Applying to medical residencies is a long, complex journey with many phases. If you’re in the midst of this process, you know that once you’ve completed residency interviews, the next step is creating your NRMP Rank Order List of the residency programs you hope to attend. During this stage, many applicants take the additional step of sending a letter of intent to their first-choice residency in order to up their chances of matching with that program.
If you’re at this stage, you might find that it’s time to write a letter of intent—sometimes jokingly referred to by applicants as “love letters”— to let a residency know that they are your top-choice program. It can be tricky to write these well, however, and people have varying opinions on their necessity and efficacy.
Letters of intent do have an important place in the residency application process. In this guide, we’ll break down what purpose letters of intent serve and what you can reasonably expect from sending one, plus we’ll give you guidelines on how to write your own, complete with a real-life example.
The purpose of sending a letter of intent is to communicate to a residency program that they are your top choice and that you intend to rank them first on your Rank Order List (ROL). While there are plenty of conflicting opinions as to whether letters of intent make a difference in programs’ final rankings, there is evidence that some programs do take letters of intent into consideration. For instance, a survey of OB/GYN residency program directors showed that 29 percent of respondents noted that they would consider ranking a candidate more highly if they were aware that the candidate planned to rank them first.
While a letter of intent won’t make up for a poor interview or a weak application, it can sometimes do the work of prompting a re-review of your application materials or of giving you an edge over another candidate with whom you were essentially tied in the residency’s ranking.
Sending a letter of intent is not mandatory, and plenty of residency applicants receive a match without writing one. Nevertheless, writing a letter of intent ensures that you have done all that you possibly can to increase your chances of matching with a residency program—and, at the very least, it never hurts. That’s why it’s a step we recommend taking the time to complete.
In this section, we’ll go over key parameters regarding writing your letter of intent, such as when, how, and to whom you should send your letter.
You should plan on sending your letter while you’re creating your ROL: between January 15th, when the NRMP opens up to ranking, and the ROL deadline in late February (the exact date varies year to year). This gives you a window of approximately five to six weeks.
You should make sure to send your letter of intent early enough within that window to give it the best chances of making an impact. Sending a letter close to the deadline means program directors won’t have much time to take it into consideration when making their own rankings. On the other hand, sending your letter too early may mean you run the risk of being forgotten later when final decisions are being made.
While there’s no way of knowing exactly when a given program will finalize their list, if possible, we recommend that you aim to send your letter of intent during the early-to-middle stretch of the ROL period (roughly the last week of January to the first week of February).
Your letter of intent can take the form of either old-fashioned snail mail or email. A physical letter, which could either be a typed letter or a neatly handwritten card, carries a personal touch and is more likely to stand out in our increasingly digital age. On the other hand, sending your letter of intent via email is common and sufficient. Plus, if you are running up against the ROL deadline, email is probably a safer bet to ensure that your letter reaches the program in time.
If you’re sending a typed letter, format it as a formal letter with addresses and the date included (see our example below). This works in email, too, as you can send a similarly formatted letter as a PDF attachment. The one exception to our recommendation to use a formal letter format is if you decide to send a handwritten note—in this case, the personal touch of handwritten correspondence makes up for the lack of formality.
For an emailed letter of intent, we suggest using either “Letter of Intent” or “Letter of Interest” as your subject line. Address the letter to the residency’s Program Director, by name.
While your letter of intent should be long enough to convey your genuine interest and thoughts regarding the residency, you don’t want to overwhelm busy program directors with pages and pages. A well-written, concise letter is more likely to be carefully read and will ultimately do a better job of creating a lasting impression. Therefore, we suggest writing a single-spaced page or less, including the heading (200–300 words, give or take).
There’s a debate over whether or not you should reach out to more than one residency program. While there are many differing opinions as to whether or not it’s acceptable to send out multiple letters of intent, our recommendation is that you send a letter only to your top choice of residency programs. This means writing to one program only.
Why should you only write one letter of intent? While it’s certainly possible to tell more than one program that you intend to rank them first and get away with it, there are far too many anecdotes out there of this strategy blowing up in applicants’ faces. For example, if you tell a residency that you plan to rank them first and then don’t, you run the risk of being caught in a lie if the program in turn ranks you highly enough that you would have definitely matched there had your letter been genuine.
In short, sending out multiple letters of intent puts you at risk of attaching poor ethics and ill will to your name among people in your field who you’ll have a high chance of interacting with further down the line and who may be in positions to influence other outcomes in your career, such as jobs or publications. It’s not worth the risk to your reputation and relationships.
(Note: it likely goes without saying, but you should also only write a letter of intent to a program where you’ve actually interviewed.)
Now that we’ve covered how to write your letter, you’re probably wondering what should actually go in it. Here are some key points you’ll want to hit as you’re writing:
Since the NRMP has strict guidelines prohibiting both applicants and residency programs from asking how the other plans to rank them, you’ll also want to make sure to not include anything in your letter that could come across as soliciting that information or as a quid pro quo. Even a statement as seemingly innocuous as “I look forward to your response” could be read in the wrong light. Remember that you are freely offering your intent to rank the program first and should expect nothing in return.
Here’s a sample letter of intent:
Elena Mendez
4717 Willow Brook Ave, Apt 4
Los Angeles, CA 90029
February 1, 2019
Evelyn Kirkpatrick, MD, MEd
Director, Pediatric Residency Training Programs
Cincinnati Children’s Hospital Medical Center
3333 Burnet Ave
Cincinnati, OH 45229
Dear Dr. Evelyn Kirkpatrick,
I am writing to convey my strong interest in the pediatric residency program at Cincinnati Children’s Hospital. I was deeply impressed by my visit to Cincinnati Children’s when I interviewed with you on November 15th. I would be thrilled to match with the pediatric residency program there and intend to rank it first.
Cincinnati Children’s stands out to me among the programs I interviewed with as having many exciting qualities that make it my top choice residency. I am especially drawn to the abundance of research opportunities afforded by the flexible curriculum and strong institutional support. Additionally, doing rotations in a true community hospital, especially one as large and diverse as Cincinnati Children’s, greatly appeals to me for the unusually broad range of experiences that I know it would bestow.
I am also keenly interested in doing my residency at Cincinnati Children’s because of its location. Though I have been living in California since I left home for college, I grew up nearby in Dayton and am eager to relocate to Ohio for the possibility of living near family and friends.
I believe I would be an excellent fit for your program. My main area of research interest is genomics, which I know is a strength of Cincinnati Children’s, and I am particularly excited by the option to spend six months of individualized time in the Research Pathway. I am also drawn to the strong sense of comradery I observed among the current residents during my visit and would look forward to opportunities to collaborate and be part of such a robust community.
For these reasons, Cincinnati Children’s is my top choice residency program and I would be honored to complete my residency with you.
This letter works well because it demonstrates knowledge of the residency program and is specific as to why that program is the applicant’s first choice. On top of this, the applicant makes a point of clearly stating that she intends to rank the program first and keeps things concise and to-the-point. Short and sweet does it!
The plethora of conflicting information surrounding medical residency letters of intent can make them seem tricky or unnecessary to write, but in reality, they are fairly straightforward and can play an important role as you’re applying to medical residencies. Following the steps in this guide will help you demystify the process and get you on the path towards landing that coveted residency match.
