2023 Guide to the Letter of Intent for Residency


Applying to residency programs is a long and tedious process, and it doesn’t stop after residency interviews. After completing a challenging (but hopefully inspiring and exciting!) round of interviews, you will need to create your NRMP Rank Order List of the residency programs you most want to attend. While it’s not required, many applicants also choose to send a letter of intent for residency in the hope it will give them an edge over their competition.

PLEASE NOTE: Not all specialties allow applicants to send a letter of intent. Check with the residency program before writing a letter of intent, and if the program does not allow them, do not send one.

In this post, we’ll break down the anatomy of a residency letter of intent, how and when to send one, and key tips for how to write a residency letter of intent effectively.


The Anatomy of a Residency Letter of Intent

Your residency letter of intent must be succinct, clear, and to the point—not more than one page (around 200-300 words) in length. While it’s short and sweet, it’s also formal, so keep everything professional and use complete sentences over bullet points and colloquialisms.

This is not the time to beat around the bush. Your opening paragraph should clearly state who you are, when you interviewed with the program, and that you intend to rank this program as your #1 choice when you submit your Rank Order List (ROL).

In your body paragraphs, you can dig into exactly why the program is your first choice and why you think you will make a great fit for it. You can’t write this section effectively without first completing plenty of research. Fortunately, you likely already researched the program extensively when you were preparing your answers to common residency interview questions.

Why do you believe this program is the best one for you? Are you excited about the research opportunities they provide? Did you learn something about the program during your interviews that just clicked? Do you share the same values and mission of the school?

And don’t forget that it’s just as vital to show how you will make effective contributions and enrich the program. What are personal examples from your own past that demonstrate how you have lived the values of the program? How do your skills complement the program? How will this program help you realize your short-term and long-term goals?

As always, be specific. To save yourself time, use your answers to common interview questions as a place to get started.

Plus, if you have updates to your application materials, such as a new paper that’s up for publication or any new and relevant volunteer or employment experiences, include this information as well. If it makes you a more appealing candidate, include it.

In the conclusion, quickly summarize why you are deciding to rank this program first and once again reiterate that they are your #1 choice.


How and When to Send a Letter of Intent for Residency

A Letter of Intent is like a proposal

A residency letter of intent should only be sent after you have attended your residency interviews, which take place during the fall and winter of your final year of medical school but long before the final ranking deadline. Plan to send your letter of intent in late January or early February.

Your letter of intent can be typed or written out by hand and sent by email or by physical mail. A handwritten note sent physically can add a nice, personal touch that stands out, but there’s only a short window to send the letter, so this may not be feasible. If you’re pressed for time, an email is more than sufficient, and there’s no chance of it getting delayed or lost in the mail.

It is imperative that you address and send your letter of intent to the residency program director. You do not want your letter lost in a sea of emails. Do your research. Check the program’s website, call the school, and do whatever you need to do to ensure your letter makes it to the right person. If you’re sending an email, use “Letter of Intent” as your subject line, address the letter to the residency program director, and be sure to use their full name.


Residency Letter of Intent Tips

1 | Keep Your Letter of Intent Commitment

Just like with your letter of intent for medical school, you should only write and send one residency letter of intent. No, a letter of intent is not legally binding, but you are making a commitment to the program that you will rank them first above all others. You’re making a promise.

Sending more than one letter of intent compromises your ethics. Since ethics are of paramount importance to doctors, breaching your ethics at this early stage is a clear indication you are not ready for the responsibility of being a physician.

While it’s certainly possible to get away with sending more than one letter, it’s much more likely that you will be caught in the lie, and the medical community is extremely tight-knit. The people you’re lying to could be in a position to influence your publications or other opportunities down the line, so you do not want to put your reputation in jeopardy by showing yourself to be unethical.

2 | Be Clear and Direct

This is no time to be vague or wishy-washy. Clearly state your intention. Directly say that you intend to rank that program as your first choice. If you’re not able to declare your decision confidently, there is no point in sending a letter of intent.

Don’t worry about using flowery language. This is a busy time for residency programs, so get to the point. Do not include any information that is not relevant to why you and the program are an excellent fit for each other.

3 | Explain Why You Are an Ideal Fit

If you are ranking this program first, why? What stood out to you about this program? Why do you believe you will be a good fit? How specifically do your interests, skills, values, and experience complement the program?

You’re making this decision for a reason, so don’t overthink it. You know why this program is your top choice. You have interviewed at and thoroughly researched other programs, and you know that this residency program is #1 for you. Why do you believe this program will help you reach your goals above all others you’ve considered? Why do you think you will thrive in this program? How do you know you will make fast friends with your peers?

This is your final chance to sell yourself. Show how much consideration you have put into this decision by being detailed, thoughtful, and, above all, enthusiastic.

4 | Use Specific Examples

As always, be specific. You’re up against countless other candidates with similar qualifications and dreams as you. It’s not enough to say you share the same values as the school; give clear examples of how you have exemplified those values in your life. Just like with your personal statement, telling a story about how you have used your strengths is much better than simply stating what those strengths are. Back up your claims with genuine evidence from your past.

If you can, pull something you learned about the program during your interview. This demonstrates that you’ve taken a great deal of time to arrive at this decision and are factoring in what you learned about this program and the others you visited during your interviews.

This isn’t just a dream you’ve had since you were a premed; after thoroughly considering your revised and informed hopes for your future as a professional physician, you have determined this program is your best fit for specific reasons.

5 | Include Any Relevant Updates

Is there anything new the program should know about since you submitted your application? Do you have any recent publications? Have you participated in any presentations? Have you been involved in any relevant research, volunteering, or employment experiences? Is there anything that makes you more qualified for this program now than you were when you originally submitted your application?

If you have achieved anything that’s relevant to this program or boosted your qualifications for it, be sure to briefly mention it in your letter of intent.

6 | Ensure Your Letter Gets to the Right Place

Don’t let your letter of intent get lost in junk mail or buried underneath a sea of other generic emails. Do your research to find the direct contact information of the residency program director, which may involve more than checking a website. You might need to do more digging or make a few phone calls.

You are writing to a real person, not a faceless admissions committee member. Address your letter to them directly, and if sending an email, make sure to use “Letter of Intent” in your subject line to make it perfectly clear what this email is regarding.

Don’t take any chances. If this residency program is truly your top choice, do everything you can to ensure you write an effective letter of intent that ends up in the right place at the right time.


Maximize the Impact of Your Letter

Med School Insiders offers thorough and effective editing and advising services to maximize the impact of your letter of intent. We’ll help you make all of the right decisions to get the attention of your top choice program.

Learn more about our suite of services designed to get you matched with your ideal program. We also offer a number of online resources, including guides on the entire residency application process, how to choose a specialty, how The Match algorithm works, and more.


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