your program chair, or someone in the field with connections to your #1 program, much moreso than a letter or email from you. After the call is made it is legally binding under match rules, so they'd better be your #1 on your ROL. Program directors who are lied to may try to end your career.

If it's not your #1, then a letter of "interest" is pretty useless to a PD and a waste of time.

Phone calls are NOT legally binding. Only the NRMP match agreement is.

"This Agreement contains the entire agreement between the parties with respect to the Matching Program and its results. Any representations, promises, or conditions not incorporated in this Agreement will not be binding upon any of the parties."
-http://www.nrmp.org/res_match/policies/map_main.html

 

[docmed2012]

If you decide to tell a program that they will be #1 on the ROL, and the program gives a clear indication that you are are in the top applicant pool, do you have to stop interviewing at other places at this point?

It's pretty early - are you positive you have your final ROL? But letters of intent in residency match (I'm guessing it's the same for the DO?) are VERY different than a letter of intent from medical school.

For the match, there is your number 1 spot, and everything else. Program directors know this. If you truly know what your #1 ROL spot is (though, it's awfully early), then yes, you want to let them know that they are your #1. There's often talk that if a program knows they are your #1, they'll bump you up a bit in their ROL of applicants. This information is better conveyed by a call from your program chair, or someone in the field with connections to your #1 program, much moreso than a letter or email from you. After the call is made it is legally binding under match rules, so they'd better be your #1 on your ROL. Program directors who are lied to may try to end your career.

If it's not your #1, then a letter of "interest" is pretty useless to a PD and a waste of time.

 

[turkeyjerky]

If you decide to tell a program that they will be #1 on the ROL, and the program gives a clear indication that you are are in the top applicant pool, do you have to stop interviewing at other places at this point?

No, and it would be a big mistake to do so.

 

[HumbleMD]

If you decide to tell a program that they will be #1 on the ROL, and the program gives a clear indication that you are are in the top applicant pool, do you have to stop interviewing at other places at this point?

No way. First of all, this would never happen, as PDs don't typically make RTM courtship calls until January/February when interviews are done. Second, you probably won't be deciding your #1 spot until then either, after all of your interviews are done. Third, even though it is against match rules for you or a program to misrepresent information (especially rank list position), it certainly happens. Don't let their words influence your actions or decisions in the match, because a whole lot of smoke being blown up some rear ends during the match.

PS, I really don't understand a program telling you that you are RTM would influence an applicant's ROL. It's nice to know, but my #1 is my #1, no matter what #6 might tell me.

 

[gutonc]

If you decide to tell a program that they will be #1 on the ROL, and the program gives a clear indication that you are are in the top applicant pool, do you have to stop interviewing at other places at this point?

Not to belabor the point but, unless that "clear indication" was a signed (by the PD) contract arriving by courier, then this would be the dumbest thing you could possibly do during interview season.

 

[mcl]

Yikes! I see a lot of thought processes on this thread which may set some unrealistic expectations for Match Day.

Letters of intent are generally NOT that meaningful to programs, and the more competitive the program or specialty, the less meaningful they are. Expressions of interest or even promises to rank a program first are NOT binding in any way. Anyone can have a last-minute change of heart when they submit their ROL. Program directors may be a little disappointed if your name isn't on their list of matched applicants, but they will get over it as they start concentrating on the people who did match to their program.

The degree to which an email or letter will affect your position on the program's ROL depends in large part on how competitive you are as an applicant. Keep in mind that programs get lots of these letters from a significant percentage of the applicants they interviewed. A candidate who is in my top 10% who expresses strong interest might move into a "rank to match" position or a place just beyond that level. Someone farther down on list might move up just 1-2 spots (or not at all). Someone in the lower third probably won't move up regardless of the level of interest they express.

Most PDs who contact applicants (bear in mind that not all programs do) will say something encouraging because they don't want to scramble. If you know you are 25th on my ROL and that we usually fill within the top 20, chances are good you're going to rank another program higher even if you liked my program best. It doesn't mean that programs are lying to you--we interview a lot of people and we like a lot of people--but it does mean that you can't take a positive email or comment as a guarantee.

So send your email or letter of interest, but don't get so invested in that one program that you are disappointed on Match Day if you dont get your first choice. Rank programs in the order of your preference, not according to any response you've received from a program. Rank any program that you've visited that you think you could tolerate--but DON'T rank any place/places where you know you'd be miserable. You have a real chance at matching at any place on your rank list. Then wait, feeling confident that you've done all within your power to affect the process and decide that you are going to be happy with the result regardless of what that is.

