LOI regret

[nibhighfootballrules]

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Is there any way to respectfully rescind a LOI? If you had a strong relationship with a PD would asking to speak pre-ROL deadline and explaining your reasoning help make this acceptable without burning every bridge in that system?

 

[ACSurgeon]

Is there any way to respectfully rescind a LOI? If you had a strong relationship with a PD would asking to speak pre-ROL deadline and explaining your reasoning help make this acceptable without burning every bridge in that system?

As a student you are at a disadvantage in this process. Don’t shoot yourself in the foot with this program that you clearly liked enough to send a LOI. Unless you don’t want to match there, just leave good enough alone and learn a lesson not to send strong communication like a LOI without being 1000% sure.

You might not match at whatever program(s) you now prefer to this program, so you could end up there anyways.

I don’t think you burn a bridge for post-training employment if you rank them lower after telling them they’re your number 1. And if it’s not an academic program, you don’t have to worry about a different hospital within the same system down the road. It’s not like they’re gonna blackball you for this. Also, sending them a letter telling them you take back your LOI can have the same negative effect.

There’s a reason you sent the LOI and you’re clearly interested in maintaining a good reputation with this program/hospital system. Are you sure you made a mistake sending that LOI?

 

[nibhighfootballrules]

As a student you are at a disadvantage in this process. Don’t shoot yourself in the foot with this program that you clearly liked enough to send a LOI. Unless you don’t want to match there, just leave good enough alone and learn a lesson not to send strong communication like a LOI without being 1000% sure.

You might not match at whatever program(s) you now prefer to this program, so you could end up there anyways.

I don’t think you burn a bridge for post-training employment if you rank them lower after telling them they’re your number 1. And if it’s not an academic program, you don’t have to worry about a different hospital within the same system down the road. It’s not like they’re gonna blackball you for this. Also, sending them a letter telling them you take back your LOI can have the same negative effect.

There’s a reason you sent the LOI and you’re clearly interested in maintaining a good reputation with this program/hospital system. Are you sure you made a mistake sending that LOI?

Thanks for the reply. I don't know if im just experiencing buyers remorse to a certain extent/accepting the fact surgical training is going to be a major adjustment which in and of itself is a daunting prospect.

There are definitive, objective facts that ultimately led me to send the LOI that aren't going to change. The fear is the overall morale of the program (junior residents worked to the bone relative to other options, some truly difficult attendings that in my and current residents opinions dont benefit your education just make life unnecessarily hard, and outside people (not within the program) warning of malignancy.) I weighed these "red flags" against the objective pro's of the program and ultimately decided how you deal with stress and co-workers is subjective and within your control whereas the pro's which cant be found in the other programs I'll have no control over.

Also, I felt like I had strong relationships with current residents who were willing to be candid about the program and all of them echoed things were trending in the right direction with undeniable evidence that this was the case and who not once said they would not reccomend going there. Plus I think long term I'd want to work at the hospitals associated with this residency program and they continually hire people who have trained there (which a) made me feel people must not despise the place if they are willing to come back and b) knowing the ins and outs of the system would help me determine if thats the best career path for me long term vs training elsewhere)

With regard to the potential new #1 I think it's a "grass is greener" situation where I just have this idea that it'll be easier without the unnecessary added misery. I also fear that if I did end up there and that wasn't the case id be regretting giving up the pro's of the other program without reaping any of those perceived benefits.

 

[ACSurgeon]

Thanks for the reply. I don't know if im just experiencing buyers remorse to a certain extent/accepting the fact surgical training is going to be a major adjustment which in and of itself is a daunting prospect.

There are definitive, objective facts that ultimately led me to send the LOI that aren't going to change. The fear is the overall morale of the program (junior residents worked to the bone relative to other options, some truly difficult attendings that in my and current residents opinions dont benefit your education just make life unnecessarily hard, and outside people (not within the program) warning of malignancy.) I weighed these "red flags" against the objective pro's of the program and ultimately decided how you deal with stress and co-workers is subjective and within your control whereas the pro's which cant be found in the other programs I'll have no control over.

