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Yes USMLE scores are important - but not everything for a Medical Residency in USA! To be Pre-Informed is to be In Form :-) Sharing Wisdom learned through application experience and mistakes - especially for IMGs / FMGs!

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Tuesday, September 11, 2007

Letters Of Recommendation (LOR) : Basics and Tips

Some Recommendations about being Recommended !

Why US LORs Rock ?

First of all, why do Program Directors need LORs at all? Because they carry a big responsiblity in choosing the right people to look after their patients safely for the next three years and are seeking assurance about the guys they are interested in! It's like - while choosing a good car dealer for buying a used car, we naturally ask information from friends we know and trust. Likewise, it is best if the LOR is from someone whom a Program Director can trust and believe. Hence, LORs from the MDs that are already established in the USA carry much more credibility and trust than those in other countries - unless they are big figures internationally. Some programs may even put forth a requirement of Recommedations from US Doctors as their criteria , for example check out the application criteria of the Quad Cities Genesis Family Practice Program.

That is not to mean that other LORs are utterly useless - but do get them from professors from your Medical school, which are more trustworthy than some friendly private practitioners.

Secondly, the practice of "You write the letter - I will sign it" by docs in our home countries is now known to most PDs here... :-) US Docs will hardly do that - which adds to their reliability !

Do all LORs need to be from MDs ?

Not really - but some programs may have special requirements. Like some family practice programs would want at least one recommendation from a family practice physician.

How many LORs are needed for ERAS / Match ?

Most programs wanna see a minimum of 3 Letters of recommendation - in addition, ERAS allows you to attach one more LOR allowed per program, bringing the total to a maximum of 4 LORs that you can allot to a single program.


Should LORs from people in the same specialty that you are interested in?

Not necessarily , but please have atleast one and the more the better. The practical disadvantage in having all from the same specialty could be that if could weaken your case if you were planning to apply for other specilaties as a backup with the same letters.

Should my LOR have an AAMC ID on it ?

Yes - its safer that way -why ? Coz then it ensures that ERAS scans and attaches the LOR image to only YOUR application and not someone else by mistake. In case the recommender forget to write the AAMC ID on the letter, you can write it yourself on the backside of the letter before you mail it to ERAS.

What formats should your LOR be in ?

There are no Universal formats per se, but its good to follow some practical tips :

1. Let the letter be addressed as "Dear Program Director"


2. Make the Letters 'specialty neutral' If you plan to use the same letter for different speciaties- what I mean by this is that don't let the letter specifically mention that you would be a great fit for 'pediatrics' or 'Internal medicine' - just let them say that you would be a great fit for 'your residency program'. Two reasons for this : a. The same letters can be used for multiple specialties and b. This also avoids a mistake by ERAS guys sending the wrong letter to the wrong specialty and embarrassing you ;-) Another reason this becomes important is that most people have the impression that they will be able to see the scanned LORs online after ERAS uploads them - Unfortunately NO , YOU CAN'T :-( You can only 'assign' the name of the person writing the letter to the programs you apply to and hope that ERAS sends the right letter to the programs..The new ERAS system now allows you to specify which specialty/specialties you would like the LOR to be sent to, to eliminate such errors.


3. Don't have it too short - atleast 3/4ths of a page or more


Click Here to view Sample Letter of recommendation (LOR) that a friend forwarded me over email ...


Read about the official Recommendation Requirements specified by ERAS Here.



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Comments on "Letters Of Recommendation (LOR) : Basics and Tips"

 

Blogger Digitaldoc, MD said ... (September 11, 2007 8:01 PM) : 

chanda said ... (March 18, 2006 10:35 AM) :

what charactristics of the candidate should be highlighted in the LOR?