 

[HumbleMD]

Program directors may be a little disappointed if your name isn't on their list of matched applicants, but they will get over it as they start concentrating on the people who did match to their program.

Heh, tell this to our Dean who is also the Gen Surg PD. He was lied to by an applicant 2 years ago and still talks about it. He swears she will never match here for fellowship if it's the last thing he does.

Most PDs who contact applicants (bear in mind that not all programs do) will say something encouraging because they don't want to scramble. If you know you are 25th on my ROL and that we usually fill within the top 20, chances are good you're going to rank another program higher even if you liked my program best. It doesn't mean that programs are lying to you--we interview a lot of people and we like a lot of people--but it does mean that you can't take a positive email or comment as a guarantee.

I still don't understand this logic. I have my ROL, based entirely on my preferences for programs. Even if my #1 said I was highly unlikely to match, I have nothing to lose by still making them #1. Conversely, if #2 said I was RTM, that'd be fine and dandy, but my #1 is still my #1. Are there applicants who run around bragging about how deep or not deep they had to go on their ROL? I've heard of this from PDs, but not from applicants. My happiness is worth way more than my pride.

 

[Law2Doc]

Heh, tell this to our Dean who is also the Gen Surg PD. He was lied to by an applicant 2 years ago and still talks about it. He swears she will never match here for fellowship if it's the last thing he does....

I've heard stuff like this as well.
As well as PDs who no longer will interview applicants from certain schools because he has been burned by too many applicants from that school in the past. While I don't think a letter of intent has a huge impact, I do think that a perceived lack of integrity can shape a PDs view of certain applicants and schools going forward. If you must, only tell one place they are your first choice. For everyplace else just tell them how much you loved their program. It probably won't change anything but will keep your integrity intact.

 

[mcl]

Heh, tell this to our Dean who is also the Gen Surg PD. He was lied to by an applicant 2 years ago and still talks about it. He swears she will never match here for fellowship if it's the last thing he does.

OK--I'll agree to the caveat that someone who plans on going into fellowship needs to be more careful about definitively telling more than one program that they are #1. There are plenty of evasive ways to profess interest without making a promise. But the vast majority of residents don't go on to fellowships, and honestly I think a PD who holds this kind of grudge is acting a little less than maturely. Mileage may vary, of course

I still don't understand this logic. I have my ROL, based entirely on my preferences for programs. Even if my #1 said I was highly unlikely to match, I have nothing to lose by still making them #1. Conversely, if #2 said I was RTM, that'd be fine and dandy, but my #1 is still my #1. Are there applicants who run around bragging about how deep or not deep they had to go on their ROL? I've heard of this from PDs, but not from applicants. My happiness is worth way more than my pride.

I think that everyone has their point of pride. Many applicants would prefer to say that they matched at their first choice program (people definitely ask) and end up arranging their ROL according to where they think they have the best chance of matching. But your philosophy is definitely best, and I hope that all applicants will follow your fine example.

 

[Law2Doc]

...But the vast majority of residents don't go on to fellowships...

while this is true, if you define "vast majority" on a per person basis rather than a per field basis, in some specialties 90+% do in fact go into fellowships. You'd be foolish to ruffle feathers in any of those many fields.

 

[HumbleMD]

Other question. I've had 3 programs (all in "less desirable" locales) in which the program directors told me to "let us know if you're interested in January." Do you think this is code for asking us to tell them that they are #1 on my ROL (none of them will be), or merely that we write them to let them know we're still interested? If it's the latter, I suppose I'll be writing three letters of interest in January...

 

[Prop]

I've been told this as well, and one of the PDs explained why he wanted me to contact them in January if I was interested.

They do interview about 10 times the needed number of interns, and many of the less desirable programs know that they are not the Ivy league places that we all would love to match at. Therefore, if they like you as a candidate (and maybe think you would be competitive at other places that are more desirable), then they will only rank you if they know you would actually want go there. If not, they would rather rank another applicant who actually do want to go to their program.

One place I interviewed at told me that I would fit in perfectly, and that I would have no problem matching. At the end of the day the PD told me this again, and then said I should email him in January to let him know if I was planning to rank them high/top. If he knew that I ranked them as my #1, he would rank me to match. If not, I would go down on their rank-list, as he thought I would match at another place instead, and he would rather rank another desirable candidate higher.

