Learn how to secure strong ERAS letters of recommendation for residency, including request tips, sample scripts, and strategies to impress programs.
The ERAS letter of recommendation is a critical part of your medical residency application
What You'll Learn
How Many Letters You Need
The minimum most programs expect, the maximum ERAS allows per program, and why you should only send the full set when every letter is strong.
Who Should Write Your Letters
Why attendings who supervised you closely beat big names, plus when you need specialty-specific, department chair, or standardized letters like the SLOE.
When Letters Are Really Due
Why the date programs begin receiving applications is the deadline that matters, how far ahead to ask, and how recent your letters should be.
How to Ask the Right Way
A step-by-step approach to requesting letters in person or by email, what goes in your request packet, and sample emails you can adapt.
How Letters Move Through ERAS
How the Letter Request Form, the Letter Writer Portal, and MyERAS fit together, and why you should waive your right to view your letters.
What Makes a Letter Strong
What program directors look for, including specific examples and a comparative ranking, with a template and an annotated sample letter.
ERAS letters of recommendation at a glance
ERAS LOR summary table
How many letters of recommendation do you need for residency?
Who should write your residency letters of recommendation?
ERAS letter of recommendation deadline and timeline
How to ask for a letter of recommendation for residency
How the ERAS Letter Request Form and Letter Writer Portal work
What makes a strong letter of recommendation for residency?
Managing your letter writers after they say yes
ERAS letter of recommendation FAQs
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ERAS letters of recommendation at a glance
Most residency programs require three letters of recommendation, and ERAS lets you send up to four to each program. Your letters should come from physicians who supervised you clinically within the past year, ideally including at least one or two in your chosen specialty. Letter writers upload directly to the AAMC Letter Writer Portal (the ERAS LOR portal will no longer be available starting in 2027), and every letter should be in before programs begin receiving applications in late September 2027.
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An important part of applying to residencies is getting physicians to vouch for your clinical skills. Over the course of medical school, you’ve likely developed some great relationships with doctors and professors who will be excited to write on your behalf. But when, how, and who exactly to ask can be a challenge. Perhaps you’ve been diligent, requesting letters of recommendation from the beginning of your rotations. Or maybe you’re requesting letters of recommendation a few months before ERAS begins processing medical residency applications in late September.
Regardless of where you are in the process, you likely have questions like:
“I had good working relationships with a number of doctors throughout the last four years, but I never got to know any of them personally. How well does someone need to know me in order to write for me?”
“I have a good relationship with Dr. Gupta, but she’s spread thin and is known to write short, and not always warm letters. I don’t know Dr. Braswell as well, but he has connections at Stanford, which is my ideal residency program. Who’s the better person to write for me?”
“Should I get a recommendation letter from Dr. Lee? I don’t think I did a stellar job when he was supervising my radiology rotation, but I’m applying for a radiology residency and I feel like the two radiology-specific letters I have might not be enough.”
“One of my recommenders fell off the map. Will it be too late to submit their letter of recommendation if they get it to me next month?”
We’ve written a comprehensive guide to the ERAS letter of recommendation to answer these questions and more. Though letters of recommendation are one of the materials in the residency application process that you don’t have much control over, it’s important to know as much about these letters as possible.
In the NRMP’s 2024 Program Director Survey, letters of recommendation were rated the second most important factor in selecting which candidates to interview, with 84 percent of program directors stating that they took letters of rec into account. (The Medical Student Performance Evaluation or Dean’s Letter was rated as the most important factor for 85 percent of program directors.) Additionally, letters of recommendation received an average “importance rating” of 4.2, on a scale of 1–5.
Why are these letters so significant? Because everything you’ve done up to this point on the road to becoming a doctor has been more or less academic—you’ve been in the classroom, studying, acing tests, and so on. But now residency programs are hiring you as part of a job application process. That’s why references and evidence of how you’ve worked with others are crucial.
This guide covers the ins and outs of the ERAS letter of recommendation to make sure that your second-most important application piece shines.
