Essential Guide for DO Graduates: Letters of Recommendation for OB GYN Residency

Understanding OB GYN Letters of Recommendation as a DO Graduate

Letters of recommendation (LORs) are one of the most powerful parts of your OB GYN residency application—especially as a DO graduate. Programs want evidence that you can function as a capable, compassionate, and coachable obstetrics and gynecology resident in a busy clinical environment. Strong letters bridge the gap between board scores, grades, and who you are in real life on L&D at 3 a.m.

As a DO applying to OB GYN, your letters can:

• Demonstrate you perform at or above the level of MD peers
• Highlight osteopathic strengths (holistic care, communication, hands-on skills)
• Reassure programs about your readiness for surgical and obstetric responsibilities
• Counterbalance any weaker metrics (e.g., modest board scores, limited research)

This article walks you through how to get strong LORs, who to ask for letters, how many you need, what they should say, and strategies specific to the osteopathic residency match and ACGME OB GYN programs.

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How Many Letters You Need and Which Types Matter Most

Core numbers and general rules

Most ACGME OB GYN residency programs require:

• 3 letters of recommendation total (some accept 4; check each program’s website or ERAS page)
• At least 2 letters from OB GYN physicians (preferably academic attendings)
• Remainder from:
  • Another OB GYN faculty member
  • A core clerkship director (IM, surgery, family medicine with strong OB exposure)
  • A research mentor (OB GYN or women’s health-related is ideal)

For a DO graduate targeting competitive ACGME OB GYN residency programs:

• Aim for 3 OB GYN–focused letters whenever possible
  • 2 from clinical OB GYN rotations (including sub-I / acting internship)
  • 1 from an OB GYN subspecialty or research mentor (MFM, REI, Gyn Onc, UroGyn, etc.)

If you have a particularly strong non-OB GYN letter (e.g., surgery or IM attending who supervised you extensively on women’s health), it can supplement but should not replace your core OB GYN letters.

ERAS upload strategy

Most programs only review 3 letters, even if ERAS allows more. Consider this:

• Upload 4 letters total:

  1. OB GYN sub-I / acting intern letter (anchor letter)
  2. Core OB GYN clerkship letter
  3. OB GYN subspecialty or research mentor letter
  4. Strong non-OB specialty letter (surgery, IM, or FM with heavy OB; use selectively)

• For each specific program:

  • Assign the 3 most OB GYN–relevant letters
  • Use the 4th only if it clearly adds a new, strong dimension (e.g., research, leadership)

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Who to Ask for Letters (and Who Not To)

Knowing who to ask for letters often matters more than any other step. As a DO graduate, you should be strategic about balancing osteopathic and allopathic experiences.

Priority #1: OB GYN faculty who supervised you closely

The best letter writers are:

• OB GYN attendings who:
  • Directly observed you on L&D, in clinic, and/or in the OR
  • Can speak to your work ethic, growth, and interpersonal skills
  • Know you well enough to share specific examples

Ideal letter writers:

• Sub-I / Acting Internship supervising attending
• Core OB GYN clerkship site director or key faculty
• Fellowship-trained subspecialists (MFM, Gyn Onc, REI, UroGyn) who saw you regularly

For DO graduates, academic OB GYN attendings—especially at ACGME-sponsored hospitals—carry extra weight because they can compare you to MD peers.

Priority #2: OB GYN program directors or clerkship directors

If possible, secure at least one letter from:

• OB GYN Clerkship Director
• OB GYN Residency Program Director or Associate Program Director
• Chair of OB GYN at your institution or an audition site

These letters:

• Signal that leadership in the department trusts you
• Often include explicit statements like “I would rank this student highly in our obstetrics match”
• Show that you made a positive impression on people who make hiring decisions

If you rotate at an outside institution for an audition sub-I, politely inquire whether the PD or APD ever writes letters for strong students; even if they don’t personally write yours, they may co-sign or contribute.

