A residency letter of intent is your final handshake with your top-choice program. It’s a targeted, personal letter you send after your interview, making it crystal clear that you plan to rank them #1.
This isn’t just another thank-you note. Think of it as your last chance to make a compelling case for why you belong there, reinforcing your commitment and showing you truly understand their mission and values.
Does a Letter of Intent Actually Influence Residency Rankings?
Before you spend hours crafting the perfect letter, let's get to the question on every applicant's mind: does this actually work? The answer isn't a simple yes or no. While it’s not a magic bullet that can launch a borderline candidate to the top of a rank list, a well-written LOI can absolutely be the tiebreaker between two equally strong applicants.
Your entire application—the ERAS submission, personal statement, and interview—builds the foundation. The letter of intent is that final, personal touch that tells a program director you aren't just interested; you’re all in.
Setting Realistic Expectations
The med school rumor mill often inflates the power of an LOI, so it's crucial to ground your strategy in reality, not just anecdotes. A letter of intent packs the most punch when a program already sees you as a great fit. It confirms their positive impression and can nudge them in your favor if they're on the fence between you and someone else.
However, it’s not going to rescue a bad interview or make up for major gaps in your application. Program directors are sharp—they’re looking for genuine, specific reasons you’ve chosen them. A generic, copy-paste letter can do more harm than good, flagging you as someone who didn't put in the thought. You can get a better sense of their evaluation process by reading up on what programs look at for ERAS.
What the Data Suggests
While personal stories are compelling, the hard data gives us a clearer picture. Program directors vary quite a bit in how much weight they give these letters. Survey data actually shows that most programs don't change their rank lists based on post-interview communication alone.
Here’s a rough breakdown:
- 35–50% of program directors report they never change their rank list based on an LOI.
- 25–40% say they rarely change it.
This means for a solid majority, the letter has little to no direct sway. Only a small fraction—around 10–20% of programs—report that they sometimes adjust their rank lists after receiving a compelling letter of intent.
This data isn't meant to discourage you. It’s meant to empower you. Think of the LOI as a low-probability, high-impact tool. Its real purpose is to be a professional, heartfelt confirmation of your interest, not a last-ditch effort to change a program director's mind.
Ultimately, your goal is to write a letter so authentic and well-reasoned that it leaves a great final impression, whether it moves your number on the rank list or not. It solidifies your image as a thoughtful, dedicated applicant who has made a very careful decision about their future.
The Anatomy of a Compelling Letter of Intent
A great residency letter of intent isn't just a simple "I'm interested" note; it's a carefully constructed, persuasive argument. It needs a clear blueprint designed to connect your past journey with that program's future. When you break it down, a winning letter has three core sections, and each one has a very specific job to do.
Think of it like building a case in court. You start with a bold opening statement, present your irrefutable evidence in the middle, and finish with a closing argument that leaves no doubt about your intentions.
The Introduction: Your Direct Statement of Purpose
Your opening paragraph needs to be sharp and to the point. Program directors are incredibly busy people, so there's absolutely no room for a long, winding backstory.
Get right to it. State your name, the program you’re writing about, and immediately declare your intent to rank them #1. This isn't the time to be shy.
This direct approach signals confidence and shows you respect their time. It instantly frames your letter not as a casual update, but as a serious communication about your final ranking decision.
Example Opening:
"Dear Dr. [Program Director's Last Name],
I am writing to express my sincere and enthusiastic intent to rank the [Specialty] Residency Program at [Institution Name] as my #1 choice in the upcoming NRMP Match. My interview on [Date] solidified my belief that your program offers the ideal environment for my professional growth and aligns perfectly with my career aspirations."
This gets the job done perfectly. It’s unambiguous, professional, and ties your decision back to your interview experience.
The Body: Crafting Your "Why"
This is the heart and soul of your letter. It’s where you have to prove your case, and personalization is everything. The body paragraphs absolutely must connect specific aspects of their program to your unique skills, experiences, and goals.
Generic compliments are easy to spot and will completely undermine your message. You have to draw a straight line from what you saw and experienced to what you want to achieve as a resident.
- Mention Specific Faculty: Did a conversation with a particular faculty member stick with you? Or does their research genuinely align with your interests? Name them and briefly explain the connection.