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ERAS LOR summary table
| ERAS Letters of Recommendation Quick Facts | |
|---|---|
| How many letters are required? | |
| Maximum per program | |
| How many to request | |
| Who should write them | |
| Specialty letters | |
| Standardized letters | |
| How recent | |
| How they are submitted | |
| Target date | |
| Can you see them? |
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How many letters of recommendation do you need for residency?
You need at least three letters of recommendation for most residency programs, and you can assign up to four to each program in ERAS. Requirements vary by program, so check each program's website or its listing in the AMA's FREIDA database before you finalize your letter plan.
Should you send 3 or 4 letters of recommendation?
Send four letters when you have four strong ones. Three is the common minimum, and a fourth strong letter adds another credible voice to your application at no cost.
Don't add a fourth letter just to fill the slot. A generic or lukewarm letter can weaken an application that three strong letters would have carried. If your fourth option is a writer who barely knows you, stop at three.
How many letters of recommendation do you need by specialty?
Most specialties expect three to four letters, but many also expect specific letter types. For instance, internal medicine requires 3–4 total letters, typically 2 of which should be IM attendings, with many academic programs also requesting a Department of Medicine chair letter or a letter from a research mentor. Always confirm with individual programs, because requirements change from cycle to cycle.
If you're applying to a preliminary or transitional year alongside an advanced specialty, plan a separate letter set for each. Prelim programs usually want letters from the field they're housed in, such as medicine or surgery.
Can you send different letters to different programs?
Yes, ERAS stores all of your uploaded letters, and you choose which four (or fewer) go to each program. This lets you send specialty-specific letters to each specialty or a letter from a writer with ties to a particular program.
Can you submit ERAS without letters of recommendation?
Yes, you can certify and submit your ERAS application before all of your letters are uploaded. Programs see each assigned letter as soon as your writer uploads it.
That said, don't treat it as a plan. Many programs won't review an application or won't offer an interview until a minimum number of letters arrive. Submit on time, then follow up with any writer whose letter is still missing.
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Who should write your residency letters of recommendation?
Ask attending physicians who supervised you closely in a clinical setting, know your work well, and will write you a strong letter. A detailed letter from someone who watched you care for patients beats a vague letter from a famous name every time.
Request letters from four to five writers per specialty you're applying to. That cushion protects you if a writer goes silent near the deadline or you decide one letter isn't your strongest.
Do your letters have to come from your chosen specialty?
No, but at least one should, and ideally two (some specialties like internal medicine typically require two). Program directors want evidence that physicians in their field have seen you work and believe you'll succeed in it. Your remaining letters can come from other clinical rotations, a sub-internship, or a research mentor.
Department chair letters: What they are and how to request one
A department chair letter is a letter from the chair of the department in your chosen specialty, often summarizing your performance across rotations and feedback from faculty. Some programs require one, most commonly in internal medicine and surgery. A chair letter counts as one of your four letters.
Many schools have a set process for chair letters, so start with your department's administrative staff or clerkship director. If there's no process, email the chair to request a meeting, adapting the scripts later in this guide. You don't need a prior relationship with the chair; they write these letters every year.
Bring your CV, personal statement draft, rotation evaluations, and a short list of programs you're targeting. The chair will often meet with you briefly and gather input from faculty who supervised you.
What are SLOEs and SLORs (standardized letters)?
Standardized letters use a fixed form so programs can compare applicants on the same criteria, such as clinical skills, work ethic, and a ranking against other students the writer has evaluated. The best-known example is the Standardized Letter of Evaluation (SLOE) in emergency medicine. Several other specialties, including orthopedic surgery and otolaryngology, use or encourage their own standardized letters.
Standardized letters are usually written after a rotation in that specialty, often an away rotation, and frequently by a group of faculty rather than one person. If your specialty uses them, schedule rotations early enough that the letter can be written and uploaded before programs receive applications.
Can residents, PhDs, or research mentors write your letters?
Residents can contribute, but a letter signed only by a resident carries little weight. If a resident knows your work best, ask whether they and their supervising attending can write or co-sign a letter together.