If this is true or not is another story - you never know. But I don't think it means that you are their top choice, just that they think that you would fit in well with their program and that they would be happy to have you as an intern.

My advice would be to email the PD in January telling them that you plan to rank them highly (not no 1, as this is not your intention), so they will know that you still plan to rank them. Then it's up to them to decide whether they believe they have a chance of getting you or not...

 

[mcl]

I've been told this as well, and one of the PDs explained why he wanted me to contact them in January if I was interested.

They do interview about 10 times the needed number of interns, and many of the less desirable programs know that they are not the Ivy league places that we all would love to match at. Therefore, if they like you as a candidate (and maybe think you would be competitive at other places that are more desirable), then they will only rank you if they know you would actually want go there. If not, they would rather rank another applicant who actually do want to go to their program.

One place I interviewed at told me that I would fit in perfectly, and that I would have no problem matching. At the end of the day the PD told me this again, and then said I should email him in January to let him know if I was planning to rank them high/top. If he knew that I ranked them as my #1, he would rank me to match. If not, I would go down on their rank-list, as he thought I would match at another place instead, and he would rather rank another desirable candidate higher.

If this is true or not is another story - you never know. But I don't think it means that you are their top choice, just that they think that you would fit in well with their program and that they would be happy to have you as an intern.

This sounds much too much like the "quid pro quo" ranking that the NRMP does not allow. I hope the PD didn't really word it that way when he spoke with you.

 

[NotAProgDirector]

I've been told this as well, and one of the PDs explained why he wanted me to contact them in January if I was interested.

They do interview about 10 times the needed number of interns, and many of the less desirable programs know that they are not the Ivy league places that we all would love to match at. Therefore, if they like you as a candidate (and maybe think you would be competitive at other places that are more desirable), then they will only rank you if they know you would actually want go there. If not, they would rather rank another applicant who actually do want to go to their program.

One place I interviewed at told me that I would fit in perfectly, and that I would have no problem matching. At the end of the day the PD told me this again, and then said I should email him in January to let him know if I was planning to rank them high/top. If he knew that I ranked them as my #1, he would rank me to match. If not, I would go down on their rank-list, as he thought I would match at another place instead, and he would rather rank another desirable candidate higher.

If this is true or not is another story - you never know. But I don't think it means that you are their top choice, just that they think that you would fit in well with their program and that they would be happy to have you as an intern.

My advice would be to email the PD in January telling them that you plan to rank them highly (not no 1, as this is not your intention), so they will know that you still plan to rank them. Then it's up to them to decide whether they believe they have a chance of getting you or not...

I would point out that the match makes this kind of horsetrading completely pointless.

Let's say there are 3 applicants to my program: A, B, and C. Let's say that I like them in that order -- A is stronger than B is stringer than C. Therefore, I rank A - B - C.

Let's say that I know that A doesn't want to come to my program. So I could change the rank list to B - C - A. But that actually doesn't do much, since if A matches elsewhere I would simply get B or C instead.

I guess the only benefit to something like this is that I could match A if he/she didn't match elsewhere. Now, I have A who is a stronger resident, but perhaps someone for whom my program wasn't their top choice. Maybe they will be less happy here. But maybe they'll be perfectly happy and I'll have a great resident. So it works both ways.

I agree with the above poster, this is absolutely a match violation.

 

[Sol Rosenberg]

I agree with the above poster, this is absolutely a match violation.

Very interesting. I had a PD of a mid-tier program of a fairly competitive specialty basically spend our entire interview telling me exactly the same thing under the guise of, "Let me give you some advice about how to get from the middle of program rank lists to the top."

He said to send letters telling your top programs that you are ranking them highly and that he (though he said other PDs, in general) liked to rank highly people who really want to go to that program -- basically everything that Prop mentioned in his post. He also proudly told me that he always gets his #1, #2, etc. I didn't realize that this was a match violation, though I did realize that it was at least a form of gaming the match (of course you will usually get your first N people if you rank the people who profess their love for you highest.)

I was wondering what programs get by gaming the match like this? Bragging rights (We always get our #1-#N,) Anything else? I understand what APD is saying about guaranteeing that person a spot, but why would a PD go to those lengths, just because of a letter that a candidate sends? I still don't get it...

 

[mcl]

Very interesting. I had a PD of a mid-tier program of a fairly competitive specialty basically spend our entire interview telling me exactly the same thing under the guise of, "Let me give you some advice about how to get from the middle of program rank lists to the top."

