The Complete Guide to Crafting Your Letter of Intent for Residency

Understanding the Letter of Intent in Residency Applications

A letter of intent (LOI) in the residency match is a targeted, post-interview communication where you tell a program they are your top choice and that you would strongly prefer to match there. Unlike a standard thank-you email, a letter of intent residency message is a strategic document with a specific purpose: to signal high, genuine interest and potential commitment.

In most cases, an LOI is:

• Sent after you have completed your interviews
• Directed to one program only (or very rarely two in special circumstances)
• Sent to the program director (with or without copying the coordinator)
• Lean, focused, and professional in tone

Because Match communications are regulated, your letter of intent must balance authenticity with compliance. You should never request or pressure programs for ranking information, nor should programs request your exact ranking intentions. However, you can volunteer your intentions and enthusiasm, and many programs appreciate this.

Key points to remember up front:

• A letter of intent will not rescue a weak application, but it can positively reinforce a strong fit.
• Programs vary widely in how much weight they give LOIs.
• Alignment between your letter and your actual rank list is both an ethical and professional obligation.

This guide will walk you through what an LOI is, what it is not, when to send LOI messages, what to include, and how to write one using a clear LOI template you can adapt.

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Letter of Intent vs. Other Residency Communications

Before drafting anything, you should be clear on how LOIs differ from other common communications during application season.

Thank-You Notes

• Purpose: Courtesy and professionalism.
• Timing: Within 24–72 hours after an interview.
• Audience: Individual interviewers and/or the program coordinator.
• Content: Gratitude, brief reflection on specific aspects of the day, possibly one or two sentences on fit.

Thank-you notes are not the place to declare that a program is your “number one choice” or to send strong ranking signals. They are short, polite, and low-stakes.

Update Letters

• Purpose: Provide new, meaningful information after your application is submitted.
• Timing: After significant updates (publication acceptance, honor society induction, new leadership role, etc.).
• Audience: Program director and/or program coordinator.
• Content: Objective updates, brief restatement of continued interest.

Update letters are focused on facts about your candidacy more than your ranking intentions.

Letters of Interest

• Purpose: Express sincere interest in a program without making a #1 commitment.
• Timing: After interview season has started, often to programs where you feel strong fit.
• Audience: Program director, occasionally department chair.
• Content: Why you are a good fit, why you like the program, but no direct “you are my #1” statement.

Letters of interest can be sent to multiple programs and are less ethically binding than an LOI.

Letters of Intent

This is the strongest signal you send:

• Purpose: Declare that a program is your top choice and highlight specific reasons and fit.
• Timing: Late interview season through the rank list certification window.
• Audience: Usually the program director, sometimes with the coordinator CC’d.
• Content: Clear statement of very strong (or top) preference, evidence-based fit, professional closing.

An LOI typically uses phrases like:

• “I plan to rank [Program Name] as my first choice.”
• “[Program Name] is my top choice program, and I would be thrilled to train there.”

Use them sparingly and intentionally.

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Ethics and Strategy: What a Residency LOI Can and Cannot Do

Match Rules and Ethical Considerations

The NRMP and specialty organizations have clear expectations:

• Programs cannot ask you to reveal your rank list order.
• You are allowed to voluntarily tell a program they are your top choice.
• You should not mislead more than one program by telling multiple programs they are your “#1.”

Ethically, you should:

1. Mean what you say.
   If you write “I will rank you first,” then your certified rank list must reflect that.

2. Avoid hedging language that is intentionally confusing.
   For example, “You are one of my top choices” is fine; “You are my top choice among many” is ambiguous and can be perceived as disingenuous.

3. Be honest about your enthusiasm level.
   If you are uncertain, a letter of interest is more appropriate than a full letter of intent residency message.

How Programs Actually Use LOIs

Programs differ widely:

• Some do not factor LOIs into their ranking at all, treating them as noise.
• Some view LOIs as a positive signal of genuine interest, especially if:
  • You are a “borderline” candidate on their list
  • You are from a distant region and they worry you might not come
  • You have unique circumstances (couples match, family in the area, visa needs)

For these programs, a thoughtful LOI can:

• Help nudge your rank position up slightly
• Reassure them about your likelihood of matching and staying
• Highlight features of your fit they might have missed

However, an LOI will not:

• Overcome glaring academic or professionalism concerns
• Push you from “likely to go unranked” to “top of list” by itself
• Compensate for a poor interview performance

Think of an LOI as a tiebreaker or amplifier, not a magic fix.

Common Strategic Mistakes

1. Sending LOIs to multiple programs with #1 language
   Programs talk to each other; this can damage your reputation.

2. Overly generic content
   Vague praise (“Your program is wonderful”) with no specifics suggests you’re sending the same LOI to several programs.

3. Overly long or emotional letters
   PDs are busy. Long, dramatic emails can backfire. Aim for ¾–1 page maximum.

4. Inconsistent statements
   Saying “your location is perfect for my partner’s job search” to multiple cities is risky; if discovered, it undermines credibility.