PhD faculty and research mentors can write one of your letters, especially if you're applying to research-heavy or academic programs. Treat it as a supplement to your clinical letters, not a replacement.
Does the MSPE count as a letter of recommendation?
No, the Medical Student Performance Evaluation (MSPE), also called the Dean's Letter, is a separate, required part of your ERAS application. It doesn't count toward your four letters.
Which letter writers should you avoid?
Avoid anyone who hasn't worked closely with you, however prominent they are. Avoid anyone who hesitates when you ask whether they can write a strong letter; a lukewarm letter hurts more than it helps.
Be cautious with writers who are hard to reach. Some busy physicians are slow to respond yet write excellent letters, so you don't need to rule them out. Just request an extra letter as a backup.
Letters of recommendation for IMGs, reapplicants, and dual applicants
International medical graduates: Letters from US clinical experience (USCE), such as hands-on electives or observerships, usually carry the most weight with US programs. Letters from your home country can still help, especially from an internship or a clinical supervisor who knows you well. Letters not written in English need a translation.
Reapplicants: Get at least one new letter that reflects what you've done since your last application. Ask previous writers to update the date and add recent accomplishments rather than reusing an unchanged letter.
Applying to more than one specialty: Build a separate letter set for each specialty, with specialty-specific letters in each. ERAS lets you assign different letters to different programs, so a general letter can go to both.
Gain instant access to 30+ exclusive full-length residency personal statement essay examples, complete with thorough breakdowns to help you match with your first choice.
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ERAS letter of recommendation deadline and timeline
Your letters should be uploaded before programs begin receiving ERAS applications in late September. Ask your writers about two months before that date and set a personal target two to three weeks earlier.
When are letters of recommendation due for ERAS?
ERAS has no single hard cutoff for letters. Writers can upload letters throughout the season, and programs see each assigned letter once it arrives. In practice, the deadline that matters is the date programs begin receiving applications, because that's when they start reviewing files and sending interview invitations.
Applicants whose letters arrive weeks later risk being reviewed after early interview spots fill. Many programs also won't consider an application complete, or won't offer an interview, until a minimum number of letters is in.
When should you ask for residency letters of recommendation?
Ask at least two months before programs begin receiving applications. The best time is often the start of a rotation in your target specialty, or right after you finish a rotation where you performed well.
Asking at the start of a rotation has significant benefits. It shows a genuine interest in the specialty, prompts the writer to observe your work closely, and gives you a reason to ask for feedback throughout. If you'd rather see your evaluation first, ask at the end of a strong rotation, and tell the writer early on that you're interested in the field.
If an attending offers to write a letter after a rotation, accept. You can decide later whether to assign it. If a writer finishes a letter months before you apply, ask them to update the date and add any new accomplishments before they upload.
How recent should your letters of recommendation be?
Your letters should reflect work you did within about 12 months of applying. Most come from third- and fourth-year rotations, sub-internships, and away rotations. An older letter isn't automatically excluded, but it should come from a writer who can speak to your current abilities, and the letter itself should be updated and re-dated.
Month-by-month letter of recommendation timeline
| ERAS LOR Timeline | |
|---|---|
| Fall–winter of third year | |
| January–March | |
| April–June | |
| June | |
| July–August | |
| 4–6 weeks before program access | |
| 2–3 weeks before program access | |
| Program access date | |
| After submission |
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How to ask for a letter of recommendation for residency
To ask for a residency letter of recommendation, follow these steps:
Choose writers who supervised you closely and saw you perform well.
Ask in person when you can, or by email if meeting isn't practical.
Ask directly whether they can write you a strong letter, and listen to the answer.
Explain why you'd value their letter and which strengths they're best placed to describe.
Send your letter packet and the ERAS Letter Request Form within a day or two of their yes.
Share your target upload date and send reminders as it approaches.
Should you ask in person or by email?
Ask in person whenever possible, and definitely if it's been a while since you worked together. A short meeting lets you gauge their enthusiasm and talk through what you hope the letter will emphasize. Email works for writers you know well or when a meeting isn't practical.