Also, I felt like I had strong relationships with current residents who were willing to be candid about the program and all of them echoed things were trending in the right direction with undeniable evidence that this was the case and who not once said they would not reccomend going there. Plus I think long term I'd want to work at the hospitals associated with this residency program and they continually hire people who have trained there (which a) made me feel people must not despise the place if they are willing to come back and b) knowing the ins and outs of the system would help me determine if thats the best career path for me long term vs training elsewhere)

With regard to the potential new #1 I think it's a "grass is greener" situation where I just have this idea that it'll be easier without the unnecessary added misery. I also fear that if I did end up there and that wasn't the case id be regretting giving up the pro's of the other program without reaping any of those perceived benefits.

Surgical training is hard without unnecessary toxicity from egomaniacs. You don’t owe anyone anything. Your rank list should be your exact preference on the day you submit it. Programs will often lead students on and then rank them low or not at all. So, do what’s best for you.

You don’t know what kind of job you’re going to want after 5-7 years. So, do what’s best for you now, and figure out your post-training job closer to that time.

An “associated hospital” has close to a zero percent chance of holding a grudge that someone sent a letter of intent 5 years prior to a residency program of a different hospital (but within the same system). Either they’ll have an opening for your specialty or they won’t. If they do, they’ll hire you if you’re a good fit at the time.

Now with that in mind: pretend you never sent that LOI and sit down and truly make your list. Let the chips fall where they may.

Best of luck!!

 

[spideydoc22]

^this.

nobody cares about your LOI. It was very sweet of you to send one before, and the program may have ranked you a few spots higher, but nobody is going to hold it against you if you end up ranking somewhere else higher and you end up somewhere else. At the end of the day, a program isn’t going to not rank someone because they ranked you higher due to a LOI. If you match somewhere else, they will get someone a rank lower as if you didn’t exist. It doesn’t hurt them at all.

It will be forgotten about within 6 months when the next match cycle is under way.

 

[DrStephenStrange]

I guarantee you the PD and/or whoever else interviewed you have way more important things to worry about than to hold a grudge against you for 5-6 years. You will likely be forgotten within the first few weeks post match. As a resident, I work closely with auditioners throughout the cycle, and when it comes time for ranking, I can hardly even remember their names unless they were truly remarkable. So I doubt it’s any different for anyone higher up with way more responsibilities.

 

[nibhighfootballrules]

Thank you both for the insight. To be honest this was not the response I was expecting… there seems to be endless threads online clarifying that switching your ROL after a LOI is the KOD, so thank you for this fresh perspective.

Just curious if you have any opinions or advice on my situation. I narrowed my list down to 3 real contenders mostly due to geographic considerations to benefit my family (I understand I could very well fall below that, but 2 are programs I am closely associated with…where I have had strong relationships over the past 1-2 years) which complicates things given one of them I sent the LOI too. The LOI program is considered the more prestigious of the 3. It has robust volume and opportunities in the subspecialties I am most interested in and true flexibility due to the structure of the curriculum such that as a senior resident you can accumulate a vast number of cases in your desired subspecialty even before fellowship. The downside is there are attendings that are universally accepted as unpleasant to work with and make your life unnecessarily miserable when dealing with them (full disclosure this is a small percentage of the overall faculty.) Additionally the residents seemed burnt out as junior residents with clear morale issues.

The other “home program” I got along better with the residents and felt I fit more and they appeared to be happier with less burn out, better operative skills and by virtue of their curriculum have inherently less exposure to the toxic attendings. The downside is the commute for a large portion of my training would be close to 2 hours in total a day which is just time away from family and sleeping which seems like a large sacrifice that given my options isn’t necessary. The program is additionally less reputable and weaker in some of the subspecialties I am interested in.