He said to send letters telling your top programs that you are ranking them highly and that he (though he said other PDs, in general) liked to rank highly people who really want to go to that program -- basically everything that Prop mentioned in his post. He also proudly told me that he always gets his #1, #2, etc. I didn't realize that this was a match violation, though I did realize that it was at least a form of gaming the match (of course you will usually get your first N people if you rank the people who profess their love for you highest.)

I was wondering what programs get by gaming the match like this? Bragging rights (We always get our #1-#N,) Anything else? I understand what APD is saying about guaranteeing that person a spot, but why would a PD go to those lengths, just because of a letter that a candidate sends? I still don't get it...

I know it's like spitting hairs, but what you describe isn't exactly the same as above, and not necessarily a violation in my experience.

In Prop's post, the PD is saying: Let me know if you plan to rank us first--if you do, we'll rank you to match but if you don't, we'll rank you lower. A quid-pro-quo scenario for that particular program.

In your example, the PD is giving general strategic advice (similar to mine, actually) that you have nothing to gain by not telling programs you like that you plan to rank them "highly." It may make absolutely no difference in your final ranking, but for programs who care about how far down they go on their rank list, it may move your name up. But he's not asking you to make an explicit promise before he makes an explicit promise to you. He's obviously proud that he has correctly guaged the sincerity of the intentions of the candidates he has ranked most highly in the past.

Basically, the rule of thumb is this: It is NOT a match violation for a PD to tell an applicant that he/she is ranked in a position that guarantees a match if the applciant ranks the program first. It IS a violation to indicate that the guaranteed match position on the rank list is contingent on the applicant's promise to rank the program first.

As to the benefit to the program, it's often a matter of perception within the program (being able to say "we were able to recruit our top applicants") and perhaps it can be used as a yardstick for the PD's faculty evaluation. I know that our department generally feels that recruiting years were more "successful" if we matched high on our list rather than farther down. Certainly the year we didn't fill wasn't seen as a successful recruiting year! But all of it is smoke and mirrors, really. Some of our strongest residents have come from lower on our rank list, and some of our biggest disappointments have come from the applicants who were ranked to match. It's hard to guage anything accurately from a 1/2 day visit filled with a handful of interviews and a couple of meals.

 

[Saluki]

Very interesting. I had a PD of a mid-tier program of a fairly competitive specialty basically spend our entire interview telling me exactly the same thing under the guise of, "Let me give you some advice about how to get from the middle of program rank lists to the top."

He said to send letters telling your top programs that you are ranking them highly and that he (though he said other PDs, in general) liked to rank highly people who really want to go to that program -- basically everything that Prop mentioned in his post. He also proudly told me that he always gets his #1, #2, etc. I didn't realize that this was a match violation, though I did realize that it was at least a form of gaming the match (of course you will usually get your first N people if you rank the people who profess their love for you highest.)

I was wondering what programs get by gaming the match like this? Bragging rights (We always get our #1-#N,) Anything else? I understand what APD is saying about guaranteeing that person a spot, but why would a PD go to those lengths, just because of a letter that a candidate sends? I still don't get it...

This is interesting, because on SDN I've seen several people advising that you shouldn't tell programs near the top of your list that you're ranking them highly as it lets those programs know that you're not ranking them number one....

 

[studyingforever]

I know it's like spitting hairs, but what you describe isn't exactly the same as above, and not necessarily a violation in my experience.

In Prop's post, the PD is saying: Let me know if you plan to rank us first--if you do, we'll rank you to match but if you don't, we'll rank you lower. A quid-pro-quo scenario for that particular program.

In your example, the PD is giving general strategic advice (similar to mine, actually) that you have nothing to gain by not telling programs you like that you plan to rank them "highly." It may make absolutely no difference in your final ranking, but for programs who care about how far down they go on their rank list, it may move your name up. But he's not asking you to make an explicit promise before he makes an explicit promise to you. He's obviously proud that he has correctly guaged the sincerity of the intentions of the candidates he has ranked most highly in the past.

Basically, the rule of thumb is this: It is NOT a match violation for a PD to tell an applicant that he/she is ranked in a position that guarantees a match if the applciant ranks the program first. It IS a violation to indicate that the guaranteed match position on the rank list is contingent on the applicant's promise to rank the program first.