Priority #3: Osteopathic physicians and DO role models

As a DO graduate, it’s valuable—but not mandatory—to include at least one OB GYN DO letter, especially if:

• You’re applying to programs with a strong osteopathic presence
• You want to highlight your osteopathic identity and skills (OMT, holistic philosophy)
• You had an outstanding educational or mentorship relationship with a DO OB GYN

However, do not choose a DO letter just because the writer is a DO if they:

• Barely know you
• Can only provide generic praise (“hard-working, pleasant, team player”)

A generic DO letter is weaker than a specific, detailed MD letter from an attending who knows you well.

When to use a non-OB GYN letter

Consider one strong non-OB GYN letter if:

• The writer supervised you intensively over time (e.g., longitudinal FM or IM preceptor, surgery service where you functioned like a sub-I)
• They can attest to:
  • Procedural skills
  • Response to feedback
  • Teamwork and professionalism
  • Ability to handle sick patients

Choose non-OB letter writers such as:

• General surgery attendings (especially if you did many pelvic or gynecologic procedures)
• Family medicine attendings heavily involved in prenatal care or deliveries
• Internal medicine physicians in women’s health or high-risk pregnancy co-management clinics

Avoid letters from:

• Residents (unless co-signed by an attending)
• Fellows without attendings’ involvement
• Non-physicians (NPs, PAs, nurses, midwives)
• Distant mentors who haven’t worked with you clinically in years

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How to Get Strong LOR: From Average to Outstanding

A “good” letter only confirms that you’re safe and competent. An outstanding letter argues that a program should fight to recruit you. Here’s how to get strong LORs rather than bland ones.

1. Start planning early

As a DO graduate, delay or uncertainty about the osteopathic residency match landscape can make planning feel confusing. Anchor your timeline like this:

MS3 (Core OB GYN rotation):

• Treat this as a month-long audition for your first OB GYN letter
• Be punctual, prepared, and present on L&D, clinic, and the OR
• Ask for mid-rotation feedback and act on it quickly
• Near the end, identify one attending who has:
  • Seen you in multiple settings
  • Given you feedback you’ve implemented
  • Commented positively on your growth and engagement

MS4 (Summer/Fall):

• Schedule at least one sub-I/acting internship in OB GYN (home or away) that ends by August or early September
• This rotation should ideally produce your anchor letter for the bulk of your applications

2. Behaviors on rotation that lead to strong letters

Attendings need specific stories for effective letters. Give them material:

• Own your patients
  • Know all key details without reading directly from the chart
  • Anticipate next steps (labs, ultrasounds, consults)
• Show surgical curiosity and initiative
  • Volunteer to close skin, place staples, or suture lacerations when appropriate
  • Ask for feedback on your knot-tying, instrument handling, and sterile technique
• Demonstrate OB commitment
  • Show up early to round, even on post-call days
  • Offer to help with triage, NST interpretations, postpartum questions
• Be teachable
  • Accept feedback gracefully; change behavior by the next shift
  • Avoid defensiveness—programs want residents who grow rapidly during internship
• Model professional communication
  • Communicate clearly with nurses, midwives, and co-residents
  • Be calm and supportive in high-stress moments (e.g., fetal distress, hemorrhage)

Concrete example:

A student who volunteers to stay late for a stat C-section, reads about indications and techniques that night, and then the next day explains the procedure steps succinctly is much more likely to get a letter saying, “This student behaves like an intern and is deeply committed to obstetrics.”

3. Ask explicitly for a “strong” letter

When you’re ready to ask, do it in person if possible (or via a well-crafted email if not) and use very clear language:

“Dr. Smith, I’ve really appreciated working with you this month. I’m applying to OB GYN residency, and I was wondering if you feel you know me well enough to write a strong letter of recommendation for my application?”

This wording gives them a gentle escape route if they can only write something generic. If they hesitate or seem lukewarm, thank them and ask someone else.