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When to Send LOI Messages in the Residency Timeline

Understanding when to send LOI communications is as important as what you say.

General Timeline Overview

• Late interview season (January – early February)
  You’ve completed most or all interviews and have a reasonable sense of your preferences.

• Before rank list certification (typically late February)
  You have finalized your decision about your #1 program.

Practical Guidance on When to Send LOI

1. After completing your interview at that program
   Never send a letter of intent before you have interviewed. You need real data from your visit to justify your top-choice decision.

2. Once you are truly confident it is your #1
   Do not rush. Compare:

   • Training curriculum and case mix
   • Resident culture and wellness
   • Research and fellowship opportunities
   • Geographic needs (family, partner, etc.)
   • Support systems, cost of living, lifestyle

3. Optimal window: 1–3 weeks before rank list deadline

   • Early enough that your letter can be read and mentioned in rank meetings
   • Late enough that your preferences are mature and stable

4. If your top choice is clear earlier
   You can send an LOI earlier in the season (e.g., late January), especially if:

   • The program has already completed most interviews
   • You’re certain your view won’t change with remaining interviews

“When to Send LOI” Based on Specific Situations

• Couples Match:
  Send once both partners have a sense of overlapping rank lists. Mention the couples match explicitly to help programs contextualize your situation.

• Late Interview at Your Top Program:
  If your interview is close to the rank deadline, send an LOI within a few days of the interview so there is time for it to be seen.

• Reaching Out After a Long Gap:
  If you interviewed many weeks earlier, sending an LOI closer to the deadline is reasonable—it re-anchors you in the PD’s mind.

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How to Write a Strong Letter of Intent: Structure and LOI Template

A clear structure makes writing your LOI much easier and more efficient. Below is a practical framework, followed by a customizable LOI template.

Core Principles of a Strong LOI

• Brevity: Aim for 3–6 short paragraphs; under one page.
• Specificity: Reference at least 2–3 concrete program features or interactions.
• Professional tone: Polite, confident, not overly emotional or casual.
• Consistency: Aligns with your personal statement, ERAS, and interview narrative.

Step-by-Step Structure

1. Subject Line (for email LOIs)
   Examples:

   • “Letter of Intent – [Your Name], [Specialty] Applicant”
   • “[Your Name] – Letter of Intent for [Program Name]”

2. Greeting
   Address the Program Director by name:

   • “Dear Dr. [Last Name],”

3. Opening Paragraph: Gratitude + Clear Statement of Intent

   • Thank them for the opportunity to interview.
   • State your ranking intention in clear, unequivocal language if appropriate.

   Example language:

   • “After completing my interviews, I have decided to rank [Program Name] as my first choice in the Match.”

4. Middle Paragraph(s): Reasons and Evidence of Fit
   Highlight 2–4 highly specific reasons why the program is an excellent match for you. These might include:

   • Particular rotations or tracks (e.g., global health, clinician-educator, research)
   • Resident culture and mentorship model
   • Procedural volume or case mix
   • Opportunities related to your career goals (academic vs community, fellowship interests, etc.)
   • Geographic/family reasons (brief, professional, not overly personal)

   Use details from your interview day or second look:

   • “During my conversation with Dr. X, I especially appreciated…”
   • “Hearing about your residents’ experience on the [specific rotation] confirmed…”

5. Closing Paragraph: Reaffirm Enthusiasm + Professional Sign-Off

   • Reiterate enthusiasm and fit.
   • Acknowledge Match rules (optionally).
   • Express thanks again.

   Example:

   • “Thank you again for your time and for considering my application. I would be honored to train at [Program Name].”

6. Signature
   Include:

   • Full name
   • Medical school, expected graduation year
   • AAMC ID (optional but often helpful)
   • Preferred contact information

Adaptable LOI Template

You can copy-paste and personalize the following LOI template:

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Subject: Letter of Intent – [Your Full Name], [Specialty] Applicant

Dear Dr. [Program Director Last Name],

Thank you again for the opportunity to interview at the [Institution Name] [Specialty] Residency Program. It was a pleasure to learn more about your program and to meet your faculty and residents.

After carefully reflecting on all of my interviews and considering my personal and professional goals, I have decided to rank the [Institution Name] [Specialty] Residency Program as my first choice in the Match. I am confident that your program is the best place for me to grow as a clinician, educator, and colleague.

Several aspects of your program particularly resonated with me. I was especially impressed by [specific feature #1, e.g., “the structured mentorship program and the strong support for resident-led research projects”]. My conversation with [faculty/resident name] about [specific topic] reinforced my sense that your program offers outstanding preparation for [your career goal, e.g., “a career in academic hospital medicine”]. In addition, the [specific feature #2, e.g., “diverse patient population and the emphasis on caring for underserved communities”] aligns closely with my values and prior experiences.

I also greatly appreciated the welcoming and collegial atmosphere among the residents. Hearing about their experiences with [specific rotation/initiative] and their descriptions of the culture at [Institution Name] made it clear that this is an environment in which I would be excited to train and contribute.

