Residency Advisor
The biggest myth about “you are my top choice” emails is that program directors just…believe you.
They don’t. They verify, triangulate, and quietly compare notes in ways applicants never see. And yes, some of you get caught playing games.
Let me walk you through how that actually happens on the other side of ERAS.
The Reality: PDs Assume You’re Lying Until Proven Otherwise
Most PDs I know default to skepticism about “top choice” claims. Not because they’re cynical monsters, but because they’ve seen too many cycles.
They’ve seen:
- The applicant who told three programs “I will 100% rank you #1” in the same region.
- The couple who both swore a program was their top choice, then matched somewhere else entirely.
- The candidate who sends a breathless “you’re my top choice” email in January and then oddly never replies to a February outreach.
After a few years of that, no one takes those letters at face value. A PD at a midwest IM program said it bluntly during a committee meeting I sat in on:
“Everyone has three ‘top choices’ and five ‘perfect fits.’ Show me behavior, not poetry.”
So how do they verify? They don’t have a formal verification system. They have patterns. Back-channel conversations. And they pay close attention to inconsistencies.
The Channels PDs Actually Use To Check Your Story
There isn’t a secret national database of your love letters. But there are ways PDs piece together what’s real and what’s fluff.
1. The Regional Back Channel: “So, Did They Tell You the Same Thing?”
Programs in the same city or region talk. More than you think.
IM PDs from three hospitals in the same metro area? They see each other at:
- Local consortium meetings
- GME committee sessions
- Hospital system leadership calls
- Regional specialty society events
This is where the quiet checks happen.
I’ve literally heard:
“Hey, did you get a ‘you’re my top choice’ from [Applicant Last Name] too? Because we did.”
Sometimes they’re joking. Sometimes they’re not. But if you send that exact same “you’re my top choice” line to multiple programs in the same city or same sub-specialty tier, do not assume it stays private.
No one is exchanging screenshots. But a quick, “Yeah, they told us we were their #1 also,” is enough to reclassify you from “committed” to “just another applicant playing the game.”
And once they put you in that box, your email stops helping and starts hurting.
2. Your Own Communication Trail Gives You Away
This is one PD’s phrase I’ll never forget:
“If we’re really your top choice, you don’t act like everyone else.”
They look at patterns of communication, not just your big dramatic “top choice” email.
Here’s what they quietly track:
- How quickly you responded to interview invitations
- Whether you tried to move your interview earlier or later (and how desperate you sounded)
- Whether you sent any pre-interview interest email at all
- If you asked thoughtful follow-up questions about their program specifically, not generic fluff
- Whether you went dark for six weeks and then reappeared the week before the rank deadline with “you are my absolute top choice”
That last one is a classic red flag. A PD at a coastal EM program once muttered in front of the committee:
“Funny how we only become their top choice after they’ve wrapped up all their other interviews.”
They’re not dumb. They can see the timestamp on your email and they remember when your interview happened relative to everyone else.
 of LOI vs interview, Reputation of home institution input](https://cdn.residencyadvisor.com/images/articles_svg/chart-signals-pds-use-to-judge-sincerity-of-top-choice-c-8990.svg "Signals PDs Use to Judge Sincerity of Top-Choice Claims")
| Category | Value |
|---|---|
| Consistent interest over time | 90 |
| Pre-interview communication | 75 |
| Specific program details referenced | 80 |
| [Timing](https://residencyadvisor.com/resources/letter-of-intent-strategy/timing-mistakes-when-a-letter-of-intent-hurts-more-than-helps) of LOI vs interview | 60 |
| Reputation of home institution input | 50 |
Percentages here are not exact data, but they mirror the rough weight PDs act like they give these factors. Sustained, aligned behavior beats a single flowery email every time.
3. The “Home Institution” and Advisor Network
You think your dean’s letter, your home PD, your sub-I attendings are just quietly supporting you in the background? They’re also part of the information loop.
PDs call each other. Especially for borderline candidates they’re considering bumping up the list based on a “you’re my top choice” email.
Typical conversation:
- “Hey, [Home PD], we’re very interested in [Applicant]. They told us we’re their top choice. You hearing that from others?”
- “They’re really focused on the West Coast this year. I know they loved your program, but they’re also strongly considering [X] and [Y].”