- Reference Unique Rotations or Clinics: Talk about a specific training opportunity that excites you—maybe it’s their global health track, a specialized procedure clinic, or a community outreach program. Explain how it fits into your long-term plans.
- Connect with the Program Vibe: Did you get a great feeling from the residents? Mention the camaraderie you witnessed or the supportive teaching style you observed. Explain why that matters to you.
The goal here is to go far beyond what anyone could find on the program’s website. You need to weave in personal insights from your interview day. Show them you’ve done more than just read a brochure—you’ve been genuinely reflecting on why you're a perfect fit. If you're struggling to frame your story, our guide on how to write a personal statement for residency has some great tips that are easily adapted for an LOI.
The Conclusion: A Confident and Professional Close
Your final paragraph should be a strong, clear, and confident reaffirmation of your commitment. There should be zero ambiguity left in the reader's mind. Reiterate that the program is your top choice and thank the program director and the rest of the committee for their time and consideration.
Keep it brief and professional. Avoid any language that sounds demanding, desperate, or transactional. The tone should be one of genuine gratitude and excitement for the chance to train with them.
A great letter of intent doesn’t just tell a program they are your top choice; it shows them why through thoughtful, specific, and personalized evidence. It’s the final piece of your application puzzle that confirms mutual interest.
Beyond the letter's structure, the art of persuasive writing itself plays a huge role. For some solid, general advice on crafting emails that get replies, many of those same principles apply here. Clear, compelling communication is what will make your letter stand out in a sea of applicants.
Annotated Residency Letter of Intent Samples and Templates
Knowing the theory behind a powerful letter of intent is one thing, but seeing it in action is where everything clicks. Moving from abstract advice to concrete examples is how you really learn to transform a standard, forgettable letter into something that a program director actually remembers.
So, let's break down several fully annotated residency letter of intent samples. Each one is built for a common applicant scenario, and my commentary will point out exactly what makes each component work. Think of these less as templates and more as practical learning tools. They're here to show you how to write, not just what to write.
Sample 1: Dermatology Applicant
Dermatology is notoriously competitive. Your letter has to do more than just say "I like your program"; it needs to prove you have a deep, nuanced understanding of what they do and how you fit in.
This sample is from an applicant, Dr. Anya Sharma, writing to her top-choice academic program. It's a place known for its tough medical dermatology cases and translational research, so her letter needs to hit those notes perfectly.
The Letter
To: Dr. Evelyn Reed, Program Director, Department of Dermatology, University Medical Center
CC: Ms. Julia Chen, Program Coordinator
From: Anya Sharma
Subject: Letter of Intent – NRMP #1 Ranking – Anya Sharma
Dear Dr. Reed,
I am writing to express my sincere and enthusiastic intent to rank the Dermatology Residency Program at University Medical Center as my #1 choice in the upcoming NRMP Match. My interview experience on January 15th was incredibly inspiring and solidified my belief that your program’s unique focus on complex medical dermatology and resident-led research is the ideal environment for my career aspirations.
Annotation 1 (Opening): Perfect. It's direct, confident, and gets straight to the point. Putting her name and rank intent in the subject line ensures it gets noticed immediately. CC'ing the coordinator is a small but very professional touch.
During my interview day, I was particularly impressed by my conversation with Dr. Marcus Thorne about his work on cutaneous lymphomas. His approach to patient care and research perfectly mirrors my own goals. Furthermore, the opportunity to rotate through the dedicated autoimmune skin disease clinic during the PGY-3 year is a significant draw, as my research during medical school focused on immunobullous disorders.
Annotation 2 (Specific Connections): This is where the letter shines. Anya names a specific faculty member and a niche clinical opportunity. It proves she was genuinely engaged and has an interest that goes way beyond the program's homepage. Crucially, she links her own past research to a future opportunity at their program.
I was also energized by the residents’ palpable sense of camaraderie and intellectual curiosity. Speaking with Dr. David Liu, a current PGY-2, about the weekly grand rounds and the supportive mentorship culture confirmed that this is a community where I would not only learn but thrive. My experience leading our medical school’s dermatology interest group has taught me the value of collaborative learning, a quality I see reflected in your program’s culture.