Thank you again for your time and for considering my application. I understand that the NRMP Match process is binding, and my ranking of your program as my first choice will be reflected on my final rank list. I would be honored to join your residency program and contribute to your team.

Sincerely,
[Your Full Name]
[Your Medical School], Class of [Year]
AAMC ID: [Number, optional]
Email: [email address] | Phone: [phone number]

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You can shorten or slightly modify this LOI template, but maintain the clarity of your ranking intention and the specific reasons for your fit.

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Practical Tips, Examples, and Special Situations

Customizing Your Letter to Each Program

Even if you are only sending one true LOI, you may also send letters of interest to other highly ranked programs. Each letter should be:

• Program-specific: Reference unique rotations, tracks, faculty, or hospital systems.
• Experience-based: Tie your reasons back to your own background or goals.
• Sincere: If you cannot honestly identify unique, compelling reasons, your interest level might not be as high as you think.

Example of strong specificity:

“Your four-week dedicated PGY-2 ultrasound rotation, combined with the longitudinal scanning opportunities in the ED, aligns perfectly with my interest in point-of-care ultrasound and my goal of becoming an ultrasound faculty champion.”

Versus a weak, generic statement:

“Your curriculum is excellent, and I know I would get good training.”

Tone and Length

Aim for a letter that feels:

• Confident but not arrogant
• Enthusiastic but not overly emotional
• Professional yet human

Keep it roughly 300–500 words. Program directors will appreciate the respect for their time.

Email vs. Uploaded Letter

Most LOIs are sent via direct email, not as attachments:

• Pros of email body text:

  • Easier for PDs to read quickly
  • Searchable in their inbox
  • Less formal friction

• Attachment (PDF or Word):

  • Sometimes used if your school mentors insist on “formal letterhead”
  • If you choose this, still include a brief note in the email body summarizing the key message

In nearly all modern contexts, an email-only approach is perfectly acceptable.

Couples Match Considerations

If you are in the Couples Match:

• Briefly disclose the couples match in your LOI.
• Emphasize your partner’s concurrent applications in the same geographic area.
• Do not overshare personal details; keep it professional and concise.

Example sentence:

“My partner and I are participating in the Couples Match, and we are both focusing our top choices in [city/region], which makes [Program Name] an especially compelling option for us.”

International and Visa Applicants

If you require visa sponsorship:

• You generally do not need to restate this in your LOI unless it was a major point of discussion at the interview.
• Instead, focus on your commitment to the program and region, and your long-term goals, to reassure them about your likelihood of staying.

If You Change Your Mind After Sending an LOI

This is a delicate situation.

• If your rank list is not yet certified:
  If something major changes (e.g., family emergency, partner’s job), consider:

  • Whether changing your rank list is absolutely necessary
  • If it is, an honest follow-up email to the PD is more ethical than silently reversing your previously stated commitment.

• If your rank list is already certified:
  You must not alter your certified list in a way that contradicts your written promise unless forced by extraordinary circumstances—and at that point, you should still consider notifying the program. Bear in mind, this can impact your professional reputation.

In all cases, try to avoid this scenario by waiting to send an LOI until your decision is very stable.

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Frequently Asked Questions About Residency Letters of Intent

1. Does a letter of intent really help my chances of matching?

It can help marginally, but it is not a guarantee. Programs vary widely:

• Some place moderate value on LOIs as signals of genuine interest, especially when fine-tuning the middle of their rank list.
• Others consider them but do not adjust rankings based on them.
• A few formally ignore LOIs in their process.

Consider an LOI as a useful but limited tool—it can strengthen your position if you are already competitive and a good fit, but it will not overturn major application weaknesses.

2. Can I send a letter of intent to more than one residency program?

You should not tell more than one program that they are your absolute #1. That crosses an ethical line and can damage your professional reputation if discovered.

However, you can:

• Send one true LOI to your top choice.
• Send letters of interest (without #1 language) to other high-ranked programs.

Be precise with your wording to avoid misleading implications.

3. When to send LOI messages: early or closer to the rank deadline?

Both approaches can work, but a common strategy is:

• Wait until you have completed most or all of your interviews and your preferences have stabilized.
• Send your LOI 1–3 weeks before the rank list deadline so:
  • Your decision is well informed.
  • The letter is still fresh at the time of final ranking meetings.

If you are absolutely certain earlier, it is acceptable to send earlier—but avoid multiple reversals.

4. Is there a universal LOI template I can use?

There is no single official template, but you can safely adapt a standard structure:

1. Thank them for the interview.
2. Clearly state your intention (e.g., “I will rank you first”).
3. Provide 2–4 specific reasons and experiences that support your choice.
4. Reaffirm enthusiasm and close professionally with your contact information.

Using a concise LOI template like the one above and customizing it with program-specific details is the most efficient and effective approach.

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A well-crafted letter of intent residency message will not override your board scores, letters, or interview performance, but it can serve as a clear, professional signal of your commitment and fit. Used thoughtfully, at the right time, and directed to the right program, it is a valuable final step in your residency application strategy.