When you meet, explain why you're asking them in particular. It's fine to mention qualities or experiences you hope they'll highlight. A letter that confirms what the rest of your application says makes your whole application more convincing.
What to include in your letter request packet
Once a writer agrees, send them:
Your CV
Your final or near-final personal statement
Your ERAS Letter Request Form
A short biographical sketch with your career goals
A few specific cases or moments from your time together, to jog their memory
Your USMLE or COMLEX scores, if available
Your transcript
Your target upload date
Sample emails asking for a residency letter of recommendation
Sample email to request a meeting with someone you know well
Dear Dr. [Last Name],
I hope this message finds you well. I'm applying to [specialty] residency programs this fall and would value your perspective on the process. If you're willing, could we meet briefly in the next few weeks? Please let me know what times work for you.
Thank you for your consideration!
Best,
[Your Name]
Sample email to request a meeting with someone you haven't spoken to in a while
Dear Dr. [Last Name],
I hope this message finds you well. My name is [Your Name], and I worked with you during my [rotation/elective] in [month/year]. I especially enjoyed [specific, authentic detail about the experience]. Since then, [major update, e.g., "I completed a sub-internship in [specialty] and am certain I want to pursue it"].
I'm applying to residency programs this fall and would value your perspective. If you're willing, please let me know when you might be available to meet.
Thank you for your consideration!
Best,
[Your Name]
Sample email asking directly for a letter of recommendation
Dear Dr. [Last Name],
I hope this email finds you well. I'm applying to [specialty] residency programs this fall, and I was wondering whether you'd feel comfortable writing me a strong letter of recommendation. [One authentic sentence on why you value their perspective and which of your qualities they can speak to.]
If you're willing, I'll send my CV, personal statement draft, ERAS Letter Request Form, a brief biographical sketch, my exam scores, and my transcript. I'm hoping to have all letters uploaded by [target date].
Thank you for considering my request.
Best,
[Your Name]
We haven't included an email for asking someone who may not remember you, because you shouldn't ask them.
Should you offer to draft your own letter?
Don't offer, but be ready if a writer asks. Busy physicians sometimes ask applicants to send a draft. If that happens, write a factual draft in the writer's voice, focused on specific things they saw you do, and leave room for their own assessment and comparisons.
Avoid superlatives you can't back up, and never invent observations. The writer is responsible for the final letter and should edit it freely. If you'd rather not draft it, a detailed list of shared cases and accomplishments is a good alternative.
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How the ERAS Letter Request Form and Letter Writer Portal work
In ERAS, you never handle your letters yourself. You create a Letter Request Form in MyERAS, give it to your writer, and your writer uploads the letter directly to the AAMC Letter Writer Portal. You then assign the uploaded letter to the programs you choose.
What is the ERAS Letter Request Form?
The Letter Request Form is a document you generate in MyERAS for each letter writer. It carries a unique Letter ID that connects the writer's upload to your application. You create a separate form for each letter, even if one writer is writing more than one letter for you.
When you create the form, you enter the writer's name and details, a short description of the letter, and whether you waive your right to see it. Some forms also ask whether the letter is meant for a particular specialty or program. Use a clear, specific title, because you'll pick letters by that title when you assign them.
Send the form as a PDF along with your letter packet. Writers who have never used the portal will need the Letter ID to get started.
How letter writers upload letters in the LOR portal
You can share this section with your writers.
Go to the AAMC Letter Writer Portal and sign in, or create an account if it's your first time.
Enter the Letter ID from the applicant's Letter Request Form.
Upload the letter as a PDF, on institutional letterhead and signed.
Confirm the upload. The applicant will see that the letter has arrived, but not its contents if they waived their right to view it.
A writer can also designate a delegate, such as an administrative assistant or clerkship coordinator, to upload on their behalf.
How to assign letters to programs in MyERAS
Once a letter is uploaded, its status changes in MyERAS. You then assign up to four letters to each program from your program list. Only uploaded letters can be assigned to programs, and the “Assign” option becomes available after upload.
