Letters of Reference

Programs may ask you to submit both personal and professional letters of reference (LoR).

These letters can be very valuable to program directors looking for distinguishing characteristics among the many applications they receive. While CVs and personal statements have many similarities from candidate to candidate, the letters of reference are an opportunity to qualify those distinguishing factors that set you as a candidate apart. The quality of your letters of reference may be the strength of your application.

The following tips on letters of reference were developed by the Department of Family Medicine, with contributions from medical students, at the University of Washington (Leversee, Clayton, and Lew, Reducing Match Anxiety, University of Washington, Department of Family Medicine).


  • Your letters of reference often become an important reflection of your academic performance and can also serve as an important source of information about your noncognitive qualities.

Number of Letters

  • Most residency programs request three letters of reference. Sometimes they specify certain departments or rotations from which the letters should originate. You will only be able to submit four LoRs to any given program through ERAS®.
  • Be sure to follow instructions for each program. For example, some programs will require letters from particular departments; others require letters from attendings rather than residents. Occasionally, a letter from a person not involved in the profession of medicine will be requested.
  • Do not send more letters than requested unless you have one that is especially dazzling. Some selection committees suspect “the thicker the application, the thicker the student.” Some programs review only the first letters to arrive up to the number they request, and subsequent letters are ignored.

Time Line

  • Starting
    • It is easy to procrastinate. Common reasons include:
      • "I don't know anyone well enough to ask for a letter."
      • "I hate asking for recommendation letters...I'll wait until August."
      • "I did well on surgery, but that was six months ago. They won't remember me."
      • "Dr. Scholarmann is on sabbatical, and I'll just wait until he gets back."
      • "I'm an average student, so I'll just get a two-liner from one of my attendings later on. A quick phone call will solve that problem when the time comes."
      • "I'll really impress them on my next rotation and get the best letter yet."
    • As a courtesy, make arrangements to obtain letters as soon as possible. You may begin now by requesting letters from previous rotations. There may be a reason to postpone a letter request until you have had a specific rotation if it is obviously an important one for your particular interest, but there is no harm in requesting letters early on to be safe.
    • Allow at least a month from the time you request a letter until it must be delivered. Bear in mind that faculty are busy, may travel or be unavailable at the initial time of request, and usually have multiple letters to write.
  • Requesting a Letter
    • In most instances, you will request a letter from a rotation in which you did well that relates to your chosen field or that was requested by a specific program’s application requirements.
    • When possible, choose someone who knows you well instead of someone who doesn’t. Choosing at least one person who is likely to be recognized by the program is also a good idea. Choose someone who can judge your clinical skills and intentions, not just a friend.
    • Request a letter from a mentor in your specialty of choice.
    • Avoid requesting a letter from a resident or fellow. They may have the best knowledge of your clinical skills, but the attending should write your letter. Help the attending by providing the names of the residents and fellows with whom you worked so he or she can consult them for input if needed.
    • Help the person preparing your letter by providing a CV, a personal statement, and a photograph.
    • Make a 15-minute appointment with the letter writer to review your CV personally. Help the letter writer with additional personal information, particularly if you can remind him or her of a specific event or situation in which you think you performed well on his or her rotation.


MyERAS allows you to request as many letters of reference as you deem necessary; however, MyERAS will allow you to assign a limited number of letters to each program. As an applicant, you will enter the letter of recommendation (LoR) authors you’ve chosen into MyERAS. The system will then generate a Letter Request Form you can email, mail, or deliver in person to each of the authors you choose. You will also need to select whether to waive your rights to see the completed letter upon submission by the author, though the author may choose to share the letter directly with you for your reference and to show their support.

Letter submission must be completed through the Letter of Recommendation Portal online. LoR authors must register through ERAS on the Letter of Recommendation Portal and use a letter ID you provide on the original Letter Request Form. They may also submit their letters to your school’s designated dean’s office for submission directly to the ERAS PostOffice.

New letters may be submitted on your behalf at any point during application season.

Strolling Through the Match

This publication was developed to help you make appropriate decisions about your professional career and to learn more about the process of getting post-graduate training.

Download the document(80 page PDF) or order a free copy through the AAFP catalog.