ERAS Letter of Recommendation: The Definitive Guide (2023)

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How to get the best rec letters for medical residency, including a sample letter of recommendation for residency

A smiling doctor wearing a white coat speaking with a medical school student

THE ERAS LETTER OF RECOMMENDATION IS A CRITICAL PART OF YOUR MEDICAL RESIDENCY APPLICATION

Introduction

An important part of applying to residencies is getting physicians to vouch for your clinical skills. Over the course of medical school, you’ve likely developed some great relationships with doctors and professors who will be excited to write on your behalf. But when, how, and who exactly to ask can be a challenge. Perhaps you’ve been diligent, requesting letters of recommendation from the beginning of your rotations. Or maybe you’re requesting letters of recommendation a few months before ERAS begins processing medical residency applications on September 15th.

Regardless of where you are in the process, you likely have questions like:

  • “I had good working relationships with a number of doctors throughout the last four years, but I never got to know any of them personally. How well does someone need to know me in order to write for me?”

  • “I have a good relationship with Dr. Gupta, but she’s spread thin and is known to write short, and not always warm letters. I don’t know Dr. Braswell as well, but he has connections at Stanford, which is my ideal residency program. Who’s the better person to write for me?”

  • “Should I get a recommendation letter from Dr. Lee? I don’t think I did a stellar job when he was supervising my radiology rotation, but I’m applying for a radiology residency and I feel like the two radiology-specific letters I have might not be enough.”

  • “One of my recommenders fell off the map. Will it be too late to submit their letter of recommendation if they get it to me next month?”

We’ve written a comprehensive guide to the ERAS letter of recommendation to answer these questions and more. Though letters of recommendation are one of the materials in the residency application process that you don’t have much control over, it’s important to know as much about these letters as possible.

In the NRMP’s 2021 Program Director Survey, letters of recommendation were rated the most important factor in selecting which candidates to interview, with 85 percent of program directors stating that they took letters of rec into account. Additionally, letters of recommendation received an average “importance rating” of 4.2, on a scale of 1–5.

Why are these letters so significant? Because everything you’ve done up to this point on the road to becoming a doctor has been more or less academic—you’ve been in the classroom, studying, acing tests, and so on. But now residency programs are hiring you as part of a job application process. That’s why references and evidence of how you’ve worked with others are crucial.

This guide covers the ins and outs of the ERAS letter of recommendation to make sure that your second-most important application piece shines.

Click on any question below to jump directly to it.

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How many letters of recommendation do I need for the residency application?

You need at least three letters of recommendation per residency, and you can submit up to four per residency. You can check school-specific requirements using the AMA’s FREIDA database.

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From whom should I request ERAS letters of recommendation?

You should request letters of recommendation from those who have worked with you in clinical settings, know you well, and can persuasively articulate your strengths. Though three letters are conventional, you will want to ask for more than three letters in case a recommender goes M.I.A. as the deadline to submit approaches or you’re concerned that one of your letter writers may not write a strong letter of recommendation. (It’s worth mentioning: if you believe a writer will not write you a strong letter of recommendation, ask someone else.)

We suggest requesting letters from 4–5 recommenders for each specialty to which you plan to apply.

Finally, you want to make sure that you’ve worked with the writers of your letters within one year of applying to residencies.

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Do I have to send letters exclusively from physicians working in my chosen specialty?

No, you do not have to send letters exclusive to your chosen specialty, but you should have at least one letter of recommendation from a physician in your specialty of choice. Ideally, you should have two letters of recommendation from physicians in your specialty of interest, most likely attendings with whom you worked on your rotations.

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When should I request letters of recommendation for residency?

You should request letters of recommendation at least one month before September 29th. Ideally, you would request letters of recommendation at the very beginning of a rotation, especially if you know it’s a specialty you hope to pursue for residency. Though asking for a letter before you’ve even worked with a physician may seem counterintuitive, there are certain perks to doing so, including the following:

  • Making your intentions clear since the beginning indicates to letter writers that you have a strong and genuine interest in their specialty, and they can then comment on this in your letter.

  • Letter writers will make a greater effort to assess your performance during the rotation, and their deep knowledge of your performance will come across more strongly in their letter than it otherwise might if you ask them for a letter after the fact.

  • It will challenge you to perform your best during the rotation if you know from the get-go that your performance will be included in a letter to residencies.

  • It incentivizes you to seek feedback on your performance throughout the rotation, which can both make you a stronger applicant and result in higher quality letters.

However, it’s understandable if you’d rather wait until after a rotation is done to request a letter of recommendation, especially if you’re interested in seeing the grade you received in a rotation or elective before doing so. If you’re uncomfortable or unsure about requesting a letter of recommendation from the beginning of a rotation, you should request letters at the end of rotations in which you’ve performed well. Just be sure that you’ve communicated the seriousness of your interest in that specialty well in advance of requesting the letter. If you take this approach, you may have your letter writers save the letter for you in their files or with an advising service at your school if available.