Check your assignments carefully before you submit. Make sure each specialty gets its specialty-specific letters, and that program-specific letters only go to the programs they were written for.
Should you waive your right to view letters?
Yes, waive it. Program directors give more weight to confidential letters, because the writer knew you wouldn't read them. Declining to waive can read as a red flag. If you're worried about a letter's tone, the better fix is choosing a writer you're confident in.
Should letters be addressed to specific programs?
No. Most letters are addressed to "Dear Program Director" or similar, so they can go to every program in that specialty. Program-specific letters are only worth it when a writer has a genuine connection to that program. In that case, create a separate Letter Request Form and assign the letter only to that program.
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What makes a strong letter of recommendation for residency?
A strong residency letter shows the writer knows you well, describes specific things they saw you do, and compares you directly with other students they've supervised. Generic praise without examples reads as lukewarm, even when the adjectives are glowing.
What program directors look for in residency letters
Program directors read letters for evidence they can't find elsewhere in your application: how you work with patients and teams, how you respond to feedback, and how you'd perform as a resident. The strongest letters include:
Context: how long and in what setting the writer worked with you
Specific examples: concrete moments that show clinical reasoning, reliability, or compassion
Comparative ranking: a statement like "among the top 5% of students I've worked with in 15 years."
Fit for the specialty: why you'll thrive in this field in particular.
An unqualified close: "My highest recommendation" or "I would gladly rank her to join our program."
Program directors also notice what's missing. A letter that only mentions punctuality, or that never ranks you, can signal hesitation.
Residency letter of recommendation template
This template shows the structure most strong letters follow. Share it with a writer who asks for guidance, or use it if you're asked to prepare a draft.
Dear Program Director,
Paragraph 1: Introduction and context. I am writing in strong support of [Applicant] for your [specialty] residency program. I am a [title] in [department] with [X] years of experience, and I supervised [Applicant] during [rotation] in [month/year] for [length of time].
Paragraph 2: Clinical skills, with an example. Describe one or two specific patient encounters that show the applicant's knowledge, judgment, and skills.
Paragraph 3: Professionalism and teamwork, with an example. Describe how the applicant worked with patients, nurses, residents, and other students.
Paragraph 4: Distinguishing qualities. Research, leadership, advocacy, teaching, or other strengths relevant to the specialty.
Paragraph 5: Comparison and recommendation. Rank the applicant against peers and state your recommendation without qualification.
Sincerely,
[Name, degree, title, institution, contact information]
ERAS letter of recommendation example (annotated)
Here is a sample letter of recommendation for residency, with notes on why each part works.
Dear Program Director,
I am writing in support of Ms. Rachel Armendariz for your residency program. I have 15 years of experience in pulmonary and critical care medicine and a background in translational research. I worked closely with Ms. Armendariz during her third-year clerkship and during her pulmonary elective. In addition to her many accomplishments, Ms. Armendariz's clinical abilities, leadership, advocacy, and patient focus set her apart. I have observed Ms. Armendariz during workups, taught her in class, and I oversaw her clerkship.
Why it works: The writer establishes credibility and explains exactly how they know the applicant, across two rotations and a class.
Ms. Armendariz's excellence goes well beyond her outstanding USMLE scores. She is warm and engaged with patients and colleagues. In addition, she is capable of synthesizing new information. In part, this is a product of her meticulous preparation; before Ms. Armendariz had even encountered pulmonary edema, she had already assimilated the key points of responding to respiratory failure into a detailed poster for our care team, ensuring even those new to the rotation could easily be brought up to speed.
Why it works: A specific, memorable example backs up the claim about preparation and teaching.
Moreover, Ms. Armendariz has made advocacy a key part of her medical education. When she discovered that a series of arrhythmia pamphlets were available in English only, Ms. Armendariz communicated with the head of Cardiology about the lack of Spanish-language informational materials and even recommended a fellow classmate with translation experience to address the discrepancy. Her leadership in addressing gaps in care has prompted several positive responses, especially during inpatient procedures. In fact, Ms. Armendariz's intuitive sense of patient needs made her an informal mentor to students entering the clerkship after she had finished.