Annotation 3 (Cultural Fit): She smartly moves beyond the academics to talk about culture. Mentioning a resident by name and connecting that conversation to her own leadership experience shows she's thinking about how she'll contribute to their community, not just what she'll take from it.
My long-term goal is to pursue an academic career focused on treating severe dermatologic conditions while mentoring the next generation of physicians. The structured research track and the robust faculty mentorship at University Medical Center provide the exact framework I need to achieve these ambitions. I am confident that I have the clinical skills, research background, and dedication to excel as a resident in your program.
Thank you once again for your time and for the opportunity to interview. I am deeply excited about the prospect of joining your team and contributing to the outstanding work being done at University Medical Center.
Sincerely,
Anya Sharma
AAMC ID: 12345678
Sample 2: Family Medicine Applicant
For primary care fields like Family Medicine, programs are looking for a demonstrated commitment to community, continuity of care, and specific patient populations. It’s all about the mission.
This letter is from Dr. Ben Carter, who is passionate about rural and underserved medicine. He needs to show that his values align with the program's DNA.
The Letter
To: Dr. Sarah Jenkins, Program Director, Valley Community Health Family Medicine Residency
CC: Mr. David Rodriguez, Program Coordinator
From: Ben Carter
Subject: My #1 Choice for Residency – Ben Carter
Dear Dr. Jenkins,
I am writing today to express with great enthusiasm that I will be ranking the Valley Community Health Family Medicine Residency as my #1 choice for the NRMP Match. My interview with you and the team on January 22nd was a powerful experience that confirmed my desire to train in a program so deeply committed to underserved and rural populations.
Annotation 1 (Opening): The subject line is a little warmer but still professional and clear. Ben immediately connects his decision to the program's core mission, showing right away that he "gets" what they're all about.
What resonated most with me was your program's "longitudinal community project" initiative. Having spent two years volunteering at a free clinic in a rural part of my state, I have seen firsthand the health disparities that exist. The chance to work closely with the community in Northwood County and develop a health intervention project aligns perfectly with my passion for public health and sustainable care models.
Annotation 2 (Program-Specific Detail): This is excellent. Ben doesn't just offer a generic compliment about their community focus. He names a specific initiative and directly links it to a significant personal experience. This proves his commitment is long-standing, not just something he cooked up for his application.
Furthermore, I was very impressed by the strong behavioral health curriculum integrated into your clinic. My conversation with Dr. Emily Sato about the warm handoffs between physicians and therapists highlighted your holistic approach to patient wellness. As someone who hopes to pursue additional training in addiction medicine, this integrated model is exactly what I am looking for in my training.
Annotation 3 (Future-Oriented Fit): He shows he's thinking several steps ahead. By connecting a specific part of their curriculum to his own sub-specialty interest (addiction medicine), he demonstrates he's thought deeply about how this specific program will help build his future career.
The genuine warmth and support I felt from everyone, especially the PGY-1 residents I spoke with during the pre-interview social, were remarkable. It was clear that Valley Community Health is more than just a residency program—it is a family. I am eager to contribute my passion and dedication to your team.
Thank you for your time and consideration. I am incredibly excited by the possibility of training with you and serving the community of Northwood County.
Best regards,
Ben Carter
AAMC ID: 87654321
Sample 3: International Medical Graduate (IMG)
For an IMG applicant, the letter of intent is a prime opportunity to proactively address their unique background and reinforce why they are choosing a U.S. program. It's about building connections and showing you're ready to hit the ground running.
This sample comes from Dr. Fatima Al-Jamil, an IMG applying to an Internal Medicine residency.
The Letter
To: Dr. Robert Miller, Program Director, Metropolitan Hospital Internal Medicine Residency
CC: Ms. Laura Williams, Program Coordinator
From: Fatima Al-Jamil
Subject: Letter of Intent: #1 Rank – Fatima Al-Jamil (ECFMG ID: 123-456-7)
Dear Dr. Miller,
I am writing to formally and enthusiastically state my intention to rank the Internal Medicine Residency Program at Metropolitan Hospital as my #1 choice in the NRMP Match. My interview on January 18th reinforced my long-held admiration for your program's exceptional clinical training and its dedication to serving a diverse, urban patient population.
Annotation 1 (Opening): Fatima includes her ECFMG ID in the subject line—a small but very helpful detail for an IMG applicant. She immediately hones in on two key program features: clinical rigor and patient diversity.