In addition, some attendings may offer to write you a letter of recommendation after your rotation. If this happens, accept their offer. Even if you decide to submit other letters when you ultimately send in your application, having that additional letter available may help reduce stress if a writer is lagging on their submission. Plus, anyone who volunteers to write for you is likely pretty excited about your candidacy.

Finally, if you submit letters well in advance of the deadline, make sure to communicate with letter writers before they submit to have them update the dates on the letter and include any additional information, especially if you’ve made recent additions to your CV and certainly if you have a polished personal statement to show them.

(Further reading: The Ideal ERAS Timeline)

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When is the ERAS letter of recommendation deadline?

Letters are accepted throughout the application process, but you never want to be the applicant who sabotages their match by submitting late. And “late,” in the case of the residency application, is September 28th, the first day that ERAS sends applications to programs. Make sure to communicate with your letter writers to upload their letters before September 28th to make sure you’re in the running for those early interview notifications. Many programs require that an applicant have a minimum of two letters uploaded before they will schedule an interview, which is yet another reason not to miss the September 28th date.

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How many letters of recommendation should I send to residency programs?

We recommend sending four letters of recommendation, even if three is conventional. That additional letter, assuming it’s as strong as the others, will make you a more competitive applicant.

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Can I send different letters to different residency programs?

Yes. While you can only send four letters of recommendation to any given program, ERAS allows you to store as many letters as you’d like and to pick and choose which letters you’d like to send to each program.

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Does the MSPE count as a letter of recommendation?

The Medical School Performance Evaluation (MSPE), also known as the Dean’s Letter, is one of the required materials you’ll need to submit as part of your ERAS application. However, the MSPE does not count towards your four letters of recommendation.

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Does a department letter count as a letter of recommendation?

Some residency programs will ask you to submit a “department letter” or “chair’s letter,” which is a letter of recommendation written by the chair of the department (i.e. the specialty) you’ve chosen to go into. While department letters are often standardized, this letter does count as one of your four letters of recommendation.

Because many medical schools have an established protocol that facilitates the writing of department letters, first check in with your department’s administrative staff or your school’s clerkship director. If no such protocol is in place, you can reach out to the department chair via email, adjusting the script given below, to request a meeting. It’s okay if you have no prior relationship with the chair—they will be familiar with the requirement and will have written plenty of these letters before.

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What types of recommendation letters for residency should I avoid?

Don’t ask someone with whom you have not worked closely to write you a letter of recommendation, even if they’re superstars in their specialty—you’ll fare better having a letter from someone who knows you well and can speak to your strengths in detail, even if theirs isn’t the splashiest name in the field. Avoid accepting letters of recommendation from writers who hesitate when you ask if they can write you a “strong letter of recommendation.” A lukewarm letter will reflect poorly on your potential.      

Finally, consider avoiding letters from someone who is difficult to communicate with or unresponsive to your emails or requests to meet in person. This is not, however, a rule. Sometimes these people are flaky schedulers because they’re passionate about their field and may still be able to write a strong letter for you. In other cases, though, these people can be scattered, which may affect their ability to write about your specific strengths. In borderline situations like this, it’s better to request more letters of recommendation in the event that one of your writers doesn’t come through, rather than to count them out entirely.

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Should I ask for a residency recommendation letter in person or via email?

Ask for letters from professors in person whenever possible, and definitely if it’s been a while since you’ve interacted with them.

Before you ask for a letter of recommendation, prepare a packet for your recommenders that includes:

  • Your CV or resume

  • Your final or near-final personal statement

  • Letter request form from ERAS

  • A biographical sketch including career goals

  • Copy of USMLE Step 1 and Step 2 scores if available

  • Medical school transcript

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How should I ask for an ERAS letter of recommendation in person?

Below are email scripts you can use to arrange an in-person meeting:

Word-for-word email script when planning to ask someone you know well in person

Dear [Professor/Physician’s Name],

I hope this message finds you well. I’m applying to medical residencies in [specialty] this fall and was wondering if you’d be willing to share your insights on the process. I’ve always valued your perspective and your guidance would be much appreciated as I begin drafting materials. If you are willing, please let me know when you would be available to meet in person. Thank you for your consideration!

Best,

[Your Name/Last Name]

Word-for-word email script when planning to ask someone in person whom you haven’t seen or spoken with in a while

Dear [Professor/Physician’s Name],

I hope this message finds you well. My name is [Name/Last Name], and I participated in your [rotation/elective/class] during [Semester/year]. I really enjoyed working with you and learning about [specific and authentic details about your experience]. Since we last talked, [major update in your professional life, i.e. ‘I did rotations in San Francisco in [specialty] and became certain I want to pursue [xyz].’]

