How Can I Get a Good Letter of Recommendation?

Benjamin S. Bryner, MD


April 05, 2013


I'm working on my residency application and I need to get letters of recommendation. Whom do I ask and how do I go about it?

Response from Benjamin S. Bryner, MD
Resident in General Surgery, University of Michigan Health System, Ann Arbor, Michigan

Letters of recommendation are an inevitable part of academics and employment. They provide a qualitative element to your application and can help you or hurt you.

It's easiest to tackle the question of how to get a good recommendation by breaking it up into smaller questions:

Whom should I ask?

You obviously want to ask someone who can write you a good letter, and you need to know what that looks like before you ask.

  • The College of Medicine at Illinois provides guidance for faculty on writing letters of reference. You can review this information to get an idea of what you want (check out the "good" and "bad" examples).

  • Another letter-writing resource is provided by the Howard Hughes Medical Institute. This article also offers some insights on why someone might decline to write a letter for you.

A good letter conveys that the writer knows you and doesn't see any red flags or have concerns about you. Most important, it should distinguish you from the other applicants, either quantitatively, by describing you as one of the top students the writer has known, or qualitatively, by describing specific ways that you are exceptional (the latter is better).

OK, now that I know what I'm looking for, whom should I ask?

The ideal person to write a letter of recommendation is a well-respected, mid- or late-career faculty member with whom you've had substantial clinical and/or research experience. If this ideal person doesn't exist, you will need to use multiple letters of recommendation to cover different parts of your experience.

You absolutely need someone who knows you well from clinical experience, even if it's the most junior faculty member in that department. You also need a letter from a significant "name" in your desired field. Usually the chair of your department fits this description, and usually he or she will be willing to write you a letter, even if you don't know him or her that well.

If you've spent a significant amount of time in research, you should request a letter from your research mentor. You should select at least one subinternship (fourth-year clinical rotation) with the primary goal of getting a good letter of recommendation from a specific person. (Obviously the rotation should be a good experience for you as well; if you aren't having a good experience you probably aren't getting quality exposure to that faculty member.)

Unfortunately, the resident or clinical fellow who really clicked with you on your third-year rotation isn't an acceptable letter-writer. They can best help you in other ways (telling you the unvarnished truth about the program, suggesting other programs that might be similar, giving you advice about which faculty members to approach for a letter, etc).

Can I get a letter from someone outside my chosen specialty?

It depends. Only if:

  • you had an exceptionally meaningful clinical experience with that person;

  • you had a meaningful research experience with them relatively recently; or

  • the recommender works in a closely allied field (for example, pediatric emergency medicine if you're applying to pediatrics).

For surgical specialties, the value of a nonsurgeon recommendation is low. Be clear about your career intentions if someone from another specialty has mentored you but you're applying to a different specialty (for example, you've done plastic surgery research but are applying to general surgery programs).

The bottom line is that it's best to ask a faculty member from the department to which you're applying. Also note that you need to get enough letters to meet the minimum requirements, but you do not need to submit the maximum number of letters that the application will allow.

How should I ask?

In person. Set up a meeting and be a few minutes early, dressed nicely in clinic clothes (not scrubs). Be ready with these 5 things: a copy of your personal statement if they don't know you well; a copy of your CV no matter how well they know you; a specific timeframe for when you need the letter; the details of how to send it or upload it; and any form that goes along with the letter. If the form asks you about waiving the right to review the letter, go ahead and waive it. If you're worried about getting a weak letter, ask the adviser what kind of letter he or she could write before you formally enlist them.

When should I ask?

Early, obviously.

Academic physicians are insanely busy, are constantly putting out fires by taking care of issues that cannot wait another 5 minutes, and don't have the same level of administrative support that some other busy professionals may have. If the deadline is looming and they haven't submitted the letter yet, you could ask their administrative assistant to remind them. It is also appropriate for you to send a short, polite email reminding them of the deadline.

OK, they sent it. Now what?

Send a thank-you email that is formal, appreciative, and brief. A card would be fine but isn't necessary in this situation. Now you can move on to worrying about the rest of your application, which is another matter entirely.