signing an offer

Is this for an R1 position? I may be speaking in error, but I thought the deadline for offering/accepting a position outside the match has already passed. If this is for an R2 or R3 position, then that's a different story.

Either way, if you sign a contract you are obligated to stay with that program. If you back out to accept another program's offer, the PD could potentially cause significant problems for you (including reporting you to ERAS, other services that deal with fellowship matches, and other medical organizations). Our PD wouldn't hesitate to call the other PD and tell him/her if you backed out on a contract (assuming he could figure out where you opted to go instead). On the flip side, if it was our PD who rec'd a phone call from another PD stating that you backed out on a contract, he would consider it a lack of integrity on your part and rescind his offer too. Keep in mind you'd be screwing over a lot of people, including the other residents who were counting on your presence. While you think the program can always get another person, they may have lost opportunties for good candidates during the time they thought you were coming.

My advise: call your first choice program and tell them your dilemma. Find out where they're at with their decision and what chances you have. Don't commit to a program unless you're ready to go there. Best in luck with making the decision and I hope it works out the way you want.