Every Question You Have About Letters of Recommendation for Medical School

By: Rob Humbracht

The topic on which I get the most questions every application cycle is letters of recommendation.  The following FAQ represents every question I've received over the past few years.

Have a question that we haven't answered here?  Please submit a comment, Facebook post, or Twitter message and we will:

  1. respond to you personally, and

  2. add the question to this article so that it becomes the most comprehensive FAQ it can be.

Enjoy!


Letters of Recommendation FAQ


Introduction

The rule of thumb for letters of recommendation: Get the Best Set of Letters You Can.  

It will be tempting to get lost in the nuances and details of how many letters to get, which people to choose, and what each med school’s requirements are.  When in doubt, refer back to our rule of thumb, and remember that your chances will be helped the most by getting letters from people who support you wholeheartedly, who know you personally, and who can write the best letters on your behalf.

How many letters are required by med schools?

It depends on the school.  US medical schools typically require two or three letters of recommendation, but some require as many as five.

Typically, you'll need the following letters of recommendation:

  1. Option 1 - A committee letter, or
  2. Option 2 - Three individual letters, two letters from science faculty and one additional letter

What's a committee letter?

A committee letter, or composite letter, is written by the pre-med advising office of your college or university.  Not every college offers such a letter, and a quick glance at your career services website should answer whether your school does.

Should I get a committee letter?

If you have the option, then yes, you probably should.  Think of the committee letter as Yelp.  Sure, you might try a restaurant that has no reviews, but you'd probably be more interested in eating at a restaurant with 4.5 stars.

So that analogy isn't perfect, but I think you get the point: it’s better to get a committee letter if you can.  If you don’t, med schools might wonder whether there's something you're trying to hide or whether you were told by the committee that they didn't think you were a strong candidate.

There are dozens of exceptions to this rule:

  • Some colleges don't offer committee letters to non-science majors
  • Some colleges don't offer committee letters to alums
  • Some colleges have several additional hoops you have to jump through that may make you ineligible to get a committee letter

The takeaway: Get a committee letter if you can, but it won't ruin your chances if you can't.

How many med schools require two letters?  Three? Four?  Five?

We researched how many letters were required at each medical school and then put the results into a histogram.  The chart below shows how many schools require at least 0, 1, 2... letters of recommendation.

Minimum Letters of Rec

Which two schools require five letters?

University of Central Florida and University of South Florida.

Here's what those five look like for UCF:

https://med.ucf.edu/administrative-offices/student-affairs/admissions/admissions-process/letters-of-recommendation/

For traditional applicants (applicants who take no more than one year off before starting medical school), UCF requests:

  • “three individual faculty letters - two letters from basic science faculty, and one from a non-science faculty member, or one Pre-Med/Pre-Professional Composite Committee Letter
  • two character letters - these letters should be from those who can tell us about "who" you are. Authors may be those who have been your supervisor, friend, neighbor, someone you have volunteered with or shadowed, someone from an organization or club that you belong to, clergy, etc. One of these two letters may be from an academic peer.”

To cover your bases, plan to ask for at least three and probably at least four letters of recommendation.

What’s the maximum number of letters I can send?

Maximum Letters of Rec

Generally, it’s not advisable to send more than five.  The goal is to have the overall quality of your letters be as high as possible.

Imagine that you were giving a letter grade for the quality of each letter of recommendation you are sending to medical schools.  The grade is based on how well the letter writer knows you, with an A being “close personal friend,” and F being “doesn’t know my name.”

You might have letter grades that look like the following:

Science Letter 1   A-

Science Letter 2   B+

Non-Science professor   A-

Other 1   A

Other 2   B

Other 3   B-

Other 4   C

You should pick the set of letters with the highest overall grade point average.  In this case, your best bet is to pick the first four letters of the set.  Those four letters give an average of an A-.  By including each additional letter, you bring down the average of the set and essentially waste the time of your application reader, who now has to wade through a much larger pile of crappy letters.

But of course, if you’re curious what’s the maximum that all medical schools will take, we researched that too and came up with the following histogram:

Even though some medical schools will take up to 13 letters, most cut you off after 6 or 7 letters, and some will take only 3!

What's the ideal set of letters?

Let's outline the "utopian" set of letters for medical school.  I call it utopian, because while it is ideal, most applicants don't actually achieve the following set of letters:

  1. Science Professor who gave you a grade
  2. Science Professor who gave you a grade
  3. Non-science Professor who gave you a grade
  4. Other 1
  5. Other 2

Why professors who gave you a grade?

Letters of recommendation should comment on your academic abilities, so professors who have given you a grade are better able to do that.

What qualifies as a science professor?

Most med schools prefer biology, chemistry, or physics, but they probably won't disqualify you if you submit a letter from a discipline such as engineering, environmental science, or kinesiology.  While it is ideal to have letters from the basic sciences, see the Rule of Thumb above: get the best set of letters you can.

What qualifies as non-science?

Any discipline outside of biology, chemistry, or physics.

Other than professors, who else can write me a letter of rec?