Prateek said ... (March 25, 2006 1:09 PM) :

I would like to differ on the speciality specific bit. The letter should be speciality specific as it shows keen interest as well as a well thought out interest in the particular speciality. So if applying to more than 1 speciality have letters for both. Secondly eras doesnt make mistakes sending letters, the candidate may however alloting them, so one must double-check


Digitaldoc, MD said ... (March 25, 2006 1:17 PM) :

On The ECFMG site section for LOR specifications - they themselves ask candidates to keep letters specialty neutral, to avoid mis-allotments by their scanning clerks. The way it works it they scan the letters only AFTER you have applied to atleast one program. on ERAS, you merely type out the same of your recommender and his designation. When you application is sent the first they see wut you typed out and scan the appropriate letter to the program and assign it to that name.


hopefuldoc said ... (June 03, 2006 10:19 AM) :

if i apply with LoRs from my country, and then later on manage to get some US LoRs too, can those be added to my application in ERAS?
some friends carried such LoRs with themselves to the interviews since they wernt added later on by ERAS?is that true?

furthermore, would a program be interested in downloading the same candidate's documents twice?


Digitaldoc, MD said ... (June 03, 2006 2:42 PM) :

That will be a good strategy - you can attach a max of 4 letters for any program - and minimum of 3. In ur case, do attach 3 from India ..and later on attach the 4th one when u get it. After you do that - do send an email reminding the programs about the update to your application - and carry ALL documents - included any unattached letters, with you to the Interviews...

g/l and thanx for the excellent point !


Anonymous said ... (June 11, 2006 2:11 PM) :

can i get US LORs from my relative who is top notch cardiologist, even though i havent woked with him.....i havent even worked in US.
is it possible???
plz reply.
sid


Digitaldoc, MD said ... (June 12, 2006 1:58 PM) :

Whether that is possible or not depends on the doc himself buddy :-) he may give a reco based on his impression of your clinical acument and potential to succeed in a program ...


Anonymous said ... (July 02, 2006 9:54 AM) :

Hi Digidoc,

I did observeship under the guidance of a Indian and when asked for a letter he asked ME to write and he shall sign for it. Do you have any format of american letter that is really very good.
I am getting a chance to put all my words to make it impressive.


mbs said ... (July 18, 2006 4:55 PM) :

hi digidoc

does it make a difference if we get a letter from DO instead of MD from US.


Digitaldoc, MD said ... (July 23, 2006 1:13 AM) :

Dont think it should - they are equivanlent solid clinical docs too :-)


Anonymous said ... (August 06, 2006 10:08 PM) :

Hi Digidoc,
I've already got good step 1/2 scores - 99/98. Haven't got a US lor. Being an IMG with 3 yrs exp in Internal medicine in india, what are my chances of getting university calls?I've worked with a US doc for couple of weeks. should i take an LOR from him? I might get an obship but wouldn't be finishing it by August 31st. Can i still furnish details about it if i wan't to apply on sep 1.


Digitaldoc, MD said ... (August 06, 2006 10:11 PM) :

Great scores - congrats :-) Do take that letter from the US doc. It's ok if u cannot finish it before you apply - mention it on your CAF on MyERAS anyways ..so that they know you are getting an observership :-) i rate your chances as being good - but also apply to the good community programs :-)


Anonymous said ... (August 11, 2006 11:12 AM) :

hi digital doc

could please tell me can I sen 15 LOR,S TO ERAS IF i WANT TO APPLY FOR 5 DEPARTMENTS


Digitaldoc, MD said ... (August 11, 2006 12:38 PM) :

Yeah - u can :-) and then attach 3 to 4 to each program


Anonymous said ... (August 13, 2006 12:10 AM) :

I am an IMG and was wondering how the letter writer should refer to us. Should it be as "Dr XYZ" or just "XYZ"? The LOR that I have, just states my full name despite the fact that I am a graduate. Is that OK?


Digitaldoc, MD said ... (August 13, 2006 2:28 AM) :

Thats arrite :-)


Anonymous said ... (August 15, 2006 7:13 AM) :

hi digitaldoc,

i dont have a single LOR from my own college as i did my internship from another hospital.is it ok if i submit LORs ONLY from my internship hosp &the hosp i work in.my college is in soth india &i cant go there now as im leaving 4 US in 10 days.

plz do rply.thanks a lot in advance


Anonymous said ... (September 02, 2006 11:12 AM) :

Hi Digidoc,

Thanks for the valuable info. :)

I only have LORS from U.S. physicians from my 1st choice specialties. I'm planning to apply to other specialties, as well, as backups or alternates, but dont have any LORs from physicians in these specialties. Can I still apply to the "backup" specialties and submit the same LORs, that i hold from my 1st choice specialties? Its been a 2 years or so now, since the rotations in the "backup" specialties, but would it still be possible to search and contact one of the physicians (i do recall the PDs name and 2 physicians, whom commented me nicely and gave me a good grade, but i did NOT get a LOR from them, at the time...), and obtain a possible LOR now, for the "backup" specialties, which im planning to apply to, in addition to my 1st choice specialties? What do u think? thx...


