Residency Letters of Recommendation: Everything You Need to Know

Letters of recommendation (LoRs) are becoming an exceedingly important part of a candidate’s residency application. Why, you may ask? Well, all students have objective measures–USMLE scores, M3 clinical grades, number of volunteer/research/work experiences, etc–that speak on their own. However, LoR are unique in that they allow residency programs to gain insight into the personal characteristics of each candidate. This can make a student seem particularly suited for a residency program’s culture and vibe. Additionally, a LoR can highlight the candidate’s most important accomplishments and focus on his or her strengths, lending a much clearer picture of what the applicant is actually like, behind test scores and extracurricular activities. This information can be very important when a residency program is trying to differentiate among a list of applicants, especially one in which the list contains applicants with similar test scores and grades.

Who to ask for a LoR?

• In general, you should ask someone who knows you well and can speak positively about your strengths and accomplishments either in a clinical setting or from a research/academic experience.
• It can be helpful to discuss your LoR options with a faculty advisor in the specialty you are applying into because the requirements vary (ex: some specialties only care about LoRs within their specialty, whereas others are open to LoRs from multiple specialties)
• If you had a main research mentor this individual often writes a letter
• If you took a year (or more) out of medical school to do something else, such as research or another degree, it is often advisable to have one letter from this experience to touch on what you accomplished
• The bulk of the letters should come from faculty within the speciality to which you are applying, who know you well. It is not necessary to have a letter outside of the field you are applying into to show that you are a well-rounded applicant, but this sometimes can be useful
• Keep in mind that just because a mentor/doctor you worked with may have a “big name”, this does not always necessarily mean they will write you a beneficial/helpful LoR, especially if they don’t know you well enough to make it personalized and play up your strengths.
  • However, in smaller specialities, such as surgical subspecialities, it’s more common that attendings know one-another across the country and having a positive review from a well-respected colleague will make you stand out.
  • Furthermore, often big-name individuals (eg. Chairs of Departments) will often ask YOU to draft the LoR for them (they don’t have time to write these things) and they will merely sign their name. Granted, they have to at least know you/respect you enough to let you write your own letter, but if somebody in the department they respect puts in a good word for you, this may fly.

How to ask for a LoR?

• When asking for a LoR, try to do it face to face and ask specifically if they would be willing to write you a “strong letter” of support. Also, ask them what they would need from you (CV, PS, etc).
• It is helpful to provide letter-writers with a succinct cover letter or bulleted list which states what you’d like them to cover. Even if you know them well, this can help guide the letter and emphasize aspects of your CV or application.

How many LoR do I need?

• Ideally you should have 3-4 LoR. However, when it comes time to submit your letters, don’t just upload the max allowed (4) for every program. Check on program sites prior and upload what programs require. For example,  some specialties, they may specifically say they only want 3 total letters, 2 from the specialty that you are applying to and one department chair letter, so sending 4 letters may look like you didn’t take the time to visit their website and learn about the program.

When to ask for a LoR?

• It is best to have an idea of who you would like your LoR writers to be by July prior to your application cycle. If you already asked them for a LoR previously, this can be a time for you to touch base with them again and confirm this.
• If you are starting a clinical rotation and know that one of your objectives is to identify and impress a doctor so that they would be willing to write you a LoR, then this is something you can bring up with them during the rotation (closer to the end), regardless of what month it is.
• Ideally, you want your letters finished and uploaded by the time you submit your application in mid September (but it’s not a big deal if the timing is slightly off). Therefore, you need to make sure you give your LoR writers enough time to write a letter after asking them (ie at least ~2-3 weeks)

Other tips about LoRs:

• Your dean’s letter (MSPE) does not count as one of your LoR.
• Send your LoR writer a thank you note (can be a simple email, snail mail, etc)
• If you have geographic limitations or are couples matching and are comfortable sharing this fact with your LoR writer, consider asking them to comment about this in their letter (programs want to feel like you are actually interested in coming to a certain part of the country, especially if you are not originally from there).
• If you did an away rotation, often one letter comes from the away rotation, however this is not necessary. Use discernment when using a letter from an away rotation at anywhere besides the place the away is from – it can (but not always!) be interpreted as being interested in that program instead of the program you are interviewing at.