Residency Advisor
It’s late. Your interview season blur is finally slowing down, and you’re doom-scrolling Reddit instead of sleeping. Every other post is: “Just sent handwritten thank-you notes to all 12 of my interviewers!” “Program director replied to my handwritten card!!” “Stationery recs for thank-you cards??”
And you’re sitting there thinking:
I…sent an email. One email. To the coordinator.
Or worse:
“I didn’t send anything. At all. Did I just silently unmatch myself?”
Let’s walk through this without sugarcoating, but also without the catastrophizing that your 2 a.m. brain is really, really good at.
Are Handwritten Notes Secretly Required?
Short answer: no. Longer, more honest answer: they’re mostly theater.
Are there programs where an old-school PD smiles at a nice card? Sure. But are you getting ranked 10 spots lower because you didn’t send handwritten notes? I’m willing to say flat-out: no.
Here’s the hierarchy of what actually matters to programs:
| Factor | Rough Importance Level |
|---|---|
| Interview performance | Extremely High |
| Application strength | Extremely High |
| Fit / collegiality | Very High |
| Faculty consensus | Very High |
| Thank-you / follow-up | Very Low |
No one is sitting in the rank meeting saying, “Well, she was amazing, everyone loved her, but she typed an email instead of sending a card from Paper Source, so…NRMP purgatory for her.”
I’ve heard actual PDs say things like:
- “I don’t even read thank-you notes.”
- “We’re told not to respond to anything that could be construed as a commitment.”
- “If they were great, they’re high on the list. Card or no card.”
What does that mean for you, the person spiraling on Reddit?
You’re not “the only one” who didn’t send handwritten notes. You’re just in the silent majority who doesn’t post about it.
People who sent handwritten cards are posting.
People who did nothing aren’t posting.
That doesn’t mean they don’t exist. It means they’re not broadcasting it.
Did I Hurt My Chances by Only Emailing (or Doing Nothing)?
Let’s be brutally honest: could following up help around the margins? Sometimes. But mostly in a weak, fuzzy way, like “Oh yeah, that was the student who wrote about how much they liked our clinic.”
The worst thing your lack of handwritten notes did was…nothing. It didn’t push you up. It didn’t push you down. It just…didn’t move the needle.
Where follow-up can matter a tiny bit:
- When someone is truly on the bubble and a thoughtful note makes them slightly more memorable.
- When a PD is trying to recall who’s genuinely interested in them, and you were already in the maybe pile.
- When you correct a misunderstanding or clarify something important (like a research gap, couples match detail, visa issue).
Where it doesn’t matter at all:
- When you were already ranked high. They liked you. That’s what counts.
- When you were already ranked low. A perfect calligraphy note isn’t rescuing that.
- When programs have a strict policy of not factoring post-interview communication into the rank list. A lot of them do.
Here’s the key: not sending handwritten notes won’t tank you. At absolute worst, it might mean you missed a 1–2% “nice touch” boost at a place that already liked you. That’s not the difference between matching and not matching.
Email vs Handwritten: What’s Actually Normal?
Let me cut through the Reddit distortion field with something more grounded.
| Category | Value |
|---|---|
| No follow-up | 30 |
| Email thank-you | 45 |
| Handwritten notes | 15 |
| Other (ERAS portal, coordinator only) | 10 |
Is that exact data from a randomized, double-blind RCT? No. But it lines up with what I’ve seen across multiple classes:
Most people:
- Either send a quick email (coordinator-only or to 1–2 faculty)
- Or send nothing because they’re overwhelmed, depressed, or burned out
Some smaller group:
- Goes full stationery warrior and sends handwritten notes
A tiny fraction:
- Does something weird like LinkedIn messages or long essay emails (please don’t)
So you, with your one slightly awkward email or total silence? You’re very normal. Boringly, completely normal.
“But Reddit Said Their PD Loves Handwritten Notes…”
Reddit also says people have a 275 Step 2 and 30 first-author publications “because they’re just average.” Grain of salt.