Lastly the third one in consideration is very convenient for family, great culture and fit however relatively new with minimal reputation compared to the other programs. Also downside is rather weaker exposure to the sub specialities I am most interested in and way less flexibility throughout training.

I understand this is a highly personal decision and I have struggled with it because regardless of how many residents you speak with or unbiased parties outside of the programs no one can predict what it will be like for me and what the true cost benefit analysis is. I guess I’ve just been looking for someone to blatantly tell me hey don’t come to our program you’ll regret it and will be fine going to a different one (which hasn’t been the case) or someone to tell me I’m an idiot for giving up the stated benefits because some attendings suck to work with or alternatively your insane for going somewhere that you knowingly have to work with these people. At the end of the day I just want to be a confident competent surgeon with the ability to pursue my desired subspecialty whichever that may ultimately be (not feel like I wasn’t able to because of my training program) and I’d sacrifice having to eat it to get there but would preferably rather not have to beyond the normal surgical residency amount if possible.

I apologize in advance for the long reply just really struggling to try and sort all of this out.

 

[ACSurgeon]

Thank you both for the insight. To be honest this was not the response I was expecting… there seems to be endless threads online clarifying that switching your ROL after a LOI is the KOD, so thank you for this fresh perspective.

Just curious if you have any opinions or advice on my situation. I narrowed my list down to 3 real contenders mostly due to geographic considerations to benefit my family (I understand I could very well fall below that, but 2 are programs I am closely associated with…where I have had strong relationships over the past 1-2 years) which complicates things given one of them I sent the LOI too. The LOI program is considered the more prestigious of the 3. It has robust volume and opportunities in the subspecialties I am most interested in and true flexibility due to the structure of the curriculum such that as a senior resident you can accumulate a vast number of cases in your desired subspecialty even before fellowship. The downside is there are attendings that are universally accepted as unpleasant to work with and make your life unnecessarily miserable when dealing with them (full disclosure this is a small percentage of the overall faculty.) Additionally the residents seemed burnt out as junior residents with clear morale issues.

The other “home program” I got along better with the residents and felt I fit more and they appeared to be happier with less burn out, better operative skills and by virtue of their curriculum have inherently less exposure to the toxic attendings. The downside is the commute for a large portion of my training would be close to 2 hours in total a day which is just time away from family and sleeping which seems like a large sacrifice that given my options isn’t necessary. The program is additionally less reputable and weaker in some of the subspecialties I am interested in.

Lastly the third one in consideration is very convenient for family, great culture and fit however relatively new with minimal reputation compared to the other programs. Also downside is rather weaker exposure to the sub specialities I am most interested in and way less flexibility throughout training.

I understand this is a highly personal decision and I have struggled with it because regardless of how many residents you speak with or unbiased parties outside of the programs no one can predict what it will be like for me and what the true cost benefit analysis is. I guess I’ve just been looking for someone to blatantly tell me hey don’t come to our program you’ll regret it and will be fine going to a different one (which hasn’t been the case) or someone to tell me I’m an idiot for giving up the stated benefits because some attendings suck to work with or alternatively your insane for going somewhere that you knowingly have to work with these people. At the end of the day I just want to be a confident competent surgeon with the ability to pursue my desired subspecialty whichever that may ultimately be (not feel like I wasn’t able to because of my training program) and I’d sacrifice having to eat it to get there but would preferably rather not have to beyond the normal surgical residency amount if possible.

I apologize in advance for the long reply just really struggling to try and sort all of this out.

Without knowing more, it sounds like the LOI program will best fit your goals. If it has better training and opportunities for the fellowship you desire, you should go there or to a program similarly strong without the toxicity few attending, albeit at an inconvenience to your family.

 

[LucidSplash]

A 2-hour commute (assuming this is an hour each way) is not sustainable for a surgical residency. Full stop.