Having completed my medical education at the University of Amman, I sought U.S. clinical experience to prepare for residency. My observership in cardiology at the Cleveland Clinic provided me with invaluable insight into the American healthcare system. However, it was my interview at Metropolitan that truly felt like the right fit. The complexity of cases discussed during morning report was stimulating and precisely the challenge I am seeking.
Annotation 2 (Addressing the IMG Context): She frames her background proactively and positively. Instead of letting her international training be a potential question mark, she connects it to her U.S. clinical experience and explains how it specifically prepared her for the rigors of their program.
I was particularly drawn to your dedicated Global Health track and the opportunity to work with refugee populations in the city. My personal background and fluency in Arabic give me a unique ability to connect with and care for these patients. I was inspired by Dr. Chen’s presentation on her work in this area, and I am eager to contribute my skills and perspective to this important initiative.
Annotation 3 (Highlighting Unique Strengths): This is a brilliant move. Fatima turns her IMG status into a distinct advantage. She highlights a specific, valuable skill (language) and ties it directly to a program track and a faculty member. She’s showing how her diverse background would be a tangible asset to the program and its patients.
I am confident that my strong clinical foundation, resilience, and multilingual abilities will allow me to excel at Metropolitan Hospital. I have completed all necessary ECFMG certification requirements and am eligible for the H-1B visa, which the hospital sponsors. Thank you for considering my application. I am truly excited about the prospect of becoming a part of your residency team.
Sincerely,
Fatima Al-Jamil
ECFMG ID: 123-456-7
AAMC ID: 11223344
Critical Mistakes That Can Weaken Your Application
A strong letter of intent can be the final nudge that secures your spot in a residency program. But a letter that’s full of common, avoidable mistakes? That can sink your entire application, leaving a negative impression that’s tough to overcome. Knowing what not to do is just as important as knowing what to include.
The single most damaging mistake—and one that happens more often than you'd think—is dishonesty. This usually looks like telling multiple programs they are your "#1 choice." Program directors talk. The medical community is small. Getting caught in this lie is a massive blow to your credibility and professionalism. It instantly tags you as untrustworthy.
Beyond that, sending a generic, impersonal letter is another huge miss. If your letter could be sent to any program with a quick "find and replace," it’s not doing its job. It just signals a lack of genuine interest and effort, making it seem like the program is just another name on a long list.
Sounding Generic or Vague
The whole point of a letter of intent is to be hyper-specific. Fluffy compliments about a program's "excellent reputation" or "strong clinical training" are empty. They could apply to dozens of programs. Your letter needs to prove you’ve done your research and reflected deeply on your interview day.
The best way to avoid this is to tie every point back to a concrete example.
Instead of: "I was impressed by your faculty."
Try: "My conversation with Dr. Evans about her research on pediatric asthma management was particularly inspiring and aligns with my own clinical interests."
Instead of: "Your program has great opportunities."
Try: "The opportunity to participate in the Global Health track and rotate in Guatemala is a significant reason your program is my top choice."
This level of detail is what makes your interest feel real. It changes your letter from a generic form letter into a persuasive, personal case for why you belong in their specific community.
Think of it this way: a letter of intent should be the opposite of your personal statement. The personal statement is a broad story sent to many programs. The LOI is a hyper-specific message sent to only one.
An Unprofessional Tone or Typos
It’s amazing how small errors can completely derail an otherwise great letter. Typos, grammar mistakes, or addressing the letter to the wrong person scream carelessness and a lack of attention to detail—qualities no program wants in a resident. Read your letter multiple times. Then, have someone else read it, too.
Your tone is just as critical. You want to sound enthusiastic, but still professional. Avoid language that sounds demanding ("I expect to match with you") or way too casual. This is a formal piece of communication that should reflect your maturity and respect for the program. For more on how this fits with other application materials, our guide on residency letters of recommendation can provide some great context.
Being Dishonest About Your Intentions
It’s incredibly common for applicants to send some kind of post-interview communication. One study found that a staggering 86.4% of medical school respondents sent at least one.
But here’s the kicker: the same study revealed that 1.1% admitted to telling multiple programs they would rank them first. While that number might seem small, the reputational damage is massive. It highlights just how critical honesty is at this final stage.
