Depends on the specialty. Some specialties use a match process (I think that cards does) and others are on an individual basis (GI is/or was, don't know if it's changed). When it's on an individual basis, it gets really annoying, because this GI fellow was telling me how programs would call him and try to pressure him into accepting their offer (by setting deadlines) before he had heard back from other programs.
Thx for the info K. Hrmmm... I think I've got double the problem as fellowship apps for my class start this summer, but the Canadian fellowship app window is a year later.. LoL, I guess I'll have to decide soon.