Letters of recommendation are a vital part of the application packet. While test scores and other aspects are largely homogenized across all programs, letters of recommendation can speak to a residency applicant’s unique qualities and how those qualities will make them an effective resident physician.
What are residency programs looking for in letters of recommendation? How can students go about finding the right faculty members to give them the kind of comprehensive letters that stand out? Here are some key insights on those questions.
Draw on your rotations
When you go through both your core clerkship rotations and any elective or away rotations, you build relationships with faculty members, according to AMA member Suzanne Allen, MD, MPH, vice dean for academic, rural and regional affairs at the University of Washington School of Medicine.
“As you're going through your regular required rotations—for most students, that's in their third year—think about who that you've worked with might be a good person to write a letter of recommendation for you,” said Dr. Allen, a former chair of the AMA Academic Physicians Section and a family physician from Boise, Idaho.
“In general, those are going to be people that you've spent a significant amount of time with,” she noted. “So for instance, if you were a student at the University of Washington and you were participating in our longitudinal integrated clerkship, we would highly recommend that the person you spend the most time with during that six-month experience is one of your letter writers.”
Get a specialty-specific champion
Published in 2025 in the Journal of Surgical Education, a study of nearly 400 vascular surgery applicants to a single program across three residency-selection cycles found that applicants who received interviews were more likely to have letters from vascular surgeons rather than general surgeons. Applicants invited for interviews also were likelier to have at least one letter from an away rotation, program director, division chief or chair.
“As you do a subinternship or a rotation in whatever specialty you're going into, you also want to make sure you're going to be able to get a strong letter from someone during that rotation as well,” Dr. Allen said.
Some specialties “will require you to get a letter of recommendation from the chair of the department at your medical school—so again, making sure that you're doing a rotation in that specialty where you will work with faculty within the department is going to be important for your application.”
What resonates with PDs?
Not every faculty member—even those with whom you’ve worked closely—writes compelling letters of recommendation. Advisers, often those in the student-affairs office, tend to know which faculty members have a reputation for writing detailed, personal letters that highlight an applicant’s particular strengths and include memorable anecdotes. By seeking their guidance, you will be able to choose a letter writer who can help elevate your application.
The authors of the Journal of Surgical Education study used text-analysis software to evaluate the language used in recommendation letters. Letters for applicants who received interviews were more likely to emphasize teaching, research and curiosity, and they tended to be longer. By contrast, letters that focused more on ability or work ethic-type language were less associated with interview offers.
For those still finalizing the list of programs to which they plan to apply, FREIDA™—the AMA’s comprehensive residency and fellowship database—captures more than 14,000 Accreditation Council for Graduate Medical Education (ACGME)-accredited residency and fellowship programs.
Clout may not equate to a well-written letter
While the most influential recommendation letters often come from a specialty’s department chair, program director, or another faculty member with strong national standing, that prestige alone is not enough.
David Henderson, MD, is the AMA’s vice president for medical education and workforce development. A longtime medical school dean for student affairs, Dr. Henderson said that choosing a prominent faculty member can backfire if they don’t know you well.
“If you get a letter of recommendation from somebody with a big name who doesn’t really know you, it might not be all that helpful, because they may not be well positioned to say anything specific about you that isn’t said about everybody else,” he said. “The advice I always gave students was this: If you can get a letter from somebody with a big title who knows you, that’s great. But it’s most important to get a letter from someone who knows you well and, in many disciplines, someone who has an academic position.”
Dr. Henderson added that a letter writer’s clout may matter more in physician specialties that are considered to be more competitive.
In primary care fields, “a glowing letter from someone in community-based practice can be exceedingly valuable, especially if that person knows you well through a longitudinal experience where you’ve been working with you over several years,” he said. “As disciplines become more selective, though, that kind of letter may carry less weight, because programs with only a few positions and many applicants often look more closely at recommendations from people they know or know of. The process becomes different, the more rarefied the discipline.”
Have the candid conversation
Residency programs are looking for letters of recommendation that sparkle. As you ponder potential letter writers, it’s OK to ask them if they are able to write a strong letter for you, Dr. Allen said.
“I usually recommend to students when they are thinking about asking for a letter of recommendation from a faculty member is actually asking the faculty member if they feel comfortable writing the letter and if they feel like they can actually write a strong letter of recommendation for you,” said Dr. Allen.
“One of the reasons is that what I feel would be enough time for me to write a letter of recommendation for someone—a different faculty member may not feel comfortable with that.”
When you’re asking someone to write your letter, that conversation should happen in person rather than over email.
Give writers necessary information
Your letter writers need to know your qualifications and credentials. They also need adequate time to complete a letter.
“You want to make sure that if you want those letters of recommendation in by September, that you're giving your letter writers at least six weeks,” Dr. Allen said.
“If you want all your letters in by Sept. 1, you would want to let your faculty know: ‘Oh, thank you for writing this letter. Here's my CV, my personal statement. I'm applying in family medicine, and can you please complete this by Sept. 1?’
“If you don't see [submitted in your application platform] that letter then within a month of the faculty member confirming with you that yes, they will [write it] … sometimes a gentle reminder by the end of August can be really helpful for that faculty member.”