 

[DrStephenStrange]

A 2-hour commute (assuming this is an hour each way) is not sustainable for a surgical residency. Full stop.

I agree it’s a recipe for disaster. I’m not even a surgery resident, and on some days I can barely make it through my 20 minute commute.

 

[Smurfette]

A 2-hour commute (assuming this is an hour each way) is not sustainable for a surgical residency. Full stop.

This. You're applying ortho. A surgery residency isn't easy but 2 hours of commuting will make it 1000x worse. Plus for any resident, if you have any home call, overnight calls after which you are driving home after little to no sleep, or if you live in a place with snowy winters, you shouldn't consider that long of a commute. If you end up matching there, move closer.

 

[nibhighfootballrules]

I agree the commute is less than ideal and ultimately I decided it was reason enough to not rank the program first even if I felt I liked the culture more. Between the other two programs the lack of flexibility and relative weaknesses in surgical experiences at one institution ultimately led me to my LOI. Given my self imposed geographical restrictions im realizing that no one program is going to have everything I would ideally want and im going to have to deal with the cons of whatever program I chose. Thank you everyone for your advice.

 

[wysdoc]

I agree the commute is less than ideal and ultimately I decided it was reason enough to not rank the program first even if I felt I liked the culture more. Between the other two programs the lack of flexibility and relative weaknesses in surgical experiences at one institution ultimately led me to my LOI. Given my self imposed geographical restrictions im realizing that no one program is going to have everything I would ideally want and im going to have to deal with the cons of whatever program I chose. Thank you everyone for your advice.

If you do end up at this "long commute" program, rent the smallest bachelor pad apartment you like near your site and see your family on your non-call weekends.

 

[FlowRate]

I agree the commute is less than ideal and ultimately I decided it was reason enough to not rank the program first even if I felt I liked the culture more. Between the other two programs the lack of flexibility and relative weaknesses in surgical experiences at one institution ultimately led me to my LOI. Given my self imposed geographical restrictions im realizing that no one program is going to have everything I would ideally want and im going to have to deal with the cons of whatever program I chose. Thank you everyone for your advice.

Just adding to what everyone else said about commute--often you're required to be within 30 minutes of the hospital when on call, hence yet another reason why an hour long commute is untenable.

 

[LucidSplash]

I agree the commute is less than ideal and ultimately I decided it was reason enough to not rank the program first even if I felt I liked the culture more. Between the other two programs the lack of flexibility and relative weaknesses in surgical experiences at one institution ultimately led me to my LOI. Given my self imposed geographical restrictions im realizing that no one program is going to have everything I would ideally want and im going to have to deal with the cons of whatever program I chose. Thank you everyone for your advice.

I just want to emphasize that an hour commute isn’t “less than ideal.” It will absolutely not work and likely not be allowed by the program. Maybe if you get an apartment nearby to crash at post call as a junior and then when on call as a senior taking home call. But if you match at this program you will need to either plan on moving everyone closer or getting the apartment.

 

[JuicedToTheSocks]

Surgical training is hard without unnecessary toxicity from egomaniacs. You don’t owe anyone anything. Your rank list should be your exact preference on the day you submit it. Programs will often lead students on and then rank them low or not at all. So, do what’s best for you.

You don’t know what kind of job you’re going to want after 5-7 years. So, do what’s best for you now, and figure out your post-training job closer to that time.

An “associated hospital” has close to a zero percent chance of holding a grudge that someone sent a letter of intent 5 years prior to a residency program of a different hospital (but within the same system). Either they’ll have an opening for your specialty or they won’t. If they do, they’ll hire you if you’re a good fit at the time.

Now with that in mind: pretend you never sent that LOI and sit down and truly make your list. Let the chips fall where they may.

Best of luck!!

Not sure what field OP is talking about but LOIs ARE HUGE.... even 5 years down the line... I rotated at a place and a previous student matched at my institution and the PD told me that that student burned them by telling them he wanted to matched at their institution (where he went to med school). This was 6-7 years ago when that match took place....