As to the benefit to the program, it's often a matter of perception within the program (being able to say "we were able to recruit our top applicants") and perhaps it can be used as a yardstick for the PD's faculty evaluation. I know that our department generally feels that recruiting years were more "successful" if we matched high on our list rather than farther down. Certainly the year we didn't fill wasn't seen as a successful recruiting year! But all of it is smoke and mirrors, really. Some of our strongest residents have come from lower on our rank list, and some of our biggest disappointments have come from the applicants who were ranked to match. It's hard to guage anything accurately from a 1/2 day visit filled with a handful of interviews and a couple of meals.

As far as this general rule of thumb - if a program tells an applicant that they are ranked in a position that guarantees a match (assuming the applicant wants to go there and ranks them first) and they end up not matching at that program because the program moved them lower on the ROL, is that a violation?

 

[NotAProgDirector]

As far as this general rule of thumb - if a program tells an applicant that they are ranked in a position that guarantees a match (assuming the applicant wants to go there and ranks them first) and they end up not matching at that program because the program moved them lower on the ROL, is that a violation?

No, it's not. Nothing "said" between applicants and programs is binding. Perhaps you were "ranked to match" when they said it, but then something changed later. Or perhaps they outright lied. Or, their definition of "ranked to match" is "we usually fill in our top 20, and you were ranked 18, but this year we happened to fill at 16". In no case is it a match violation. In some cases it might be a miscommunication. In others it's unethical behavior.

 

[Sol Rosenberg]

This is interesting, because on SDN I've seen several people advising that you shouldn't tell programs near the top of your list that you're ranking them highly as it lets those programs know that you're not ranking them number one....

How do they know you're not ranking them #1 (rhetorical question?) My Dean's office is pretty adamant that we should never tell anyone that we are ranking them #1, just say "very highly," or something like that, if asked. Their opinion is that you have little to gain ("You can tell them you're ranking them #1, but they won't believe you anyway,") and lots to lose if you change your mind after telling someone that you've ranked them #1. So, how can anyone realistically read anything into the code words that are in people's letters of intent (e.g. a sincere "very highly" vs an insincere "#1"?) That's one of the reasons that my home PD says that he doesn't put too much (actually any) stock into Thank yous and follow-up letters.

 

[drizzt3117]

Putting numbers on it makes it more clear. If you say "ranking them #1" that's clear. If you say top 3, that implies theyre #3. You could send "very highly" to every single program on your list and it not be technically a lie, very highly is open to interpretation, perhaps from your perspective, being on your list at all is very highly bc you have a chance to match there.

How do they know you're not ranking them #1 (rhetorical question?) My Dean's office is pretty adamant that we should never tell anyone that we are ranking them #1, just say "very highly," or something like that, if asked. Their opinion is that you have little to gain ("You can tell them you're ranking them #1, but they won't believe you anyway,") and lots to lose if you change your mind after telling someone that you've ranked them #1. So, how can anyone realistically read anything into the code words that are in people's letters of intent (e.g. a sincere "very highly" vs an insincere "#1"?) That's one of the reasons that my home PD says that he doesn't put too much (actually any) stock into Thank yous and follow-up letters.

 

[FutureDoc734]

Putting numbers on it makes it more clear. If you say "ranking them #1" that's clear. If you say top 3, that implies theyre #3. You could send "very highly" to every single program on your list and it not be technically a lie, very highly is open to interpretation, perhaps from your perspective, being on your list at all is very highly bc you have a chance to match there.

So, what is the consensus, then, on how to go about telling a program they're on your top three? Should we explicitly say that? From your comment, it sounds like saying "very highly" won't get us anywhere, yet there may be some of us that truly would be happy at any of our top three programs.

 

[HumbleMD]

So, what is the consensus, then, on how to go about telling a program they're on your top three? Should we explicitly say that? From your comment, it sounds like saying "very highly" won't get us anywhere, yet there may be some of us that truly would be happy at any of our top three programs.

I'm doing what my dean (who is a program director himself) advised. I'm having my department chair make a call to my #1 to let them know as such. Then, mum's the word for the rest of the programs. As he has repeatedly told us, there's your #1, and there's everything else (much like there's RTM and everything else). Any other words are just smoke up someone's rear end. The only exception are the 2 program where the PDs explicitly requested we "let them know if interested in January." I'll likely email them in 3 weeks to let them know that, indeed, I am interested (as if my application and hauling out for an interview weren't enough).