Obtaining Letters of Recommendation for Residency

Residency programs generally require three letters of recommendation (LOR) in addition to your Dean’s Letter (MSPE). Some programs/fields will request four, and some programs will have stipulations concerning their make-up: one may need to be a so-called “chairman’s letter” or come from an outside institution or research mentor.

Obtaining a LOR:

The most important thing in choosing your letter writers is to choose someone who knows you well (and has worked with you clinically). Most people agree that a detailed and specific letter from a lesser-known faculty is superior to generic one from a more distinguished one. If a letter doesn’t say anything special about you that a reader can’t find from your grades or CV, then it doesn’t mean anything. Generic is a wasted opportunity.

Feel comfortable asking directly if your potential writer is comfortable writing a strong letter for you (awkward as that may be). You should generally have an idea who loves you enough to write you a good letter. You can ask graduating students at your school if they have worked with particular attendings that wrote good letters and attempt to work them early during the fourth year if possible.

You will provide each letter writer with a folder containing:

  • Your Name
  • Your ERAS Letter Request Form (LRF) (available when ERAS opens in June)
  • CV
  • Personal Statement
  • Photograph

This means that you should have your personal statement and CV ready by July.

Give them advance notice (ask as early as possible) and don’t be afraid to disclose the relevant deadlines when the time comes. July is earliest date letters can be submitted. It is ideal to have all letters in by September 15 along with your application. Some letter writers will require gentle reminders. Do not be too afraid to do so politely, as your application and future are more important than the awkwardness of writing and sending an email. How early you get your application submitted can and does make a difference, particularly in fields that interview early (e.g. psychiatry, pediatrics, medicine, transitional years).

Letters of Recommendation and ERAS:

  • Your letter writer uploads their LOR into ERAS via the Letter of Recommendation Portal (LoRP). Historically, your school would upload the LOR on behalf of the writer, but this middleman step just resulted in more delays.
  • A maximum of four (but nearly always three) can be submitted through ERAS. Do not send 4 to programs that request 3. (That means that you should actually check the websites of all programs you apply to.)
  • You can collect as many letters as you want and then choose which LOR to send to each program. This can be insurance against a flakey faculty member. No one will know if you don’t use their letter.
  • Letters of Recommendation should mention your specialty. If you are applying to more than one, then you should have slightly different letters for each (can be nearly the same). “So-and-so will make a fine pediatrician” is an awkward line to read if you are the program director of a psychiatry program. ERAS allows you to pick and choose so don’t squander it by sending the wrong letter.
  • You should always check the box saying you waive your right to see the LOR. It implies a level of trust and confidence in your writer that both programs and especially writers appreciate (if you are worried about the quality of the letter, then you should be asking someone else).


Austin Castillo 02.03.18 Reply

Hi Dr. White,
I’m a third year going to apply to DR this coming cycle, and I’m struggling a little bit on deciding who to get my letters from. I already have someone in mind who I worked with both clinically and in research. But for the other two I was wondering if they both needed to be from a radiologist, or just one. I worked with the chair of OBGYN at my school during the OBGYN rotation, and he offered to write me one, but i didn’t know if I should look to get a letter from someone in a specialty more related to radiology, or if it even matters what specialty the letter comes from. What do you think?

Thank you!

Ben 02.03.18 Reply

See the LOR discussion in http://www.benwhite.com/medicine/applying-to-radiology/

1 rads. Med/surg are the more common clinical letter sources, in part because people tend to work longer with attendings. Ob/gyn is fine—a chairman of anything who writes you a good letter is definitely good.

Austin Castillo 02.04.18

Thank you for the reply and help!

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