In surgical fields especially you absolutely should not send more than one LOI because PDs not only talk but remember this sht and hold grudges

 

[DrStephenStrange]

Not sure what field OP is talking about but LOIs ARE HUGE.... even 5 years down the line... I rotated at a place and a previous student matched at my institution and the PD told me that that student burned them by telling them he wanted to matched at their institution (where he went to med school). This was 6-7 years ago when that match took place....

In surgical fields especially you absolutely should not send more than one LOI because PDs not only talk but remember this sht and hold grudges

If a PD holds a grudge, they’ll get over it. PDs do it themselves where they say you’re ranked to match, then you rank them first, and yet you don’t end up matching there. Students also send LOIs every year, ranking said program 1st, and still not match at their #1. LOI are not legal contracts, and PDs know that better than anyone.

 

[spideydoc22]

Yeah what PD has the bandwidth to hold a grudge 7 years later? Within a few weeks they are already preparing for the next match cycle, getting ready to review thousands of applicants. And again, the program doesn’t lose out on anything if you end up going somewhere else. Unless they chose to not rank someone else at all because they banked on you matching with them, and then that’s on them. They should rank everyone they could see succeed at their program, and let the algorithm do the rest. If you end up ranking somewhere else, then the program will end up with someone else as if you didn’t exist in the first place. No loss on their end.

Don’t fool yourself, you aren’t that important.

I agree to not send more than one LOI because you may shoot your self in the foot if those 2 programs end up chatting with each other before they rank. And if they find out you did that, you could end up not getting ranked by either program at all. But sending a single LOI and then changing your mind really doesn’t have any consequences.

 

[LucidSplash]

I think the people suggesting that it would be ridiculous for a surgery PD and/or a chair of a surgery department, who would also be the people deciding what partners to hire in the future for faculty positions, to hold a grudge against someone for sending an LOI and then going back on their word, then they don’t understand academic surgery. Or the egos of many in academic leadership. Maybe they wouldn’t hold it against OP later, but there is a very very good chance they would. When I interviewed at my first job, it was mentioned that they didn’t recall me from fellowship interviews and I was asked if “I’d given them the brush off.” I told them they’d declined to interview and suddenly no one wanted to talk about it anymore. But it means that they looked back at their records.

OP’s best option would be to formally rescind the LOI if they don’t intend to rank the program 1st. At least then it would be seen as above board and give the program a chance to change their rank list if they wanted to. OP might not get ranked in that scenario but at least they would later have a better chance of being seen as someone who sticks by their word, if they later want to try to apply for a faculty spot. Still might not be considered for it, but a better chance than if they let the LOI stand and don’t notify the program of their change of heart.

If OP is not interested in applying to that institution for anything in the future, it might not matter at all. But also consider that academic surgeons in positions of leadership often change institution in pursuit of career building promotions.

 

[ACSurgeon]

I think the people suggesting that it would be ridiculous for a surgery PD and/or a chair of a surgery department, who would also be the people deciding what partners to hire in the future for faculty positions, to hold a grudge against someone for sending an LOI and then going back on their word, then they don’t understand academic surgery. Or the egos of many in academic leadership. Maybe they wouldn’t hold it against OP later, but there is a very very good chance they would. When I interviewed at my first job, it was mentioned that they didn’t recall me from fellowship interviews and I was asked if “I’d given them the brush off.” I told them they’d declined to interview and suddenly no one wanted to talk about it anymore. But it means that they looked back at their records.

OP’s best option would be to formally rescind the LOI if they don’t intend to rank the program 1st. At least then it would be seen as above board and give the program a chance to change their rank list if they wanted to. OP might not get ranked in that scenario but at least they would later have a better chance of being seen as someone who sticks by their word, if they later want to try to apply for a faculty spot. Still might not be considered for it, but a better chance than if they let the LOI stand and don’t notify the program of their change of heart.