Digitaldoc, MD said ... (September 02, 2006 11:15 AM) :

yeah - go ahead and get those LORs, since they are backup specialties anyways, you could afford to wait a bit and get the LORs...:-) plus in the other letters, if the writers did not mention the specialty you applied for (i.e.said 'residency program' instead of 'internal medicine' etc. ) - u can still use them for ur 'backup' specialties


Digitaldoc, MD said ... (September 09, 2006 1:46 AM) :

To the dude with No LORs from medical scool - Thats fine...most programs dont have any strict requirements about letters being from ur medical school only


Anonymous said ... (September 17, 2006 7:00 PM) :

Hi Digitaldoc,
I am applying to Paeds and to IM, and have 2 letters from each of my professors, one specific for Paeds and the other general. I've already sent them to Eras. I thought that I'd be able to view the letters online once they upload them, so that I can assign them correctly to Paediatric and IM programs. How can we know which letter is being assigned to the program?
Thank you.


Digitaldoc, MD said ... (September 17, 2006 7:16 PM) :

I totally agree with you that it's unfortunate that ERAS will not allow us to view the scanned images online - but again might overburden their web-servers. This was a reason that recommendation letter should be kept specialty neutral rather than specific for a specialty. The same happened to my friend last year - he wrote to ERAS support telling that there were two letters from each prof for different speicialties - ERAS guys will normally attach the right specialty letters ..but I suggest you right to them jst to double-check :-)

g/l !


Dr Salman Akhtar said ... (October 08, 2006 12:16 AM) :

Hi DigitalDoc,
in the main post, u have said that
"Here's a Sample LOR that a friend forwarded me over email ..."

but i didnt find any sample LOR there, would u please tell how to get it?
thanks in advance


Digitaldoc, MD said ... (October 08, 2006 12:26 AM) :

That's coz I had put the picture image instead of words and if the pic does not show, u wont see the letter. Let me type it out instead - thankx for letting me know :-)


Anonymous said ... (November 07, 2006 10:49 PM) :

dear digi doc,
i will be going to the US for csa soon.i have 3 LOR's from different departments including casuality medicine where i was doing house surgeonship.i do know a few doctors in the UK, who know my family n know me as a person..i have never worked wit them..but they would be willing to gve me a LOR that they know me personally etc more about my character etc..so is it worth getting one from them? i will try to get myself an observership prog in the US too.do Personal reccomendation letters from other contries hold weightage?kindly let me know..
thanks you so much. this Blog id truely a blessing


Digitaldoc, MD said ... (November 07, 2006 11:07 PM) :

Sure - collect as many as you can while there is still time - coz u can send ALL of them to ERAS for scanning..and then decide while applying which 4 best LORs you wannaa assign to a program..u will have a choice for each program to assign any of those 4.


Pancuronium said ... (February 12, 2007 2:12 PM) :

Hi DD, you can add me to your fan list, your blog definetely rocks!!, here's my question, in prep for the 2009 match

Currently i've only two LORs, one of them from a french Phd, ive made a clerck in france in his service, and the other is from a local phd.

Both of them have several entries in pubmed, (75 and 30) the problem is that the first one is an IM md, and the second one is a biochem ph, and i want to be a surgeon :(...

Can i make any use of them?


Digitaldoc, MD said ... (February 12, 2007 6:18 PM) :

Not all programs will need LORs specifically from that specialty, even if they do they generally will need only ONE LOR specifically from the the specialty - I have seen that more often in Family Medicine. What the LOR does is an assessment of a reliable person who has been in a position to assess your working skills, professional conduct or clinical skills.

My advice for LORs is , collect as many as you can, send them ALL to ERAS scanning and then make the selection on ERAS while assigning them to programs.

