9 Ways To Improve Your Residency Chances Through LORs

How to increase your chances of getting into residency - that's what we will speak about today. As we have said earlier, the letters of recommendation (LOR) are the most important part of ERAS application.
That's why it's extremely important not only to get excellent LORs, but to avoid some frequent mistakes that can spoil your image in eyes of Program Directors.

9 Ways To Improve Your Residency Chances Through LORs:

1. Target each LOR to the specific specialty you are applying to. For this you will have to meet with the referee to explain the nature of the LOR and its purpose.

2. According to American Medical Association (AMA), LORs from overseas schools are not very helpful since international medical school standards vary and often are not comparable to those in the U.S.

3. Get some experience working in a U.S. health care system before applying for residency so that you can get a US LOR.

4. Teaching programs are better than private offices of physicians in US for point number three.

5. Opportunities for USCE/observerships/externships are hard to come by but if you work hard enough, you will get a good break.

6. Letter, which extols your clinical abilities in addition to other niceties, is received very well by programs.

7. Work with your letter writer to produce a well composed, personalized attestation of your capabilities as a physician and portray you as an asset.

8. Deans letter is not that important unless there are delinquencies and discrepancies in your medical education.

9. Since at least 2007, increasing weight is being given to LORs from US teaching hospitals. In same line of thought, LORs from faculty in hospitals without ACGME accreditation will be carry less importance.


  • The more LOR's the better, minimum three. Each program you will apply for cannot accept more than 4 LORs. But you can assign different LORs to different programs and therefore you can have an unlimited number of LORs but using only 4 of them to each specific program.
  • Clerkships LORs rank higher than Externship LORs which in turn rank higher than Observership which in turn ranks higher than non-obervership LOR's.
  • Better to have a specialty specific LOR rather than just a generic LOR. Even more better to have program specific LOR!
  • Physicians writing your LOR's would better be from different nationality and ethnicity (though many may disagree but skepticism is a prominent trait of most program directors!). Never take an LOR from a relative.
  • If you did not spend enough time with the doctor who's writing your LOR, ask him/her not to specify the time spent with them. Like by saying during the month of February instead of saying 2 days per week for two weeks in February.
  • The LOR must be written on an official Letterhead paper of the institute in which the writer is working or affiliated with.
  • Better to mention your AAMC ID in the subject of the LOR. (not mandatory).
  • The LOR should be addressed "Dear Program Director".
  • It's better to waive your rights to see the LOR as this will add more weight to it. However, make sure that the writer is going to meet the time line deadlines and that he/she actually likes you enough!
  • You are not going to send your LORs to the ERAS. You will send it to your designated Dean's office such as the ECFMG in the case of IMGs. (if you have waived your rights to see the LOR the same applies to the letter writer).
  • Each LOR should be clipped with a coversheet. You can obtain the coversheet template from ERAS resources to download.
  • Important that writers include contact information in details because they might be contacted by residency programs.
  • Don't take LOR's from a remote specialty, like for example you are applying for surgery and you give dermatology LOR's!
  • A good LOR is not necessarily a very long LOR, a precise descriptive single page LOR may be more than enough.
  • Let the LOR be realistic not unduly praising you. If the writer says you are the century's superman, program directors will likely laugh at it.
  • Don't worry if the LOR is mentioning some negative aspects about you such as areas that you have to improve on. In fact, this may make the LOR even stronger as it carries more objectiveness and honesty.
  • Although, not mandatory, but it's better if your LOR is recently dated (within last one year is desired).
  • For IMGs, your California Letter and Dean's Letter is not counted as an LOR. You still have to find additional minimum of three LORs.
  • For IMGs, let the writer mention your English language communication skills if English is not your native language.
  • For IMGs, LORs from your home country are OK but it is better to fortify them with US LORs.
  • If you want to apply by mid-September then your LOR should reach your designated dean's office no later than mid-August.
  • DO NOT FAKE your LOR. You will be caught and you may damage your entire medical career.

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