Why Are Residency Letters of Recommendation So Important?

Letters of Recommendation (LoRs) are a critical component of every residency candidate’s ERAS Application. In fact, Program Directors consistently rank specialty-specific LoRs as one of the most important factors for inviting candidates to interviews: in 2020, 84% of PD’s cited LoRs as an important interview invitation factor with an importance value of 4.3 out of 5.

Furthermore, specialty-specific LoRs are consistently among the Top 5 Most Important factors for ranking an applicant, according to NRMP Program Director Surveys year after year.

ERAS Letters of Recommendation serve several key functions in your residency application:

• Demonstrate experiences specific to the specialty to which you are applying
• Demonstrate good rapport with multiple physicians
• Showcase work ethic, commitment to the specialty, and contributions to medicine
• Exemplify personal characteristics, academic performance, and involvement
• Reinforce and integrate aspects of your ERAS Application and Personal Statement

Your ERAS LoRs are 1-2 page letters written by those you have worked with in the field. You should apply with 2 or more specialty-specific LoRs out of the 3 or 4 total LoRs you submit with each application.

** DO NOT SUBMIT LoRs recommending you for a different specialty than the one which you are applying to.**

Instead, ask your LoR authors to write 2 versions of your LoR. For example, the first LoR could be recommending you for Internal Medicine (especially if they are an internist) while the second LoR is a general recommendation for any specialty. Asking your authors to make a few small tweaks to their LoR (usually just a few sentences each) is an excellent way to help tailor your application to your top specialty as well as any backups to which you may be applying.

Who Should Write Letters of Recommendation? (and who should not)

The author of your LoRs is very important. It helps establish credibility, relevance to the chosen specialty, and can even serve as a bridge for further confirmation/investigation by programs of interest.

Generally speaking, your LoR Authors should be:

• Practicing in the specialty to which you are applying
• A higher rank/status than yourself (attendings, advisors, managers, etc.)
• Medical professionals – This can mean being a physician, researcher, public health advocate, etc.

The BEST Letters of Recommendation are from:

• Specialty-specific clinical settings in the United States
• High ranked authors who know you very well and have worked with you in an extended clinical setting (PDs, Department Heads/Chairs, Attendings)
• Recent – Within 1 year (or 2 years maximum)

Letter of Recommendation Authors should NOT be:

• Peers, family, or friends (use your best judgement)
• Written by those who do not know you or who have had little interaction with you
• Written with errors in spelling, grammar, and syntax

Basically, the strongest ERAS Letters of Recommendation will come from specialty-specific physicians in the USA who have worked with you extensively and can craft a very detailed, personable, precise, and persuasive reference toward your candidacy – which leads to our next important topic – how to actually get these Letters of Recommendation.