The most common are:

  • Doctors you shadowed
  • Principal investigators (or whomever you did research with)
  • Faculty advisors of clubs
  • Another health care professional (a dentist, a nurse, etc.) who can comment on your abilities to work with patients

What letters are bad to get?

Obviously, anyone who isn't positively glowing about your application will hurt you.  Ever hear the expression, "Damned by faint praise?"  That applies to letters of recommendation for med school.

Some letters won't be given a lot of weight:

  • Letters from family members
  • Letters from clergy
  • Letters from "family friends" - if they don't know you specifically in a professional setting
  • Letters from teaching assistants - it's not that they hurt your application, but they will not suffice for the science letters required by most medical schools.

Do I have to have a letter from my major?

No.  Some med schools (a minority of all schools) request one.  In other words, get one if you can, but don't sweat it if you don't.

What makes one letter better than another?

Check out "How to Write Your Own Letter of Recommendation"

Do I get to see my letters of recommendation?

No.  You should waive your right to read your letters.  If med schools see that you haven't waived your right, they won't believe a word written in the letter.

If your letter writer knows you’re going to read the letter, he or she simply will not put anything substantial in that letter.  It's like asking your boyfriend whether that dress makes you look fat; pretty much the only response you'll get will be "of course not." (whether or not that’s true, the risk of saying otherwise is worse than the reward of being truthful).

When are letters of recommendation due?

Letters of recommendation are typically not due until you submit your secondary application, which at the earliest would be July of the year you apply.

The vast majority of med schools do not read letters of recommendation until every other part of your application has been submitted.  That means they will not read your letters until they receive:

  • Your primary application
  • Your secondary application
  • Your payment for both primary and secondary
  • Any pending MCAT scores that you may have

Even for schools that screen before sending secondaries, they rarely read letters of rec to determine who gets a secondary.  Whether you get a secondary is typically based on your GPA and MCAT as well as a read of the primary application, excluding letters of recommendation.

When should I ask for letters?

You want to give the letter writer at least two weeks and preferably more.  It's not uncommon for a letter writer to take two to three months to write your letter.  If you're applying in June, we recommend asking for letters no later than May 1.

If you have a pre-med committee, then you may need to request letters much sooner.

Can I submit additional letters once I have applied?

Yes!  Letters of recommendation is one of three sections of the AMCAS that can be modified after you hit submit (the others: your school list and your contact information).  You just log back into your application and request additional letters.

How do I overcome my anxiety about asking for a letter of recommendation?

I’ve written an entire post on why it feels so awkward to ask for a letter of rec:

http://www.savvypremed.com/savvy-pre-med/2014/7/27/why-does-it-feel-so-awkward-to-ask-for-a-letter-of-recommendation

It doesn't seem like it should be so intimidating to ask a professor for a letter of recommendation, but it is.  Worries race through our minds:

"What if he doesn't remember me?"  

"She has more important things to do."

"What will I do if he says no?"

While it can feel uncomfortable to ask for a letter of rec, remember that you're not the first person to ask this professor.  Professors are used to this process, and they've seen all manner of requests - rude, annoying, meek, bashful - they're expecting you (and many of your classmates) to request a letter.

Second, you're not asking for much.  Most letters of recommendation - even the good ones - follow a template, and letters take maybe 45 minutes to crank out.  You're asking for a solid favor, but it's not that much of a time commitment.

How should I ask for a letter?

First off, be sure to ask for the letter in person if possible.  If that's not possible, try to arrange a phone call.  Because you don't get to read the letter, you want to evaluate the enthusiasm of the letter writer to help determine how good this letter will be.  The best clues are the non-verbal ones you can get only by asking for a letter in person.

Steps:

  1. Send an email asking to meet to discuss your application to medical school.  Nothing too complicated, just ask to drop by office hours or invite the professor to coffee.  Don’t ask for the letter in the email, because you’d like to ask in person (but if the professor responds by wondering whether you want a letter, then by all means make your intentions clear).
  2. At the meeting, ask for a strong letter of recommendation.  Asking for a strong letter does several things that are beneficial for you:
  • It allows the professor to say no (and trust me, you'd rather her say no than get a bad letter)
  • It allows the professor to respond to the word "strong," by either affirming that the letter will indeed be strong or that she cannot write you a strong letter.  Either way, this provides more information as you try to evaluate the strength of your letters.
  1.  After the professor agrees, ask "What can I give you to help you write that letter?"  Listen carefully to what the professor says.  Follow up with whatever the professor requests as soon as you can.  It's easy for the professor to lose track that he agreed to write you a letter, so you want to follow up with the requested materials soon to keep the momentum going on your letter of recommendation.

What are some tips for requesting letters of recommendation?

These are excellent: http://www.usnews.com/education/blogs/medical-school-admissions-doctor/2015/04/14/7-tips-for-nailing-medical-school-letters-of-recommendation

What if my letter writer asks me advice for what to say and how to say it?

Send them this: http://www.aamc.org/download/349990/data/lettersguidelinesbrochure.pdf

Where do I find sample letters of recommendation?

http://depts.washington.edu/gowwami/AWARE/documents2012/CarolTeitzLORsamples.pdf

How should I get to know my professors?