If OP is not interested in applying to that institution for anything in the future, it might not matter at all. But also consider that academic surgeons in positions of leadership often change institution in pursuit of career building promotions.

OP is interested in a job in the same hospital system. Didn’t seem like they were looking for an academic job in the same hospital as the program.

OP: I stand by not shooting yourself in the foot as a student. You’ll have much more freedom and more options when looking for an attending job. At this phase you don’t have the luxury of hurting your chances and having a program in your top 5 just blackball you. And there’s no guarantee that they’d “appreciate” the honesty and remember it in 7 years and offer you a job.

 

[spideydoc22]

I think the people suggesting that it would be ridiculous for a surgery PD and/or a chair of a surgery department, who would also be the people deciding what partners to hire in the future for faculty positions, to hold a grudge against someone for sending an LOI and then going back on their word, then they don’t understand academic surgery. Or the egos of many in academic leadership. Maybe they wouldn’t hold it against OP later, but there is a very very good chance they would. When I interviewed at my first job, it was mentioned that they didn’t recall me from fellowship interviews and I was asked if “I’d given them the brush off.” I told them they’d declined to interview and suddenly no one wanted to talk about it anymore. But it means that they looked back at their records.

OP’s best option would be to formally rescind the LOI if they don’t intend to rank the program 1st. At least then it would be seen as above board and give the program a chance to change their rank list if they wanted to. OP might not get ranked in that scenario but at least they would later have a better chance of being seen as someone who sticks by their word, if they later want to try to apply for a faculty spot. Still might not be considered for it, but a better chance than if they let the LOI stand and don’t notify the program of their change of heart.

If OP is not interested in applying to that institution for anything in the future, it might not matter at all. But also consider that academic surgeons in positions of leadership often change institution in pursuit of career building promotions.

I completely disagree with you. I’m sorry if you had a poor experience with someone in a level of leadership, but people do not behave like that in general. program directors sift through thousands of applications and interview/rank several hundred per year.

OP, please, do not send any kind of communication that rescinds your LOI. That is terrible advice and will only hurt you. Nobody is going to remember your LOI unless they have a personality problem, and you’re not going to want to work for someone like that anyway.

 

[LucidSplash]

I completely disagree with you. I’m sorry if you had a poor experience with someone in a level of leadership, but people do not behave like that in general. program directors sift through thousands of applications and interview/rank several hundred per year.

OP, please, do not send any kind of communication that rescinds your LOI. That is terrible advice and will only hurt you. Nobody is going to remember your LOI unless they have a personality problem, and you’re not going to want to work for someone like that anyway.

You’re free to disagree. OP can choose what to do. But they should be aware that these people exist and that there are definitely places that would remember when OP didn’t live up to their word, if they liked OP and planned to rank them to match. My opinions and experiences here are just as important for OP to know about as people who have not dealt with toxic leadership. My experience is not from a single place but from multiple, and also the stories of multiple colleagues in surgery from multiple institutions.

OP might not want a job with someone who might hold a grudge, I agree. So it might not be a big deal to them. But they should know that these people exist and in surgery they often make their way to the leadership positions of large systems.

OP is interested in a job in the same hospital system. Didn’t seem like they were looking for an academic job in the same hospital as the program.

OP: I stand by not shooting yourself in the foot as a student. You’ll have much more freedom and more options when looking for an attending job. At this phase you don’t have the luxury of hurting your chances and having a program in your top 5 just blackball you. And there’s no guarantee that they’d “appreciate” the honesty and remember it in 7 years and offer you a job.

I was not applying for an academic job, I applied for a job at a hospital in the same system, but the department chair at the academic hospital is still your boss if you’re at an outlying facility. You still interview with them. And in many surgery residency programs, it’s ultimately the chair and the PD that make the rank list.