Go ahead and use those, but to be on the practical side, also try your best to have one from a surgeon thru observerships / externships etc. Scores come first though :-) if they are very good, other items are often discounted


Anonymous said ... (March 03, 2007 11:58 AM) :

Hello, I applied for 2007 Match, but did not get any interviews. Can I use the same LORs for 2008 Match?


Digitaldoc, MD said ... (March 03, 2007 5:35 PM) :

yes - people have used one year-old LORs


Anonymous said ... (March 06, 2007 11:04 PM) :

Hi Digital doc...I have one query...I got the LOR IN NOVEMBER 2006 from the Neurosurgeon under whom I worked as a House officer here in INDIA....He is MCH n FRCS in neurosurgery....Can it b used for 2008 match? How worthy is it?
Also i m plannin my cs in April 2007 n will in USA stay till September ..So should I take all docs for match application like LORs n MSPE right now only? I m trying for IM


Digitaldoc, MD said ... (March 07, 2007 11:06 AM) :

LOR from an accomplished clinical guy about your clinical skills is good - ask him to focus on your medical clinical skills on the LOR.

Yes - take ALL your documents with you before you leave - worth it


Anonymous said ... (March 08, 2007 12:06 AM) :

Thanx a lot Digital doc....


Mitil said ... (April 02, 2007 9:13 AM) :

hello digitaldoc, your blog has been so helpful to me, I have a question> I am bringing some LORS from my home school where i did my internship, i do not have any AAMC id yet( planning to apply for 2008 match),so what should i do about mentioning the id on the LOR?your answer will be very helpful. thanks in advance.


Digitaldoc, MD said ... (April 02, 2007 9:34 AM) :

Hi Mitil, have already covered this on the post above - u can write the AAMC id on the letter yourself in the corner (top-left or top-right)


Abc said ... (April 18, 2007 11:16 PM) :

Hi Digdoc,
Can you tell if the programmes/ERAS check the authenticity of the LORs?
Do they contact the Consultants if suppose one is selected for interview?
Thanks.


Digitaldoc, MD said ... (April 18, 2007 11:36 PM) :

Have never heard of that happening - unless the letter seems impossibly too good to be true ;-)


smriti said ... (April 19, 2007 3:46 AM) :

hey dd!
i havent done internship in my medschool.....can i still take lors from my professors or having worked as intern or houseofficer is mandatory........plz reply soon its urgent
smriti


Anonymous said ... (April 19, 2007 11:48 AM) :

im sorry digitaldoc but i have to ask this again. are u absolutely sure we can write the AAMC ID on our LORS that we got before we got an ID? it is safe? ink or print? im sorry but i have to be absolutely sure cuz professors are not too happy about signing LORS again n again if they have mistakes !


Digitaldoc, MD said ... (April 19, 2007 3:56 PM) :

On a follow-up to 'ABC's question, this is what ECFMG says on their site: "ECFMG will make a visual inspection to determine if the document is an original or a copy. ECFMG will not conduct a primary source verification of these document types" anyways, best to keep ourselves true

Answer to Smriti: As ECFMG says - "It is recommended that your letters of recommendation be written by physicians familiar with you and your work" - it is probably best to take them from people who can write about your clinical skills. I generally advise keeping LORs as 3+1 (3 Clinical and 1 either clinical or other domains like research)

Answer about AAMC id: That's what ECFMG wrote to me once, worked for me and many friends - you can write to them at : eras-support@ECFMG.org to be sure about latest policies, though I am sure it is fine. They need AAMC ID on the letters for their own reference so that they can attach the right LORs scanned to your application when it is sent to the programs you apply to - the Program directors already know your AAMC ID.


Gary Singh said ... (April 22, 2007 8:43 AM) :

Hey do we need 3 LORs in total or 3 LORs per program? that is if I apply to 10 programs, do I need 30 LoRs atleast?


Digitaldoc, MD said ... (April 22, 2007 12:17 PM) :

You can send as many LORs to ECFMG-ERAS as you like, but can attach no more than 4 per program. The minimum required per program is 3 - this does not mean 3 separate per program - you can use the same 3 LORs to all programs you apply.
It's like sending the same 3 attachments to multiple people via email.