A lot of the students we work with go to huge research universities, where their smallest science class has 50 people in it.  In this environment it's on you, the student, to get to know your professors.

Here are some tips from former students we've worked with about how to be proactive in getting to know their professors:

  • Go to office hours when no one else will be there - week 1, right after mid-term exam
  • Go to office hours with something outside of the class to talk about professor's research, ask about prof's family and background, how class material applies to one of your other interests
  • Take the same professor for more than one class
  • Do research with a professor - either in the professor's lab or on independent project
  • Become a teaching assistant for that professor

Do my letters have to be signed and put on official letterhead?

Some med schools require it.  This past cycle, Boston University notified one of our students that one of her letters was not on official letterhead, so she had to contact the letter writer to re-submit the letter.  It wasn't a huge deal, and no other schools she applied to notified her of the issue.  You should tell your letter writers to put the letters on letterhead, but it probably won't matter much if they don't.

What if one of my letter writers disappears?

It happens every year to several of our students: they ask for a letter of recommendation, the professor says "yes," and he stops returning phone calls and emails.  The students are stuck without a critical letter (usually, it's a science professor who disappears).

You can't help whether this happens to you, but you can do the following to help mitigate the damage:
  1. Ask for a backup letter in case one of your letters of recommendation does not come through.  You can receive up to 10 letters of recommendation in AMCAS and pick and choose which ones you forward to medical schools later.  It's much better to have too many letters than too few.
  2. Ask for letters of recommendation early.  March is ideal.  If a professor disappears after asking for a letter early, you still have plenty of time to find another professor to ask.




Submit Your Questions!


Will it be looked down upon to not include letters written by science faculty? 

Question:

I'm a non-trad applicant who is applying 5 years out of college. Will it be looked down upon to not include letters written by science faculty? They would be replaced by MDs that I work with in the ER.

If you've been out of school for five years, your professors are unlikely to remember you.  It seems pointless to ask for those letters, since not only would those letters be average at best, but you're a completely different person.  Surely medical schools will cut you some slack, yes?

Robert M.

 

Answer:

Not really.  If you've been out of the classroom for five years, medical schools want you to go back to school and take classes (this is good advice for anyone who hasn't taken a science course in 3 years or more).  It doesn't matter where you take these classes as long as they are in-person, and these courses are the perfect opportunity to ask for an additional science letter.

And remember, if you can't go back and get two letters of rec, see the words of wisdom at the top of this post: get the best set of letters you can.

- Rob Humbracht  - Medical School Admissions Advisor


Isn't it common to send the same letter of rec to multiple schools using Interfolio?

Question:

Hello, under your link "How to Write Your Own Letter of Recommendation", you say to be specific regarding who it is. Isn't it common to have the same letter send to 10+ schools using Interfolio? Even if it wasn't, wouldn't it be hard to ask your recommender to write a different letter for each school?

plantat3q via Reddit

Answer:

Good catch!  That detail applies to most graduate school application processes, but not to medical school.  Although it's technically possible to upload letters aimed at specific schools, a) it's rare, and b) schools definitely don't expect it.  As a result, it's not recommended.  We've updated the original blog post to correct it.  

- Rob Humbracht  - Medical School Admissions Advisor 


Are you interested in volunteer work from high school?

Question:

Are you interested in volunteer work from high school? I ask because I've been volunteering since I was 13 and was curious whether or not that would fit in an application

- mathnerdm via Reddit

Answer:

The way I have always looked at experiences from high school is that they set the trend for the activities you've pursued more recently.  In other words, if you've been volunteering since you're 13, it shows that you have consistently embodied the spirit of giving back that med schools are looking for.

- Rob Humbracht  - Medical School Admissions Advisor 


What type of clinical volunteering stands out the most to you?

Question:

What type of clinical volunteering stands out the most to you? (ie. volunteering in an ER, shadowing GP, etc...)

- mathnerdm via Reddit

Answer:

As for the best clinical volunteering, I would argue that no one type is the best.  You need to establish two things about your application: a) you know what doctors really do (either by shadowing different doctors or by working with them in a medical context), and b) you are able to connect with people from a different background.  Many types of clinical volunteering can show these traits, so you're looking for experiences that give you hands-on experience and memorable stories to tell!

- Rob Humbracht  - Medical School Admissions Advisor 


How do you see unconventional letters of rec? 

Question:

I am a RN applying for med school this app cycle. How do you see unconventional letters of rec? I have a patient that is a PA/NP that I have had the pleasure of caring for for the last 2 years and feel that she can really attest to my dedication to medicine and my character. However, I'm not too sure if I should make the gamble. Thanks!

- ayeeff via Reddit

Answer:

I'm not sure I see how it's a gamble. If you provide the letter, the schools can simply disregard it. I think it sounds like the letter writer knows you well and can provide context about the kind of care provider you would be. The only caveat would be in the rest of your application to make a critical distinction behind why you want to undergo all of the stress and debt to become a doctor instead of pursuing the path already available to you.

- Rob Humbracht  - Medical School Admissions Advisor