Objective: The authors studied how often applicants accept positions at more than one program, or programs offer positions to applicants who have already signed contracts with other programs. Methods: An anonymous survey was distributed to all psychosomatic medicine fellowship program directors. Results: It is fairly common for applicants to sign contracts for fellowship positions and then back out of the contracts. Only one program reported ever knowingly offering a contract to an applicant who had accepted a position elsewhere. Programs are divided over whether there are extenuating circumstances under which it would be acceptable to offer a position to an applicant who has already signed a contract with another program. Conclusion: Guidelines for fellowship programs that do not use the National Resident Match Program can improve the recruitment process.