Ms. Armendariz's skill also extends to research. She has designed a study on the effectiveness of auxiliary treatments during outpatient procedures to assist our hospital in providing more comprehensive care.
Why it works: These paragraphs show initiative and leadership beyond required duties, again with concrete actions.
Ms. Armendariz is in the top 10% of medical students with whom I have worked in the last 15 years. Her attention to detail, willingness to learn, and well-rounded approach to patient care, including research design and developing best practices, make her an outstanding candidate for residency. I give her my highest recommendation for your program.
If you require any further information, please do not hesitate to contact me.
Sincerely,
Jackson Abrams, M.D.
Why it works: A clear comparative ranking and an unqualified recommendation are exactly what program directors look for in a closing paragraph.
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Managing your letter writers after they say yes
Track each letter's status in MyERAS weekly, remind writers well before your target date, and have a backup plan for any letter that stalls.
When and how to remind your recommenders
Send your first reminder four to six weeks before programs begin receiving applications, then every one to two weeks until the letter is uploaded. Writers often procrastinate, and a polite reminder is expected.
Dear Dr. [Last Name],
I hope this email finds you well. I'm planning to submit my ERAS application by [date], so I wanted to send a friendly reminder about my letter of recommendation. I've attached my Letter Request Form again for convenience. Please let me know if there's anything else I can provide.
Thank you again for your support!
Best,
[Your Name]
If an email doesn't get a response, call their office. Acknowledge that it's a busy time and say you want to make sure nothing falls through the cracks.
What to do if a letter writer doesn’t submit
First, find out why. A writer may have misunderstood your timeline or lost the Letter Request Form, and a quick conversation fixes both. If the writer is dealing with something serious, offer whatever information might help and give them some grace.
If the letter still seems unlikely, move to your backup writer right away rather than waiting. This is exactly why we recommend requesting four to five letters per specialty. Remember that you can submit your application before every letter arrives and add letters later.
How to thank your recommenders (with sample note)
Send a thank-you note once your writer uploads their letter, and follow up after Match Day to share where you matched. Writers genuinely want to know how things turned out.
Dear Dr. [Last Name],
Thank you for your guidance throughout the residency application process and for writing a letter of recommendation on my behalf. I'm very grateful for your support, and I'll be sure to let you know how things turn out.
Best,
[Your Name]
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ERAS letter of recommendation FAQs
Can a letter be uploaded after I submit my ERAS application?
Yes, writers can upload letters after you submit, and each assigned letter reaches programs once it arrives. Late letters can still delay your review, so aim for every letter to be in before programs receive applications.
Can I reuse letters from a previous application cycle?
You can, but you shouldn't reuse them unchanged. Ask writers to update the date and content, and add at least one new letter that reflects your recent work.
Do ERAS letters need to be on letterhead and signed?
Yes, letters should be on institutional letterhead and signed by the writer.
How long should a residency letter of recommendation be?
Most strong letters run about one page, or roughly 400–700 words. Length matters less than specific examples and a clear comparative ranking.
Can my letter writer use AI to write my letter?
That's the writer's decision, but the letter must reflect their own observations and judgment. Program directors value letters for their personal, firsthand detail, which generic AI-generated text can't supply. Don't use AI to invent content for a draft a writer asks you to prepare.
Can I see whether my letters have been uploaded?
Yes, MyERAS shows each letter's status, so you can tell when a writer has uploaded it. You won't see its contents if you've waived your right to view it.
Final Thoughts
Strong ERAS letters of recommendation come from planning more than luck. Choose writers who know your clinical work, ask early, send a complete packet, and track every upload until it reaches programs. Request one or two more letters than you need, and you'll have options if anything goes wrong.
For the rest of your application, see our guides to the ideal ERAS timeline, writing your residency personal statement, and program signaling.
About the Author
Dr. Shirag Shemmassian is the Founder of Shemmassian Academic Consulting and one of the world's foremost experts on medical residency admissions. For over 20 years, he and his team have helped thousands of students match to top residency programs using his exclusive approach.
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