How to submit strong letters of recommendation (LORs)
A strong letter of recommendation will vouch for your clinical skills and personal qualities.
Letters of recommendation (LORs) offer residency programs insight into your clinical performance, professionalism and potential as a future physician. Here, we answer your questions about how to choose the right people, request strong letters and manage the submission process through the Electronic Residency Application Service® (ERAS®).
What are residency references/letters of recommendation?
Why they matter in your application
Residency references—or letters of recommendation—offer program directors a more personal perspective on your skills and character. While grades and test scores show academic ability, recommendation letters demonstrate how you perform in clinical settings and how others perceive your teamwork, communication and work ethic. Strong letters can set you apart from applicants with similar credentials. The quality of these letters can significantly influence your application’s success.
Who should write your letters?
Most residency programs ask for three letters of recommendation. Ideally, your letters should come from attending physicians who have worked closely with you and can speak directly to your strengths, clinical ability, professionalism and fit for family medicine.
Ideal recommenders include:
Faculty physicians who supervised your clinical work
Department chairs or clerkship directors
Program directors or deans (if they know you personally)
Mentors who can attest to your leadership or community engagement
Avoid choosing someone solely because of their title or prestige. A strong, detailed letter from a faculty mentor is far more valuable than a generic note from a well-known physician.
Be aware of program-specific requirements
Follow the formatting and submission guidelines for each program. Some programs will require letters from particular departments, and others require letters from attendings rather than residents. Occasionally, a letter from a person not involved in the profession of medicine will be requested.
Note: You can only submit four letters of recommendation to any one program through ERAS.
How to choose the right recommenders
Faculty vs. clinical supervisors
Both academic and clinical perspectives add depth to your application. Aim for at least one letter from a family physician who observed you directly in patient care. If possible, include one from a faculty member who can speak to your professionalism, communication skills or commitment to learning. This balance shows that you excel in both academic and clinical settings.
Note: Avoid requesting letters from residents or fellows directly (attendings may consult them but should write the letter).
Best practices for requesting a reference
Ask early. Give at least 4–6 weeks’ notice before deadlines.
Ask in person or via a personalized email. Explain why you value their mentorship and why you’d like them to write your letter.
Provide context. Include your CV, personal statement draft, and details about the residency programs you’re applying to.
Be clear about deadlines and submission instructions.
Express gratitude. Follow up with a sincere thank-you note after submission.
These steps show professionalism and make it easier for your recommender to craft a strong, personalized letter.
Formatting and submission guidelines
What makes a strong letter of recommendation?
A great letter highlights your:
Clinical competence and diagnostic reasoning
Compassion and professionalism
Teamwork and communication skills
Commitment to family medicine and lifelong learning
Letters that include specific examples—like how you handled a challenging patient encounter or contributed to a care team—carry the most weight. Specific stories and observations help reviewers envision you as a resident in their program. Attention to detail shows maturity and respect for the process.
Common mistakes to avoid
Choosing recommenders who barely know you
Submitting generic or repetitive letters
Missing submission deadlines
Forgetting to waive your right to view the letter (programs prefer confidential recommendations)
Managing your references strategically
How many letters do you need?
Most residency programs require three to four letters of recommendation. ERAS allows you to upload up to four letters per program. Tailor your selection to fit each program’s focus—for example, emphasizing family medicine–specific letters when applying to primary care programs.
Timing and deadlines for submission
Encourage your recommenders to submit letters at least two weeks before your ERAS application deadline. Early submission ensures your application is complete when programs begin reviewing materials. Use ERAS to monitor which letters have been received.
Final steps before submission
Proofreading and ensuring accuracy
Before submitting, double-check that:
Each letter is uploaded under the correct recommender name
The correct letters are assigned to each program
All contact information is accurate
Attention to these details prevents unnecessary delays or confusion.
Following up with your recommenders
After submission, thank your recommenders again—ideally with a brief email or handwritten note. Share your match results when the time comes; mentors appreciate seeing where their support helped you land. Maintaining these professional relationships can benefit you throughout your residency and career.