At the end of the day, your letter of intent is a reflection of your integrity. Sending a "#1" letter to a program you don't actually plan to rank first is a gamble that almost never pays off. It can burn bridges you might need later in your career. It's much better to be honest and strategic with your one true letter of intent. Rushing this can lead to all sorts of errors, so learning how to stop procrastinating is a key skill to make sure you give this letter the time and attention it deserves.
Strategic Timing and Delivery for Your LOI
Crafting the perfect residency letter of intent is only half the battle. You also have to make sure it lands in the right inbox at exactly the right time. Send it too early, and it gets lost in the shuffle. Send it too late, and it arrives after the rank lists are already locked in.
So, when is the sweet spot? Aim for late January to early February.
By this point, you've likely finished most of your interviews and have a clear "number one" in your mind. More importantly, this window is when program directors and committees are deep in discussion, actively finalizing their rank order lists. Your letter arrives right when it matters most—during the peak of their decision-making.
Getting the timing wrong is one of the most common—and critical—mistakes applicants make.
A perfectly written letter sent at the wrong time might as well have never been sent at all.
Nailing the Logistics
Okay, you've got your timing down. Now, let's talk about the "how" and the "to whom." Little details here go a long way in showing your professionalism.
Email is the way to go—it's fast, efficient, and standard practice. Address it directly to the Program Director.
You should also CC the Program Coordinator. Coordinators are the organizational heart of a residency program, managing communications and keeping the application train on the tracks. Including them is a smart, professional courtesy that ensures your letter gets seen and filed correctly.
Pro Tip: Don't get fancy with your subject line. Be clear and direct. Something like "Letter of Intent – [Your Name] – #1 Rank" cuts through the noise of a crowded inbox and immediately signals the email's importance.
Following Up and Final Steps
The follow-up question always causes a ton of anxiety. Here’s the simple answer: don’t.
A single, well-timed, professional letter of intent is all you need. Sending multiple emails or follow-ups can come across as pushy or desperate, which is the last impression you want to leave.
Your LOI is your final, confident statement. Once you hit send, trust that you’ve made your case. The entire match process is a marathon, and understanding the complete residency application timeline can help you see how this final piece fits into the larger picture.
Now, you can shift your focus to finalizing your own rank list and trusting the process. You've done the work.
Your Top Questions About Letters of Intent Answered
Navigating the final stretch of the residency match can feel like walking through a minefield of unwritten rules. The letter of intent (LOI) is a huge source of this confusion for so many applicants. Let's clear the air and tackle the most common questions head-on.
Getting direct, clear answers helps you move forward with confidence. The goal here is to make strategic decisions, not avoidable mistakes.
Should I Send an LOI If a Program Discourages It?
The short answer is a hard no.
If a program's website, interview day packet, or any direct communication says they have a policy against post-interview communication, you absolutely must respect it.
Ignoring such an explicit request screams that you can't follow simple directions—a massive red flag for any residency program. In these cases, your ERAS application and interview performance have to do all the talking. If the policy is a bit vague or just not mentioned, a single, professional letter is generally fine. But a clear "no" means no.
What Is the Difference Between a Thank You Note and an LOI?
This is a critical distinction. These two messages serve entirely different purposes and are sent on completely different timelines.
- A thank you note is a quick, polite gesture. You should send it within 24-48 hours of your interview simply to express gratitude for their time and the opportunity. It's brief and all about appreciation.
- A letter of intent is a strategic, formal declaration you send much later—usually late January to early February. Its one and only purpose is to state that you are ranking a program as your #1 choice and to back that up with specific, compelling reasons.
A thank you note says, "I appreciate your time." A letter of intent says, "You are my future." They are not interchangeable. Confusing them dilutes the impact of both.
Is It Okay to Mention Other Interviews in My Letter?
Absolutely not. Mentioning other interviews or even hinting that you have competing offers is unprofessional and comes across as manipulative. Your letter must be 100% focused on the single program you're writing to.
The entire power of a residency LOI comes from its message of singular, unwavering commitment. The moment you bring other programs into the conversation, you shatter that sincerity and make your interest feel transactional. The process is nuanced, and many of the same principles apply to earlier stages of your medical journey, which you can explore in our guide on letters of intent for medical school.
