medschoolcoach
The residency match process can be grueling — between away rotations, the endless ERAS application materials, tough residency interview questions, and thank you letters, medical students like you have already put a tremendous amount of work into making their specialty of choice a dream.
But there is still another hurdle before match day: the letter of intent. Keep reading for an in-depth guide on improving your match chances with an LOI.
A letter of intent (LOI) for residency is a formal message sent to a residency program that indicates this program is your first choice. An LOI can slightly boost your candidacy and tip the scales in your favor if competitive residencies are making tough choices between you and other candidates.
An LOI ethically binds you to accept if this program offers you a spot, although it is not technically a legally binding agreement.
This expression of intent should come after your interview. The letter notifies the program and program directors that you’re excited to match there.
The letter of intent can improve your chances for matching with your preferred program. Residency admissions boards must make tough decisions between competitive candidates, so if you can show your commitment, it might help you edge out the competition.
I work with a lot of students who are applying to medical residencies. When they ask about letters of intent, I typically have a few constant pieces of advice:
Dr. Edward Chang, Chief Resident of the urology department at the University of Washington, wrote a good guide on writing letters of intent, which I encourage you to read in detail. Although his guide is specifically targeted to med school LOIs, the same principles apply to residency LOIs.
No, you should not send multiple letters of intent. It is in very poor form to send a letter of intent to programs that aren’t your first choice. The world of residencies is small, and program directors may talk among themselves. If they find out that you sent a letter to multiple programs, your chances of matching are nill.
Sending LOIs to more than one program would be disingenuous. However, it is acceptable to send multiple letters of interest to programs at the top of your list. Unlike letters of intent which are sent after interviews, letters of interest are sent soon after ERAS submission to indicate which programs you’d like to interview at.
A lot of programs get these letters of strong interest, and they don’t carry much weight.
Ideally, you should send a letter of intent to your preferred residency program in mid-January or the first week or two of February. This allows time for your letter to be reviewed before the NRMP rank order list (ROL) certification deadline.
Some students send letters closer to match day in mid-to-late March, but the goal of this letter should be to encourage admissions committee members at your preferred residency program to rank you high on their ROL, which is due in early March. That’s why I recommend no later than early February.
Besides sending an LOI, you can put your money where your mouth is and rank your preferred program highest on your ranking list. In reality, you likely placed a program number one on your ranking list then sent an LOI, but I just want to make sure we’re on the same page.
If there’s a program you absolutely want to match with, ask your med school faculty or physicians with whom you have a relationship to call the residency program director or admissions board to put in a good word. It could be like a bonus letter of recommendation.
Ideally, you already submitted a killer ERAS application tailored towards your preferred program. For instance, your personal statement is a great place to really hammer home how you want to match with this residency above all others. Answer how you’re a great fit for this program.
Watch this webinar from Dr. David Flick on matching with your ideal residency program for more handy guidance.
First, here’s an LOI template that is not filled out. After this, you’ll find the sample LOI that I have filled out.
We recommend that students do not utilize a singular template for a letter of intent (since many letters of intent would be too similar). However, we’ve provided below a general outline that you can follow:
Dear [Director of the Program],
Thank you so much for the opportunity to interview at your program this past December. I was so thrilled to have this opportunity, meet the faculty and residents and see the program in action. I am writing this letter to express my sincere interest in the program and that I will be ranking it as my top choice residency.
[Paragraph about why the program is a good fit from a clinical sense.]
[Paragraph about why the program is a good fit from a research sense (if appropriate).]
[Paragraph about the people you met as well as why the city is a great choice for you.]
For all of these reasons, the program is my absolute top choice for residency. I would be absolutely thrilled to match here! If there is anything more I can provide the committee, please do let me know.
Below is a sample LOI so you can get a good idea of what one looks like. You are well aware of this at this point in your career, but I encourage you not to plagiarize (or come anywhere close) if you choose to find inspiration in this sample letter.
Thank you so much for the opportunity to interview at your program last December. I was so thrilled to have this opportunity, meet the faculty and residents, and see Johns Hopkins in action. I am writing to express my sincere commitment to joining Johns Hopkins as a resident physician, as well as my intent to rank your program as my number one choice for residency.
Throughout my medical school education and clinical experiences, I have been drawn to General Preventive Medicine at your program due to the specialty’s unique challenges, opportunities for growth, and potential to make the most meaningful impact on the most patients’ lives. Your program’s reputation for excellence aligns perfectly with the electives I’ve taken, the research projects I’d like to be involved in, and my professional career goals.
During my interview day at Johns Hopkins, I was captivated by the cohesive and driven atmosphere among faculty, residents, and staff. Your robust curriculum, diverse patient care, and opportunities for research activity will provide me with the training and resources I need to become a well-rounded and competent preventive physician.
Did I mention I love Baltimore? The culture is unmatched, yes. But Johns Hopkins is so perfectly placed for massive impact in underserved populations. I am passionate about being a small part in a larger story of restorative healthcare justice.
For all of these reasons, Johns Hopkins is my absolute top choice program for residency. I would be absolutely thrilled to match here! I am always available to provide any additional information or answer any questions you may have. Thank you once again for your time and consideration.
John Hopkins, Jr.A letter of intent (LOI) is an optional part of the residency application process, as well as med school admissions before that. It’s you indicating that you ranked a certain program #1 on your rank list in early February.
Note that some programs do not accept LOIs, so check the specific program’s terms and guidelines before sending.
Also, LOIs are not required by any residency program. If you can’t decide between 2-3 programs, don’t stress — you don’t have to send an LOI.
That said, I have found a letter of intent can make a small difference in acceptance, which is a huge deal when you’re competing against other highly qualified candidates for a limited number of spots. If you know your number one program, just send an LOI. It can’t hurt.