Shiva said ... (May 23, 2007 3:00 AM) :

Hi I am planning to start US Externship for 3 month staring July 30 till Oct 21, I will attend with 2 different physicians in 2 different specialities, I do not know How could grape the PDs attention to my LOR and when should I sumbit them.
the most important is What is the possibilities that PDs will consider my LOR after September
Thanks for your time


Digitaldoc, MD said ... (May 23, 2007 11:33 AM) :

hi Shiva - congrats on ur externship. I guess getting the LOR on time from ur first specialty guy should be easier than the second. After 2-3 weeks you will be more comfortable with the externship mentor physician and you need to explain why applying on time with the US LORs determines the number of interviews you can get

in addition you should email/call the programs you apply too , telling them you are doing externship under so and so MDs, and that LORs will be available soon - when they are available, do send email updates again to all (or bett er call them) , which should make them give a second look at ur application


Shiva said ... (May 24, 2007 1:03 PM) :

Thanks I will go for your advice


Anonymous said ... (June 07, 2007 10:19 AM) :

hi digi,
is it true that one of lor should be from head of department? (read somewhere but not able to recollect)


Digitaldoc, MD said ... (June 08, 2007 10:52 AM) :

Not compulsary but a good thing to do - at times the individual residency programs may have that requirement, but is not an ERAS requirement


Anonymous said ... (June 29, 2007 7:44 AM) :

hi digi,
is it ok if one of my acquaintaces in usa writes a lor 4 me though i did not work under him.should use a date on lor when i was in usa 4 cs.please reply as my decision will be based on ur reply.if u think it is wrong and risky let me know.


Digitaldoc, MD said ... (June 29, 2007 11:29 AM) :

You can use it as your 4th LOR - written by the person in the capacity of knowing you as a person - while keeping the other 3 LORs about your medical skills


Anonymous said ... (July 01, 2007 2:27 AM) :

thanks so much,i will do that


Anonymous said ... (July 02, 2007 12:41 AM) :

hi im presently approved for clinical elective in radiology at university of california san francisco.im scheduled from aug 27 to sep23.does lors from radiology mds work for applying to residency in other specialities.how far this elective help me in getting residency and does it count to my us clinical experience.


Digitaldoc, MD said ... (July 02, 2007 12:33 PM) :

It will surely help you for radiology (which you must understand is pretty tough for IMGs) - for other specialties it would be alright to attach one Radio LOR - or two of them for transitional programs (since radiology residency needs 1 year transitional / prelim year residency before getting into the categorical program)


Anonymous said ... (July 06, 2007 8:06 AM) :

hi digidoc,
Is an LOR from relevant specialty in home coutry(India), better than a LOR from say UK in nonrelevant specialty?
thanks.


Digitaldoc, MD said ... (July 06, 2007 2:43 PM) :

get them both ! you can have a max of 4 LORs to a program - UK LORs will carry weight, but specific experience s in the specialty and having someone vouch for those are good too.


Anonymous said ... (July 26, 2007 5:33 PM) :

I have an LOR which is about 2 pages in length. The first paragraph introduces the LOR writer and his role in the hospital. The next few paragraphs describe the hospital and the community it caters to, etc. The second page is where the actual "recommendation" begins. Thus, 2 pages. Is this okay or do I have to have the LOR writer shorten this to 1 page in length? I know you mention that the LOR should be AT LEAST 3/4 of a page (or more). Will there be difficulty in uploading 2 pages as a single LOR by ERAS? Thanks in advance.


Digitaldoc, MD said ... (July 26, 2007 5:37 PM) :

Many Opine that a 'big' reco is more genuine and authentic - 2-pages is fine..make sure you have AAMC ID on both pages, jst that ERAS does not misplace the pages :-)


Anonymous said ... (August 17, 2007 4:10 PM) :

dear digidoc,
i am an internatonal med graduate . i only recently joined clinical research in the deptt of nephrology in a U.S community based medical centre.
I would complete a month under my supervisor only in the first week of september after which i can ask for a LOR . which means i would only be able to post my LOr first week of sep
i am applying for all the programs on the 1st of sep and have already posted my other documents to eras.
My question is can i mention the name of my current research supervisor in the slot for lor;s and asssign them to programs even though i did not send that particulR LETTER with my other documents and am still awaiting it.
my deans lettes, mspe and other lor;s have already reached eras .
kindly advice me how i should let eras know that i am still awaiting an Imp letter since that is the only U.S lor that i would have.
thanks
samare


Digitaldoc, MD said ... (August 17, 2007 7:21 PM) :

yes you may assign that letter in advance and keep it that way, post it when its ready. When you apply to programs, keep this letter as the fourth letter, and when its available, email all programs that it is available for download - they will receive a notification from the ERAS post-office anyways.


