Letters of Intent for Residency Match: Process + How To Guide

A letter of intent (LOI) for residency indicates that you will rank this program number one for the NRMP Match algorithm.

The residency match process can be grueling. Between away rotations, the endless ERAS application materials, a tough residency interview season, crafting a Rank Order List (ROL) to rank your preferred programs for the National Resident Matching Program (NRMP), 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 one more hurdle before match day: the letter of intent. Keep reading for an in-depth guide on improving your match chances with an LOI.

How to Choose Your 10 ERAS Experiences: Download our 10 ERAS Experiences Guidebook to hear top tips from our Physician Advisors. Learn how to choose the 10 best experiences for your specialty and craft descriptions that impress.

What Is a Letter of Intent for Residency?

A letter of intent (LOI) for residency is a formal message, one page or less in length, sent from a residency applicant to a residency program that indicates this program is your first choice on your rank order list (ROL) – in other words, you will rank this program over all other programs as your first preference.

An LOI slightly boosts your residency application and can tip the scales in your favor if competitive residencies are making tough choices between you and other similar candidates.

Check out this sample letter of intent.

An LOI ethically binds you to rank this program number on your ROL, although it is not technically a legally binding agreement.

This expression of intent should come after your interview. The letter notifies the program director and admissions committee that you’re excited to match there. A pre-interview LOI will seem insincere and presumptuous.

Check out the ERAS timeline so your LOI lands before programs finalize their rank lists.

Learn More: Couples Match for Residency — A Comprehensive Guide

Letter of Intent vs Letter of Interest

A letter of intent is ethically binding, indicating that you will rank or have ranked this program as number one. A letter of intent should moderately increase your chances of matching — especially in tiebreaker scenarios between highly qualified candidates.

A letter of interest is less binding, indicating your genuine interest in a program without a promise to rank a program number one on your ranking list. An interest letter confers almost no benefit, in most cases.

How to Write a Strong LOI

We work with a lot of students who are applying to medical residencies. When they ask about how to write an LOI, our admissions experts have a few constant pieces of advice:

• Address the LOI to the program coordinator or director.
• Briefly introduce who you are (full name) and that this is a letter of intent.
• Get to the point. Why are you an ideal fit for this program and vice-versa?
• Make it specific with a personal touch. Do you have a particular relationship with any faculty, alumni, or the city that this particular program is in? Mention details you noticed before, during, or after your interview.
• Include any recent updates that might not be in your ERAS application. Major awards, improved USMLE Step 2 scores, publications, or significant updates to your clinical rotations may warrant inclusion.
• Concisely conclude your letter with a summary of the letter and a thank you.

We wrote a great guide on writing letters of intent, which I encourage you to read to leave a lasting impression. Although this guide is specifically targeted to medical school applications, the same principles apply to residency training LOIs.

Related: How to Fill out the ERAS Experiences Section

When to Send a Letter of Intent

Ideally, you should send a letter of intent to your preferred residency program in mid-January or the first week 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 we recommend no later than early February.

To send in a letter by early February, start drafting it around the new year. Give yourself time to write a first draft, revise it with a stronger structure, and ask for editing suggestions from peers – or even chatbots. (Note: Don’t let AI write your letter, but feel free to ask AI for editing help.)

Watch this webinar from Dr. David Flick on matching with your ideal residency program for even more guidance.

Should You Send Multiple Letters of Intent?

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. An LOI is ethically-binding; although you could technically lie without breaking any laws, you should only send an LOI to your #1-ranked program.

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 nil.

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. But they shouldn’t hurt your chances — they just take more of your time.

Related: IMG-Friendly Residencies

Additional Ways to Improve Match Chances

Here are additional ways to improve your residency match chances:

• Ideally, you already submitted a standout ERAS application tailored towards your preferred program, complete with stellar recommendation letters from mentors and professors.
• Your personal statement is a great place to really hammer home how you want to match with this residency above all others. Describe how you’re a great fit for this program.
• Send the maximum number of residency program signals through the AAMC’s MyERAS portal. Learn more here.
• 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.
• Ace your interview day! Check out our free interview prep tips.
• Fill out your rank order list honestly and comprehensively. List every program you interviewed at and would be willing to go to. Don’t just list your top choices. To increase your odds in a worst-case scenario, honestly rank every program where you interviewed.
• Understand the SOAP for Match Week. In case you don’t get matched on the first round on Match Week, you’ll have to understand the Supplemental Offer and Acceptance Program (SOAP) to boost your chances of matching with a residency.
• If you want to send a non-binding letter of interest to indicate your strong interest in attending a specific program, it may slightly improve your chances — but not much.

Our Physician Advisors match 99% of US clients and 88% of IMG clients into residency.

Residency LOI Template

Here’s an LOI template that is not filled out. After this, you’ll find a sample LOI that I have composed.

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.

Sincerely,

Student

Sample Letter of Intent for Residency

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 please do not plagiarize (or come anywhere close) if you choose to find inspiration in this sample letter.

Dear Doctor Cornelius Smith,

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.

Sincerely,

John Hopkins, Jr.

FAQs

Get Guidance from a Physician With AdCom Experience

A letter of intent (LOI) is an optional part of the residency application process. An LOI indicates that you ranked a certain program #1 on your rank list in early February.

Note that some programs do not accept LOIs, so always 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.

Our students and advisors have found that 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.

We match 99% of US clients and 88% of IMG clients into residency. Build your application alongside a Physician Advisor with admissions committee experience.