I’m applying to residency programs this fall and was hoping you’d be wiling to offer your perspective on the process. If so, please let me know when you would be available to meet in person. Thank you for your consideration!

Best,

[Your Name/Last Name]

Additional guidance for asking in person

Whenever you meet in person with someone to request a letter, it’s important to let them know why you would value a letter from them. You’ll want to explain why you feel they are best equipped to speak about the specific qualities and experiences that would make you an excellent fit for the programs to which you are applying.

Don’t be afraid to request that they highlight specific qualities and experiences in the letter. This will work in your favor when the content of the letter confirms how you describe yourself throughout the rest of your application.

Once a letter writer agrees to write you a letter, provide them with the materials mentioned earlier.

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How should I ask for a residency recommendation letter via email?

Here is an exact email script you can use to request a letter via email:

Word-for-word email script when planning to ask someone you know well via email

Dear [Professor/Physician’s Name],

I hope this email finds you well. I’m applying to residency programs this fall and was wondering if you’d feel comfortable writing a strong letter of recommendation. [Authentic sentence describing why you would value a letter from them (e.g., why you value their perspective, which of your qualities they can speak to, etc.)].

If you’re willing to provide a letter, I will provide the following supporting materials: 1) my CV, 2) a draft of my personal statement, 3) the letter form for ERAS, 4) a biographical sketch for more context, 5) a copy of my USMLE scores, and 6) my transcript. Thanks for your consideration!

Best,

[Your name/last name]

(Note: We have not included a script for requesting a letter via email from a professor who may not remember you because you shouldn’t ask them for one.)

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When and how should I remind my recommenders to submit?

Recommendation letter writers often procrastinate on submitting letters on time. Therefore, you should email them using the following email script two to three weeks before September 29th:

Dear [Professor/Physician’s Name],

I hope this email finds you well. I plan on certifying my ERAS application by September 29th, so I wanted to send a reminder regarding your recommendation letter. Please let me know if there’s any additional information I can provide.

Thanks again for your support!

Best,

[Your Name/Last Name]

On top of this first reminder email, feel free to send additional reminder emails every one to two weeks if you don’t hear back from a letter writer. If you’re unable to get a response via email, call them. Just say you’re aware it’s a busy time, but you want to be sure nothing falls through the cracks.

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Should my recommendation letters be addressed to specific residency programs?

No, this is not expected.

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Will I be able to view my ERAS letters of recommendation?

You can, but you shouldn’t. You should waive your right to read your letters. Not waiving your right is a red flag.

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What should I include in my thank you notes to recommenders?

Once a person submits a letter on your behalf, you can use the following thank you note script to express appreciation (personalize this however you’d like):

Dear [Professor/Physician’s Name],

Thanks again for offering your perspectives on the residency application process and for submitting a letter of recommendation on my behalf. I am very grateful for your guidance and support throughout this process.

I’ll make sure to inform you of any updates!

Best,

[Your Name/Last Name]

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What is included in a letter of recommendation?

Here is a sample letter of recommendation for residency:

Dear Program Director,

I am writing in support of Ms. Rachel Armendariz for your residency program. I have 15 years of experience in pulmonary and critical care medicine and a background in translational research. I worked closely with Ms. Armendariz during her third-year clerkship and during her pulmonary elective. In addition to her many accomplishments, Ms. Armendariz’s clinical abilities, leadership, advocacy, and patient focus set her apart. I have observed Ms. Armendariz during workups, taught her in class, and I oversaw her clerkship.

Ms. Armendariz’s excellence goes well beyond her outstanding USMLE scores. She is warm and engaged with patients and colleagues. In addition, she is capable of synthesizing new information. In part, this is a product of her meticulous preparation; before Ms. Armendariz had even encountered pulmonary edema, she had already assimilated the key points of responding to respiratory failure into a detailed poster for our care team, ensuring even those new to the rotation could easily be brought up to speed. 

Moreover, Ms. Armendariz has made advocacy a key part of her medical education. When she discovered that a series of arrhythmia pamphlets were available in English only, Ms. Armendariz communicated with the head of Cardiology about the lack of Spanish-language informational materials and even recommended a fellow classmate with translation experience to address the discrepancy. Her leadership in addressing gaps in care has prompted several positive responses, especially during inpatient procedures. In fact, Ms. Armendariz’s intuitive sense of patient needs made her an informal mentor to students entering the clerkship after she had finished.

Ms. Armendariz’s skill also extends to research. She has designed a study on the effectiveness of auxiliary treatments during outpatient procedures to assist our hospital in providing more comprehensive care.

Ms. Armendariz is in the top 10% of medical students with whom I have worked in the last 15 years. Her attention to detail, willingness to learn, and well-rounded approach to patient care, including research design and developing best practices, make her an outstanding candidate for residency. I give her my highest recommendation for your program.

If you require any further information, please do not hesitate to contact me.

Sincerely,

Jackson Abrams, M.D.