Anonymous said ... (September 01, 2007 4:27 PM) :

hey digi doc,i got one lor from the head of department of medicine from my college in india but it is two years old(issued in feb 2005).i got it before i moved to US.can the PDs call up and ask the department if they issued such a letter cos they wont even remember now.and is it worth it to send such an old lor.i will be getting two lors from american doctors probably sometime next week.


Digitaldoc, MD said ... (September 04, 2007 5:15 AM) :

1. If you can arrange to have a letter Fedexed from yourself to the dept. head helping him/her remember the letter the person gave you in 2005 (provide a copy) and explaining that he/she may be contacted for verification - that might be helpful, if the letter helps you send a complete application early. When the US LORs are uploaded,, email all programs that new LORs are available from so and so MDs - provide names and designations


Anonymous said ... (September 06, 2007 7:06 AM) :

thanks digi doc,will do that:)
god bless ya!


Anonymous said ... (September 06, 2007 10:36 AM) :

hi digitaldoc,..
i am an IMG..did my observership in US. my question is that..if i want the MD; who is giving me a letter, to post the letter to the ERAS directly(as i'm waiving my right)..what all documents do i need to give the MD, do i have to attach document submission form even then,..and if i did not will the ERAS scan my documents to my account once they receive it...
thanks!


Digitaldoc, MD said ... (September 07, 2007 7:28 PM) :

You will need to attach the waiver agreement form and in addition its safer to attach the document submission form too - coz that will help ERAS To file your scanned LOR accurately

 

Blogger rajat said ... (November 28, 2007 9:35 AM) : 

hi doc
could you please guide as to is there
a requirement of having taken eras token before submitting your letters of recommendation ?
if i am interested in 2009 match can i start sending my letters of recommendation to ecfmg from now itself ?

 

Blogger Digitaldoc, MD said ... (November 29, 2007 3:09 PM) : 

Interesting question. The LORs need to have the AAMC ID on them for assigning it to your MyERAS profile while scanning and transmitting. The AAMC ID for 2009 Match season will be obtained only after you purchase the ERAS Token for that season, which should be available around May-June 2008. Thats's good enough to time to send in your LORs way before sept. - aim to send them all before Aug 2008 itself :-)

 

Anonymous doc.N said ... (December 14, 2007 6:02 AM) : 

dear digital doc,
this blog is really helpful .. and has guide dme in lot of things.
just one query..
i'll be applying for 2009 match but i'll be leaving for US in january 2008.
i have LORs from my medical school of dated last year.( graduated in 2005, completed internship in 2006)
can i use them for 2009 match??

 

Blogger Digitaldoc, MD said ... (December 15, 2007 1:56 AM) : 

Thanks for the kind comment doc.n
Technically, Yes you can use them - but it is advisable to keep your LORs dated not more than a year from when you apply.

 

Anonymous Doc.N said ... (December 15, 2007 11:34 AM) : 

Thanks digital doc,
thanks for ur prmpt reponse..
another query is that
i m just lil' confused with LORs being directly submitted by Professors/MDs to ERAS or do we need to keep them and submit with our documents while applying for residency?
like i have taken LORs from physicians i have worked with.. but will i have to tell them to send it directly to ERAS?

 

Anonymous Anonymous said ... (December 22, 2007 4:57 AM) : 

hey there....i forgot one question...
i had done my internship in the year2006 but not from my college....i am infact doubtful as to whether my professors there would still remember me...would their lors have more weightage or would the lors from the place i did my internship from have more weightage??

 

Blogger Digitaldoc, MD said ... (December 23, 2007 1:17 PM) : 

LORs from People with you worked under clinical capacity in the specialty you are applying from would be good - from the medical school, the dean's letter is supposed to represent that

Anyways, try more for US-physician LORs..they certainly seem to matter a lot more (in case you are IMG that is..)

 

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