Notice what just happened. Your “top choice” became “one of their strong interests” in three seconds.
No one said you lied. But they downgraded the confidence in your promise. PDs hear tone. They hear how enthusiastically your home PD backs up your story.
If your advisor or home PD has heard you say four different programs are “top three,” that ambivalence can leak out in these conversations. Not because anyone’s trying to burn you, but because your lack of clarity is obvious.
4. Couples Match: The Hidden Pattern They All Watch
If you’re in the Couples Match, your “you are my top choice” claim gets a different kind of scrutiny.
PDs ask themselves: Does this make sense with their partner’s options?
If your partner is applying to derm or ortho or another top-heavy specialty in a completely different region, and you send a “you’re my definite #1” email to a mid-tier program in a location their specialty barely exists… no one believes you.
I watched an IM PD at a solid university-affiliated program say:
“They told us we’re their number one, but their partner’s ortho list doesn’t line up here at all. I’d love to rank them higher, but I do not think they’re coming.”
Does that affect where they rank you? Sometimes, yes. If they’re deciding between two similar candidates and they trust one will actually come, that matters.
They’re not required to think that way, but a lot of them do. They’re thinking, “If we use a high slot on someone who’s almost certainly going elsewhere, we might lose a solid candidate who truly wants to be here.”
Your couple’s strategy and communication has to match reality. Otherwise, your “top choice” letter just becomes noise.
How PDs Use “Top Choice” Letters in Rank Meetings
Let’s be honest: “you’re my top choice” can help you. But only inside a very specific context.
Here’s how it usually plays out behind those closed-door rank meetings.
1. They Don’t Bump a 75th Percentile Applicant Over a Superstar Because of a Letter
PDs are not tanking their rank list because you sent a flattering email at 11:57 PM the night before the rank deadline.
If you’re objectively weaker—mediocre interviews, thin clinical feedback, shaky professionalism flags—no letter saves you. At best, if you’re in the “maybe” pile, it might nudge you a few spots up within your tier.
That’s the key: within your tier.
2. Where the Letter Actually Matters: Ties and Margins
I’ve seen multiple versions of this conversation in both IM and surgery rank meetings:
- “We like Applicant A and Applicant B about the same.”
- “A interviewed slightly better but B sent a very strong letter saying we’re their top choice.”
- “A is probably going to be ranked high at a more competitive coastal program.”
- “Let’s put B one spot above A. Better chance B actually lands here.”
That’s where your “top choice” claim moves the needle: when you’re neck-and-neck with someone else, and they think you’re more likely to actually match with them.
They’re not changing the overall top of their list. They’re smoothing out edges.
Yes, Some PDs Remember the Liars
There’s a fantasy that once Match Day is over, everyone forgets. Not always true.
I’ve heard PDs years later say:
“We’re not ranking them high—two cycles ago they told us we were #1 and then matched across the country. They were clearly blanketing those emails.”
Is that always fair? No. Because the Match algorithm can easily make someone who ranked you #1 match at #2 or #3 if your program ranked them too low. But nuance doesn’t always survive in faculty memory.
If they already had doubts about your honesty or professionalism, your “fake” love letter just adds fuel.
And word spreads in small specialties. Anesthesia. EM. Rad Onc. Some PDs rotate through national committees, they gossip off the record. No one is creating an official blacklist, but reputations congeal.
If you get known as someone who indiscriminately promised everyone “top choice,” you’re not clever. You’re tagged as disingenuous.
How They Tell a Real Letter of Intent from a Copy-Paste Job
Program directors have an almost comical radar for template emails. They see hundreds every season. There are phrases that immediately scream “I sent this to 20 places.”
Here’s how they sort genuine from generic.
1. Specificity About Their Program, Not Generic Adjectives
“Your program is an excellent fit due to your strong clinical training, diverse patient population, and commitment to research.”
That could be sent to 80% of programs.
The letters that get attention say things like:
- “On my interview day, the PGY-3 who spoke about your night float system made me realize I’d actually be well supported when cross-covering.”
- “The way Dr. X described their approach to resident autonomy in the ICU is exactly how I want to be trained.”
- “I’ve talked with your recent grad, [Name], now at [Fellowship Program], and the way they described your culture is what I’m looking for.”
PDs know you can’t fake that level of detail for 15 programs. When you name specifics that only someone paying attention to their program would know, it carries weight.
