Who to Ask for a Letter of Recommendation

One of the last critical pieces you will compile into your residency application is letters of recommendation. Choosing who to ask for a recommendation letter can be an extremely anxiety producing process. Letters are very important in the application process, so it is important to be thoughtful in who you ask to write your letters.

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The most important consideration is that your letter writer will write a positive, strong letter of recommendation on your behalf. Ask them specifically, “Would you be willing and able to write me a positive, strong letter of recommendation for my residency application?” Letters of rec are an important part of the application, and you want to make sure that your letters portray you as your best self.

There is a fine balance you want to strike. Some students opt to get an impersonal letter from an attending with an outstanding reputation and widespread notoriety. Others may elect to get letters from people who may not be well known, but the student had an enduring, well-established relationship with that particular mentor. Most people will fall somewhere between these two extremes.

“The most important consideration is that whoever you ask will write a positive, strong letter of recommendation on your behalf.”

Dr. Carter J. Boyd, Founder, Med Student Edge

You have the ability to assign 3-4 letters of recommendation in your ERAS application. In an ideal scenario, you would be able to have a letter from a juggernaut at your institution that may be less personal, but pair it with a letter from an attending you have known for a long period of time.

Some students may not know an attending well enough that they want a letter from or may not even have met someone who they are considering asking for a letter. Reach out early and build a relationship as soon as you can. Shadow. Go to grand rounds. Get on a research project. Be proactive and show you are interested. It is never too late, but the sooner you are interacting with that individual, the more time they have to get to know you and comment on why you would be a great trainee.

Letters of recommendation are a critical part of the evaluation process, particularly in small fields where attendings are well connected with those at other institutions. The key is that the letters of recommendation should be written by physicians that are in the field you are applying to. Though you may have had an outstanding relationship with an ENT physician you worked with, neurology programs won’t know how to assess that letter. The opposite is also true. An ENT program wants to read letters of recommendation from otolaryngologists, not neurologists.

For specialties in which away rotations are encouraged, letters of recommendation from the institutions you rotate at can be very telling of who you are and your caliber as an applicant. A letter from an away institution affords programs a more objective perspective than letters from your home institution. Imagine how many students have a mentor writing a letter of recommendation from their home institution that is making them look good. If someone is not going to write you a positive letter of recommendation, then you should not ask them for a letter.


  • Ask someone you know
  • Consider clout of the attending
  • Have letter writers in your specialty
  • Include away letters if you performed well

Have you asked any attendings for letters of recommendation yet? What people do you think students should be asking? Comment below and share your thoughts.

Back to more residency application resources.

Carter J. Boyd, MD, MBA
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