Residency Letter of Intent

Most residency programs participating in the 2009 match are wrapping up interviews within the next two weeks. If you haven't decided already, think carefully about what program you will rank first. Then, communicate this to the program and associate program directors of that program.

Many clients ask me why this is so important. The worst thing that can happen to a program is to have open positions that require them to enter the scramble. This is devastating to a program's reputation not only with regards to applicants but also with regards to the medical school or hospital with which they are affiliated. When a program director can boast, "we matched our top 3 ranked applicants," it looks really great for the program.

Some programs may rank as the interview season moves along while others may rank all applicants on a single day based on "scores" generated during the season. Almost every program has a "rank day" when all of the faculty gather, review applications, flash your pictures on a wall and determine the final rank order list (ROL). These meetings can become pretty heated as everyone expresses their (sometimes strong) opinions. If a program knows that you will be ranking them first, this may influence your position on their ROL since you become a definite match for the program (if they rank you highly enough).

When should you send these letters of intent? The answer is now. If you send them after the big "ranking meeting" and after a program officially submits their ROL, it may be too late. Never tell a program they are your first choice if this isn't true; this is unethical and can be damaging to your professional reputation.

For programs that aren't your #1 choice, do not include language such as, "I will rank you highly." This tells the program director that the program is not your first choice which is not ideal. It is better to write something such as, "I would be honored to match with you." Don't even mention the word "rank" in your letter to a program that isn't your top pick.

Dr. Freedman helps with all aspects of the residency match process. Visit: www.MedEdits.com