How to Get a Letter of Recommendation

During your third and fourth years of medical school, it is very important to establish good relationships with all the attending physicians you work with during your clinical rotations. Not only would it reflect positively on your rotation evaluations, which eventually show up on your MSPE letter, but also it would make it much easier to ask your attending for a letter of recommendation (LoR), which you will need when you apply for residencies. Every attending you work with is a potential LoR writer. Here is my experience with getting LoRs.

 How many letters do you need?

Most residency programs that I applied to required 3 letters. Different programs may have different requirements for the LoRs. A few programs say that the letters must have been written within the past one year of applying to residency. Most programs require that there be at least one letter from an attending of the specialty you are applying to, which for me was family medicine. Some programs also require a letter that specifically mentions the specialty you are pursuing in the letter, not just a generic letter that says you’ll be great in any specialty. You can request LoRs from as many attendings as you want, but only a max of 4 can be uploaded onto the Electronic Residency Application Service (ERAS) website, which you use to submit your applications to residency programs. And of those 4, you can choose which 3 you want to send to each program (since most programs only require 3 LoRs, at least for family medicine anyway).

Who should I request LoRs from?

Always request LoRs from attending physicians who you have worked with and who have seen you work. Some attendings feel comfortable writing one after 2 weeks, while others may only feel comfortable after 3. If an attending doesn’t feel comfortable writing you a good one, they will most likely tell you. Do not ask any residents for the LoR, even if you feel you’ve worked with them more. As you move along through your rotations, I would recommend requesting LoRs whenever you deem appropriate. Don’t put it off until the end! If you are not sure what you want to pursue, it’s important to request LoRs from attending physicians of all the specialties you are considering, as well as any “backup” specialties you may have in mind. If you decide to change your mind in terms of which specialty you want later on, you’ll at least have the specific LoRs in hand. It’s also a good idea to have a few generic LoRs as well that don’t specify which field you want to go into, especially if you are planning to apply to multiple specialties.

When should I request an LoR?

ALWAYS request an LoR during your rotation. Any later than that, then your attending may not remember how you performed, or even who you are. I’d recommend requesting an LoR a few days before your last day of the rotation, just in case the attending had some questions for you, or vice versa.

How do LORs get to the residency programs?

Before residency application season, you will have your letter writer send the LoRs to the AUC administrative office in Miami (MEAS). MEAS will keep the letters in their office until application season starts, in which you will request MEAS to upload your LoRs onto the ECFMG site. The LORs are then transferred onto the ERAS website, where they are submitted to residency programs along with the rest of your residency applications. Like I mentioned above, the maximum number of LoRs you can upload onto the ERAS website is 4.

If residency application season has already started, then it is too late to first send the LoR to AUC. Instead, you request your attending to upload their letter electronically and directly onto the ERAS website.

How do I request an LoR from my attending?

I’d recommend putting together an “LoR packet” for your attending to ease their writing process and to give your attending some direction on what to do. Here are some things I would put in the packet:

• ERAS IMG Letter of Recommendation Cover Sheet — There is a template for this that you can find online in PDF form. Fill out the boxes for the date, your letter writer’s name, your name, your AAMC#, and the specialty in which you want to assign the letter. If you are not sure what specialty you want to pursue yet, or just want a generic all-purpose letter that isn’t specific for any specialty, then write “all specialties” in that box. Indicate whether or not you waive the right to see the letter. If you waive it, you won’t be able to read what your letter writer wrote on the LoR. You should always waive it, as it looks better on your part. Sign the cover sheet. There is also instructions for the letter writer on the cover sheet that tell them to send the finished letter to ECFMG, but if application season hasn’t started yet, tell your attending to ignore those instructions and instead send the letter to AUC.

• Envelope addressed to AUC with stamp — If application season hasn’t started yet, you can’t have your LoRs uploaded onto ERAS yet, so you’ll need your letter writer to send the completed LoR to AUC first, who will hold onto them until application season begins. Have an empty envelope ready with a stamp, addressed to here:

Medical Education Administrative Services
901 Ponce de Leon Blvd., Suite 700
Coral Gables, FL 33134

• Your Curriculum Vitae (CV) — Include this so that your attending can better understand your credentials and academic and personal history. This will help them write your recommendation better. If you have a personal statement, you can include that too in the packet.

• Instructions Sheet — I like to include a short instructions sheet, or sometimes even just a post-it note with a few basic instructions on there to guide my letter writer. On the instructions sheet, remind your attending to:
  • Please address letter to “Dear Program Director.”
  • Please attach cover sheet to front of completed letter with a paper clip.
  • Please send completed letter to the administrative office of AUC (Medical Education Administrative Services) in the envelope provided.
  • Please sign in blue ink.
  • Please write on professional letterhead, either from the hospital, institution, or the letter writer’s personal letterhead. This is to ensure program directors that the letter is from a reputable source.

Put the cover sheet, envelope, CV, and instructions sheet into a professional-looking folder (i.e. nice black folder you can get at office depot) or packet. If your attending agrees to write you an LoR, you can go over the content of the LoR packet with him/her.

How do I follow up on the LoR?

Make sure your attending knows how to contact you in case he/she has any additional questions or concerns, and vice versa. After your rotation, send your attending a thank you card or email, thanking them for the awesome experience during the rotation and for offering to write you a letter. After a few weeks or months, you can contact MEAS to confirm if they have received the completed LoR from your attending.

AUC will help you collect all your LoRs until residency application season begins. In the meantime, continue doing well on your rotations and collect as many LoRs as you need. You will eventually figure out which specialty(or specialties) you want to apply to, and decide which 4 of your LoRs you want AUC to upload onto the ECFMG/ERAS Support Services website.

Best of luck!