Could there be one specific PD who really does adore handwritten notes? Yes. They might mention you fondly. But residency match is a group decision. It’s not just one person:
| Step | Description |
|---|---|
| Step 1 | Applicant Interview |
| Step 2 | Faculty Impressions |
| Step 3 | Resident Feedback |
| Step 4 | Program Director Opinion |
| Step 5 | Rank Meeting |
| Step 6 | Final Rank List |
That little gushy handwritten note? It lives in the D box at best. And D is just one vote in the room.
Also: PDs are getting told by institutional leadership and legal to be extremely careful about post-interview communication. Lots of them intentionally don’t engage with any of it to avoid accusations of favoritism or NRMP violations.
So while you’re picturing: “Every other applicant sent a 3-page, hand-lettered note and the PDs cried when they read them,”
the reality is: “Most PDs have a pile of unread emails and cards somewhere and are going off their notes from the actual day.”
If I Didn’t Send Anything, Is It Too Late?
Okay. Let’s say you did literally nothing. No email. No card. No smoke signal.
You’ve got two questions:
- Should I do anything now?
- Will it look weird if I suddenly send something late?
Here’s my take.
If your interviews were:
- Within the last 2 weeks: totally fine to send a short follow-up email now.
- 3–4 weeks ago: still okay, just frame it as “I’ve been reflecting on my interviews and wanted to say…”
- Months ago and rank lists are about to lock: sending something now is unlikely to matter and could feel performative. You can still send a genuine, brief note if it’s really bothering you, but don’t expect it to change your fate.
If you want to send something late, you’re not required to make a big dramatic production out of it. You don’t need to apologize for the timing. Just be normal.
Something like:
Dear Dr. Smith,
Thank you again for taking the time to interview me for the Internal Medicine program at [Program Name]. Over the last few weeks I’ve found myself thinking often about your residents’ camaraderie on rounds and the strong support for primary care paths.
My conversation with you about [specific topic] really stood out and reinforced that [Program Name] would be a fantastic place to train.
Best regards,
[Your Name], MS4, [School]
That’s it. You’re not fixing or breaking anything. You’re just closing the loop for your own sanity.
What Actually Matters More Than Thank-You Notes
Since we’re already spiraling, might as well redirect that energy toward something that actually moves the needle.
Here’s what matters more than any handwritten card:
How you ranked your programs
Matching is about fit and priorities. Not about stationery. If you panic-rank by “who I think liked me more” instead of “where I’d actually be happiest,” that’s way more dangerous than skipping thank-yous.The consistency of your story
Program X liked you because you were passionate about underserved primary care? Great. That’s locked in. That impression sticks far more than whether your note was digital or made of 80 lb linen paper.Your interview performance
The vibe in the room, your answers, how you treated staff, how you interacted with residents—those are the things they remember in the rank meeting.Red flags (or lack of them)
No one is saying, “She didn’t send a handwritten note, that’s a red flag.” Red flags are unprofessional behavior, dishonesty, arrogance, weird comments. Not…being normal and tired and not mailing 40 cards.
A Simple Plan If You’re Still Panicking
If your brain won’t let this go, here’s the least-drama, most-effective way to give yourself peace.
| Category | Value |
|---|---|
| Thank-you logistics | 10 |
| Rank list thinking | 45 |
| Self-care/rest | 45 |
Give this:
- 10% of your energy to follow-up (max)
- 45% to actually thinking through your rank list and long-term fit
- 45% to not burning out before Match Day
Concrete steps:
Make a quick list of the programs that actually matter to you the most. Not the ones Reddit loves. The ones that felt right to you. Circle your top 3–5.
If you haven’t sent anything and it’s still within a reasonable time frame, send SHORT, specific emails to 1–3 people at those programs (or just the coordinator if that’s the only contact you have). Not essays. Not poetry. Just: “Thank you, here’s one specific thing that stood out, I’d be happy to train there.”