4. Provide a “letter writer packet”

Make it easy for your letter writer to advocate for you. Include:

• Updated CV
• Personal statement draft (or 1–2 paragraphs about why OB GYN)
• ERAS photo (optional but can jog memory)
• Transcript and, if helpful, board scores (COMLEX/USMLE)
• A short one-page summary with:
  • Your specific interests in OB GYN (MFM, Gyn Onc, generalist, underserved care)
  • 3–5 bullet points of things you hope they might highlight (e.g., “work ethic on L&D,” “ownership of postop patients,” “strong relationships with nurses and staff”)
  • Any specific programs or regions you’re heavily targeting

You are not telling them what to write; you’re simply reminding them what they saw and giving context. For DO applicants, use this to:

• Briefly explain any nontraditional paths, gap years, or DO-to-MD environment transitions
• Highlight osteopathic strengths (e.g., “holistic counseling with prenatal patients,” “experience using OMT for pregnancy-related low back pain”) that they might incorporate.

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Content of a Strong OB GYN Letter: What Programs Look For

Understanding what residency programs actually want helps you support your writers and select the right letters.

Key themes program directors value

Across OB GYN programs, strong letters often comment on:

1. Clinical competence and judgment

   • Ability to assess unstable patients
   • Recognizing when to escalate to senior or attending
   • Prenatal counseling and postpartum care quality

2. Operative and procedural potential

   • Comfort in the OR and on L&D
   • Manual dexterity, spatial awareness, stamina
   • Ability to learn quickly and safely

3. Work ethic and reliability

   • Whether you can be counted on at 3 a.m. in a crisis
   • Punctuality, follow-through, and responsiveness
   • Ownership of tasks without needing constant reminders

4. Teamwork and communication

   • Interactions with nurses, midwives, residents, and ancillary staff
   • Empathy and professionalism with patients, especially in high-stakes scenarios (fetal demise, severe preeclampsia, cancer diagnoses)

5. Fit for OB GYN specifically

   • Genuine interest and satisfaction in OB GYN’s pace and demands
   • Comfort with women’s health conversations (sexual health, fertility, trauma-informed care)
   • Emotional resilience in obstetric crises or surgical complications

6. Comparative statements

   • “Top 10% of students I have worked with in the last 10 years”
   • “I would be delighted to have this applicant as a resident in our program”

Letters that rank you explicitly relative to peers carry more weight.

DO-specific considerations

As a DO graduate, program directors may be curious—but often not skeptical—about:

• Whether your training and clinical performance match their MD students
• How you perform on complex OB cases and in the OR
• Your ability to integrate osteopathic principles in a high-acuity setting

A strong letter for a DO applicant might say things like:

• “She functioned at the level of our best MD sub-interns from top allopathic schools.”
• “His osteopathic background contributed to excellent bedside manner and pain management strategies during labor.”
• “I have worked with both MD and DO students for over a decade; this candidate is in the top 5% across all.”

These reassure programs that your DO background is a strength, not a liability.

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Timing, Logistics, and Common Pitfalls to Avoid

Ideal timing for requesting and uploading letters

• Ask for letters:

  • At the end of the rotation while impressions are fresh
  • No later than late July or early August for writers whose letters you need for September ERAS submission

• Set gentle deadlines:

  • Give writers at least 4 weeks
  • Politely mention ERAS deadlines and your desire to have all letters in by mid-September

Sample email follow-up:

Dear Dr. Smith,

I hope you’re doing well. I wanted to gently check in about the letter of recommendation for my OB GYN residency application. ERAS opens for program review in mid-September, so having your letter uploaded by [date about 2–3 weeks away] would be ideal if possible. I’m very grateful for your time and support.

Best regards,
[Your Name]

ERAS details for DO graduates

• Waive your right to view letters. Programs expect this and may trust waived letters more.
• Use ERAS to:
  • Assign specific letters to each program
  • Double-check that the correct OB GYN–heavy letters go to your most competitive or desired programs
• Some DO graduates also apply to a mix of osteopathic-legacy and allopathic-heavy programs; customize letter assignments accordingly:
  • For osteopathic-leaning programs: include at least one strong DO letter if possible
  • For highly academic ACGME programs: prioritize letters from academic faculty and PDs, regardless of degree

Common pitfalls to avoid

1. Waiting too long to ask

   • Faculty may forget details about your performance if you wait several months

2. Choosing title over relationship

   • A mediocre Chair’s letter is weaker than a vivid, detailed letter from a mid-level attending who worked with you daily

3. Overemphasizing research when your clinical skills are your strength

   • In OB GYN, especially for a DO graduate, clinical letters usually matter more than a pure research letter—unless you’re targeting highly research-heavy programs

4. Not coordinating who covers what

   • If you know one letter will emphasize research, gently suggest another writer focus on clinical performance, teaching, or leadership

5. Ignoring typos or missing info in the letter request

   • Double-check: correct spelling of your name, AAMC ID, ERAS Letter ID, and your intended specialty and year (OB GYN, Match 2026, etc.)

