How To Ask For a Letter of Recommendation for Residency Programs

Letters of recommendation (LoRs) are a necessity for entrance into ACGME-accredited residency training programs.  Requirements may vary across programs, specialties, and institutions—some ask for up to four letters to satisfy the requirements of a completed application.  

Previously, we have written about letters of recommendation as viewed from the perspective of a program director.  This post will focus on the applicant’s perspective, specifically how to ask for and secure great letters of recommendation, submit them on time, and have them highlight your strengths to help you best stand out as an applicant.

One: ask early

Most attendings are busy and extended with clinical commitments, research, and administrative and other professional duties. That means your letter request likely won’t be at the top of their minds. And that’s OK. 

Asking well in advance of ERAS opening on September 15th will be to your advantage, as it will prevent delays in submitting your application. If you get a letter turned in right away (rare!) then you’ll be done and will be able to focus on other aspects of your application. 

To really set yourself up for success, send a follow-up email four weeks later. In our personal experiences, when an attending sees that it is the second (or third or fourth) email they become more responsive. 

Two:  Consider a “pre-written letter”

At times, attendings will be too busy to write the letter from scratch themselves.  So, some will propose (or you may politely suggest) that you compose a letter about yourself on their behalf.  In this case, you’ll be able to selectively highlight important achievements and characteristic traits. However, be sure to remain as objective as possible, sticking to facts. 

Refrain from using phrases like “This is one of the best students I have ever worked with.”  That is a part that the attending may choose to add while editing your draft, but do not be presumptuous and assume they want you to add this component yourself. Obviously, in this situation, you should not lie or exaggerate. The letter writer will have full control of edits, but the pre-written letter is always a helpful and accelerative start. It might also be a good strategy to float this idea to the attending if you haven’t seen your letter finished letter as deadlines draw near.

Three:  Compose a slick email up-front

Below is an email template to accelerate the conversation. Why does this work well? It is easy to read. It highlights certain points. And it provides all the necessary information, while giving the attending you are asking the chance to remember you amongst the many other students they have worked with, without the awkward conversation of trying to remind them who you are (obviously, if you know an attending who knows you well, just asking in person works and this step can be skipped).

Hi Dr. X,

My name is X and I am a fourth-year medical student applying to Y.

I am writing to ask if you would be willing to write a letter of recommendation on my behalf?  If you recall, we worked together on while on my _________ rotation. Specifically, I was the student that did ___________.

Here is a shortlist of my highlights and academic achievements:

  • Publication in X
  • Presentation at Y
  • Background significant for Z
  • Unique connection with the writer

Attached is my CV and Personal Statement for your review and convenience as well.

If you are agreeable and can write a favorable letter, could you please have this done by bolded date here, which will allow for timely submission of my application. I would greatly appreciate it.

If you are unable to complete this request I completely understand.  I am also happy to discuss further at your earliest convenience.

Thank you for your time,

Your name

Four: choose wisely

There are many schools of thought on who exactly should write your letters. It’s definitely a good idea to have one to two letters from the field you are applying to. An additional letter from a core rotation (i.e. surgery, medicine) never hurts. If you have a connection with an attending that could speak to you as a person or something not easily seen, ask them as well.

Also, ensure your letter writer is someone you can trust.  You’ll likely have to waive your ability to review this letter when you apply, although some may send you a finalized copy.

And let me address the elephant in the room: the majority of people will not have ‘big name’ writers. Sure, it is a tremendous boost to have these people vouch for you. But, do not despair if you don’t have any renowned people. Perhaps there is a letter writer who is a graduate of the residency program to which you are applying. Or maybe, one who is active in a particular local organization, certain niche research field, or who has strong relationships with program directors or faculty there. Point is – you can make it work.  

One other item you’ll learn is how small a field medicine is; many physicians may know each other from national conferences or other academic events, even if they work at institutions on opposite sides of the country. It is always a good idea to see if any of your letter writers have any connection to the residency programs and institutions you most strongly prefer.

A final point: once you match, it is always a nice gesture to reach out to your letter writers and let them know where are going. 

Have more questions about LoRs?  Here are some other great resources: Kevin MD’s points on how to ask for a great letter, the AAFP’s recommendations for requesting an LoR, and the ECFMG’s tips on asking for letters.

Following these simple steps will streamline securing strong letters of recommendation.  Thalamus is all about streamlining—in fact, our comprehensive interview scheduling platform is in use across the nation, connecting applicants and programs in a way that makes communication clear and easy. Find out how it works.