Skip handwritten notes unless you genuinely want to do them. Don’t do it from a place of fear. If it feels fake, it will read fake.
Then stop. No more mass emails. No more follow-up to your follow-up. Don’t become “that” applicant everyone remembers for blowing up inboxes.
Put your energy into your rank list and your life outside this process. Sleep. Talk to a non-med friend. Touch grass, literally.
The Part No One on Reddit Admits
Here’s the ugly truth almost nobody says out loud: a lot of the over-the-top follow-up stuff is about control.
You feel powerless. So you think, “If I just do one more thing—one more note, one more carefully crafted email—I can force the match to go my way.”
I get it. I’ve watched people write multiple drafts of a thank-you email like it was an NIH grant. I’ve seen them obsess over stationery types. It’s not about the note. It’s about trying to feel less at the mercy of a system that is absolutely not built around your mental health.
But the match doesn’t reward busywork anxiety. It rewards:
- Solid preparation
- Authentic fit
- Showing up like a functioning human on interview day
You already did the big stuff. The interview. That carries 99% of the weight. Your lack of a handwritten card isn’t going to erase that.
Quick Gut Check You Can Do Right Now
Before you scroll back to Reddit and find 10 more reasons to hate yourself: do this.
Open your rank list draft (or start one if you haven’t).
Look at your top 3 programs.
Ask yourself:
- “If they all loved me equally and thank-you notes didn’t exist, how would I rank these based purely on where I want to live and train?”
Whatever that answer is—that’s what actually matters.
Not what stationery you used. Not what Reddit thinks. Not whether someone else’s PD just replied “Thanks for the lovely card!”
Build your list around that answer.
FAQ: Handwritten Notes Panic Edition
1. Do programs keep track of who sends thank-you notes or emails?
Mostly, no. Some faculty might tag your email in their inbox or say “Oh, that was nice,” but there’s no official spreadsheet titled “Applicants Who Sent Paper Notes vs. Heathens Who Didn’t.” The impression you made during the interview is what’s logged in their eval system. That’s what counts when they sit down to rank.
2. Is it unprofessional if I didn’t send anything at all?
No. It might feel “wrong” because in pre-med land every small courtesy felt life-or-death, but in residency world, no follow-up is common and totally acceptable. Silence is interpreted as…silence. Not disrespect. They know you’re busy, on rotations, and interviewing at tons of places.
3. Should I send a handwritten note now to “fix” things?
Only if you genuinely want to and it’s still reasonably close to the interview. Handwritten notes are not a magic eraser. Sending a panicked, late card that screams “Please rank me” is more for your anxiety than your application. A short, sincere email is more than enough if you feel compelled to reach out.
4. Will other applicants who sent handwritten notes be ranked above me?
They’ll be ranked above you if they interviewed better, fit the program more, or had stronger applications—not because of the stationery. At most, a really thoughtful follow-up might slightly help someone who was already in a gray zone, but it’s not moving someone from “low” to “high” by itself. You’re not losing a spot solely because your thank-you wasn’t handwritten.
5. Do I have to send separate notes to every single interviewer?
No. That’s overkill for most programs, and also completely unsustainable if you had 10–15 interviews with multiple faculty at each. If you want to do something, a single email to the coordinator thanking the team, or one email to a key faculty member, is plenty. Mass emailing everyone can start feeling spammy.
6. What if I sent awkward or overly long follow-up emails—did I hurt myself?
Unless you wrote something wildly inappropriate, you’re probably fine. Faculty skim. Coordinators skim. If your email was a little long or slightly cringe, it’ll be forgotten within 48 hours. People remember red flags, not mild awkwardness. Your interview day self is still what they’re judging, not the slightly-too-formal paragraph you spiraled over.
Open your email or notes app right now and write the names of your top 5 programs in order, based only on where you actually want to be—not who you think liked you more, not who got the fanciest note. That’s the list you should be building from. Everything else is noise.
