For physicians, a letter of intent (sometimes referred to as LOI or Offer Letter) is often an interim step in the job search process, between interviewing and accepting a position. A letter of intent is not legally binding but is based on mutual interest and the good faith of both parties involved. There are several advantages for both physicians and employers to include a letter of intent as a part of the hiring process.

• A letter of intent should explain a physician candidate’s potential compensation, benefits, and responsibilities in plain English. Removing the legalese normally included in employment contracts can make the process of accepting a new job a much less daunting experience.
• A letter of intent can provide a window for negotiations on compensation, benefits, responsibilities, no compete clauses, etc. Most employers would prefer to negotiate at this stage of the hiring process rather than at the contract stage, and they certainly hope to avoid rewriting their contract multiple times at the end stages of a physician’s recruitment. Physician candidates also benefit by negotiating at this stage by speeding up the process of determining if this job is right for them.
• The clear language of the LOI helps make both sides comfortable with a decision to move forward on an actual contract and eliminates a major mental hurdle toward accepting a job or hiring a candidate.
• By signing a letter of intent, both sides are promising on good faith to cease pursuit of other jobs or candidates while completing the terms of the final contract. This should relieve the immediate pressures of interviewing or recruiting and help facilitate the acceptance of the formal contract.

My opinion, as an experienced physician recruiter, is that a signed LOI is a very strong indicator that the recruitment journey for that candidate and that particular job has ended.  This does not mean that nothing can go wrong, and neither party should slow down in their efforts once this stage has been reached. Once a letter of intent has been signed, both parties should move towards formal contract review as quickly as possible.  Employers can help make the transition from letter of intent to formal contract smoother by disclosing potential negatives, such as no-compete clauses, during the LOI process, and candidates can also request that those be included in the LOI.  If either party decides to pursue other options after signing an LOI, then ethically they should immediately notify the other party and formally rescind their acceptance.