2. Consistency with Everything Else You’ve Said
If your ERAS personal statement is all about academic medicine and NIH-funded research, and you suddenly tell a community-heavy program “You are my clear top choice because I want to focus solely on clinical practice,” they notice the pivot.
Or if during your interview you asked only about moonlighting and time off, and then your letter is 5 paragraphs about how much you love their research infrastructure… that disconnect is obvious.
Programs compare the story you told on paper, in person, and in your letters. If those stories don’t match, they don’t trust any of them.
What PDs Expect from an Honest “Top Choice” Claim
Let me be very direct: The directors who actually use these letters in decision-making have some unspoken rules. Break them and your letter is trash. Follow them and you may actually get a boost.
| Factor | What PDs Expect |
|---|---|
| Timing | Within 1–3 weeks after interview |
| Frequency | One true top-choice program |
| Specificity | Concrete details unique to that program |
| Consistency | Aligns with your stated career goals |
| Tone | Clear but not manipulative or desperate |
Timing
Send it too early—before interviews are done—and they know you’re guessing. Or worse, posturing.
Send it too late—the week of rank deadline—and it reads as transactional: “I’m done shopping, now I’ll pick someone to flatter.”
Most PDs expect it in a reasonable window after your interview, once you’ve seen a substantial chunk of your options.
Frequency
They assume you only have one true “I will rank you #1” program. If they find out you’ve sent that line to multiple places, you’re done. You’d be shocked how low the trust threshold is here.
If you want to express strong interest elsewhere, say “very highly on my list” or “among my top programs,” not “number one.” They actually respect that kind of precision.
Tone
Desperate, emotional, over-the-top letters make committees nervous. They want maturity, not melodrama.
The best letters are short, clear, and specific. Three to six sentences. Maximum one short paragraph and a line or two. No life story. No begging.
The Subtle Ways of Verifying Without “Verifying”
Here’s the part most applicants never see: PDs rarely directly ask you, “Are we truly your top choice?” But they test the edges.
Some of the ways they feel you out:
- An informal email back: “Thank you, we’re excited you feel that way. Out of curiosity, what stood out to you about our program compared to others?” If your answer is vague, they downgrade your sincerity.
- A chief resident or APD might DM or email you a question like, “Anything else you’re wondering as you finalize your list?” They’re seeing whether your level of curiosity matches your supposed commitment.
- They may check with a mentor who knows you in common: “They say they’re set on the Midwest, that consistent with what you’ve heard?” A lukewarm, “They’re keeping their options open,” undercuts you.
None of that is documented as “verification.” But it’s exactly that.
How This Changes in the Virtual Era
Virtual interviews amplified the importance of these letters. And PDs adjusted how they scrutinize them.
- Because they can’t rely on in-person “gut feel” as much, they lean more on post-interview communication to distinguish real interest from background noise.
- They also receive more letters now, because it’s easier to click send after you’ve done 22 Zoom interviews from your apartment.
So what happened? PDs got pickier about which letters they believe. More noise forces them to become more selective.
I’ve watched PDs open their email during rank meetings and literally say:
“That’s their 5th ‘you’re my top choice’ I’ve gotten this week. This is ridiculous.”
Virtual or not, their strategy hasn’t changed in principle: verify by context, not by taking you at your word.
So How Do You Play This Without Screwing Yourself?
Let me strip this down to something actionable.
- Choose one program—maybe two in rare edge cases—to tell “I will rank you #1.” Mean it.
- Use clear, non-hedged language once you know it’s true.
- Make the letter specific and short.
- For others you really like, say “ranked very highly” or “among my top programs,” and leave it at that.
- Make sure your behavior—questions, timing, follow-up—matches what you claim.
If your “strategy” right now is to send “you’re my top choice” to eight places and hope the algorithm is kind, understand this: PDs have seen that move. They don’t respect it. And sometimes they quietly punish it, especially if they catch you through the back channels.
Final Takeaways
PDs do not blindly trust your “you are my top choice” emails; they cross-check them against your behavior, your home institution’s read on you, and quiet conversations with other programs.
A true letter of intent only helps within your tier, mostly in close calls, and only when your story is specific, consistent, and believable.
Overpromising to multiple programs is not clever—it’s traceable, memorable, and occasionally damaging.