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Tailoring Your LOR Strategy for the Obstetrics Match as a DO

If your metrics are average or slightly below average

Use your letters to counterbalance any weaker parts of the application:

• Ask writers to emphasize:
  • Rapid growth over the rotation
  • Strong in-person clinical performance even if standardized test scores are not stellar
  • Emotional intelligence and patient rapport

For example, if COMLEX or USMLE scores are modest, a letter that states:

“Despite scores that do not fully reflect her abilities, on our service she functioned at the level of our strongest students and would be a tremendous asset to any OB GYN residency.”

can significantly shift how programs interpret your application.

If you are a nontraditional DO applicant

If you:

• Took time off
• Completed a prior career
• Have family responsibilities or location constraints

Your letters should:

• Present you as stable, mature, and reliable
• Highlight leadership, time management, and resilience
• Reassure programs that you can handle internship plus your additional responsibilities

Share these aspects with your letter writers so they can frame your story positively rather than leaving gaps unexplained.

Applying to a mix of community and academic programs

Community-heavy programs may value:

• Letters emphasizing work ethic, reliability, and fit with a close-knit team
• Evidence that you can step in quickly as a useful intern

Academic programs often emphasize:

• Comparative statements against MD peers
• Interest or involvement in research, QI, or teaching
• Potential for future fellowship

Consider slightly different letter combinations for different program types by selecting which 3 of your 4 letters to assign.

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FAQs: Letters of Recommendation for DO Graduates in OB GYN

1. As a DO graduate, do I need letters from MDs for the OB GYN residency match?

You do not need MD letters, but having at least one or two letters from academic OB GYN attendings (MD or DO) who frequently work with MD students can be very helpful. Programs mainly care about:

• The content and strength of the letter
• The writer’s role and credibility (PD, clerkship director, core attending)
• Clear comparisons to other students and residents

A strong DO letter from a respected academic OB GYN is just as valuable as an MD letter, but a generic letter from any writer—MD or DO—is not especially helpful.

2. Who should I ask for letters if my OB GYN rotation was at a smaller osteopathic community site?

In that case:

• Get a detailed letter from the OB GYN site director or main attending who oversaw you
• Add a letter from a sub-I/acting internship at a larger or more academic site (home or away), even if it’s later in the year, and update programs if needed
• Consider including a strong letter from a family medicine or general surgery attending who supervised you extensively in women’s health or OB procedures

This combination shows you can thrive in both osteopathic community and larger academic environments.

3. How many OB GYN letters versus non-OB letters should I use?

For most OB GYN applicants—especially DO graduates aiming for the ACGME obstetrics match:

• 2–3 letters from OB GYN attendings (ideally including your sub-I and core clerkship)
• 0–1 letter from another specialty that knows you extremely well

When in doubt, err toward more OB GYN–specific content unless your non-OB letter is exceptionally strong and adds a unique dimension.

4. Can I use the same letters if I apply to both OB GYN and another specialty?

Generally, this is not recommended. OB GYN letters should:

• Explicitly state that you are applying to OB GYN residency
• Comment on your fit for OB GYN specifically

If you are also considering another specialty (e.g., family medicine), you will need at least one or two letters tailored to that specialty as well. Using the exact same letters for two very different specialties can raise red flags about your commitment.

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Thoughtfully chosen and well-supported letters of recommendation are one of the most powerful levers you have as a DO graduate applying to OB GYN residency. Plan early, cultivate strong relationships on your OB rotations, and be clear and organized in how you ask. When your letters echo what your personal statement and experiences already suggest—that you are compassionate, capable, and committed to women’s health—they can help you stand out in a competitive obstetrics match.