Mastering Follow-Up: Strengthen Your Letters of Recommendation for Residency

Letters of Recommendation (LORs) are a cornerstone of competitive residency applications. They give program directors an inside look at how you function on the wards, in the OR, and as part of a clinical team. Yet even if you’ve chosen excellent writers and requested letters early, your job isn’t done. Strategic, professional follow-up is essential to ensuring your recommendations are submitted on time and are as strong as possible.

This guide walks you through how to follow up on your LOR requests using effective communication, professional networking etiquette, and thoughtful follow-up strategies that support your recommenders rather than pressure them.

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Why Following Up on Letters of Recommendation Matters

Following up on LOR requests can feel awkward, but done well, it is both professional and expected—especially in a busy academic medical environment.

Key Reasons Follow-Up Is Essential

1. Clarification and Context

   • Your recommender may need a reminder of your specific achievements, roles, or cases you were involved in.
   • Follow-up allows you to provide updated information—like a new research abstract, leadership role, or exam score—that can strengthen the letter.
   • It helps ensure the letter aligns with your current goals (e.g., your decision to pursue a specific specialty or track).

2. Timely Submission for Residency Applications

   • ERAS and residency programs have strict deadlines.
   • Faculty are balancing patient care, teaching, research, and administrative duties; a polite reminder can move your request up their priority list.
   • A well-timed follow-up reduces the risk of missing critical application milestones or having incomplete applications.

3. Professional Networking and Relationship Building

   • Thoughtful communication reinforces your professionalism, reliability, and respect for your recommender’s time.
   • Maintaining these relationships is invaluable beyond residency—for fellowships, job searches, and future collaborations.
   • Your follow-up can be the beginning of long-term mentorship, not just a one-time transactional request.

4. Quality Control

   • If a recommender is too busy, unresponsive, or unsure they can write you a strong letter, follow-up communication can surface those concerns while there is still time to pivot.
   • This can prevent weak, generic, or late letters from negatively impacting your residency application.

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Planning Your Follow-Up Strategy Before You Even Request the LOR

Effective follow-up actually begins before you ask for the letter. Laying the right groundwork makes later reminders feel natural and appropriate.

Set Clear Expectations Early

When you first request a letter (ideally in person or via video, then confirmed by email):

• Clarify deadlines explicitly

  • Mention both the ERAS opening date and any earlier internal deadlines (e.g., your school’s advising deadline).
  • Example: “ERAS opens for programs to review applications on September 25, so it would be incredibly helpful if the letter could be uploaded by September 10.”

• Ask directly if they can write you a strong letter

  • Phrase it respectfully: “Would you feel comfortable writing me a strong letter of recommendation for internal medicine residency?”
  • This gives them an opportunity to decline if they don’t know you well enough or can’t commit to the time.

• Confirm preferred communication method

  • Ask: “Is email the best way to follow up as the deadline approaches, or do you prefer a calendar reminder or message through the EMR/pager/text?”
  • Tailoring your follow-up to their preference makes it more likely they’ll respond positively.

Provide a Helpful LOR Packet

Make it easy for them to write—and later to remember—your letter:

Include:

• Updated CV
• Personal statement (or a draft, especially if specialty-specific)
• A short “brag sheet” or bullet list:
  • Projects you worked on with them
  • Memorable patient cases
  • Specific strengths they saw (e.g., bedside manner, leadership, initiative)
• A document listing:
  • Programs you are applying to (or at least your specialty)
  • Target submission date
  • ERAS or portal instructions

This packet becomes a reference point you can politely mention in follow-up emails: “I’ve reattached my CV and personal statement in case they are helpful.”

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Crafting an Effective Follow-Up Message for LORs

When to Follow Up on Your Letter of Recommendation

Use timing that respects your recommender’s schedule while protecting your own deadlines:

• Initial request: Ideally 6–8 weeks before you need the letter submitted.
• First follow-up: About two weeks after the initial request if:
  • You received agreement but no confirmation of completion, or
  • You sent an email request but have not heard back at all.
• Pre-deadline reminder: About 3–4 weeks before the ERAS/program deadline, even if they previously agreed.
• Final reminder: About 7–10 days before your target submission date, if the letter still isn’t uploaded.

Try to avoid last-minute, high-pressure messages within 48 hours of the deadline unless absolutely necessary.

Choosing the Right Medium for Follow-Up

• Email: Best default for most faculty—professional, trackable, and non-disruptive.
• In-person: Appropriate if:
  • You still see them regularly on service/clinic.
  • You can mention the letter briefly and naturally at the end of an encounter.
• Other channels (sparingly and only if previously used with them):
  • Secure messaging through your institution
  • Calendar invites with a polite note
  • Text/page (only for attendings who use these channels with learners and have given permission)

Whenever possible, pair brief in-person check-ins with a follow-up email so they have all the details at their fingertips.

How to Structure a Professional Follow-Up Email

A strong follow-up email is:

• Concise
• Respectful
• Clear about deadlines
• Solution-oriented (offering additional information if needed)

1. Subject Line: Clear and Professional

Examples:

• “Follow-Up: Letter of Recommendation for [Specialty] Residency – [Your Name]”
• “Friendly Reminder: LOR for ERAS Application – [Your Name]”
• “LOR Deadline Approaching – [Your Name]”

Avoid vague subject lines like “Quick question” or “Reminder” alone.

2. Salutation and Opening

Use formal address unless they’ve invited you to do otherwise:

• “Dear Dr. [Last Name],”
• “Dear Professor [Last Name],”

Then, briefly acknowledge their time and your appreciation:

• “I hope you’re doing well and that the new rotation block is off to a good start.”
• “I know this is a particularly busy time of year, and I’m very grateful for your support.”

3. Express Gratitude and Recap the Context

Quickly restate:

• That they kindly agreed to write a letter
• What the letter is for
• What the timeline is

Example:

Thank you again for agreeing to write a letter of recommendation in support of my [internal medicine/pediatrics/surgery] residency application. I truly appreciate your willingness to support me in this process.

4. Provide a Clear, Polite Reminder of the Deadline

Be specific and respectful:

As a reminder, ERAS opens for programs to review applications on September 25, and my goal is to have all letters submitted by September 10 to ensure my application is complete on time.

If your school has an earlier internal deadline, mention that as well.

5. Offer Updated Information or Materials

This is a chance to strengthen your letter and make their job easier:

• Reattach your CV and personal statement.
• Briefly mention any new achievements:
  • Recent publications or abstracts
  • Leadership roles
  • Awards or honors
  • Notable clinical experiences or QI projects

Example:

I’ve attached my updated CV and a recent draft of my personal statement in case they’re helpful. Since we last worked together, I’ve also [presented at X conference / started a sub-internship in Y / taken on Z leadership role], which aligns closely with my goal of pursuing [your specialty].

6. Reiterate Appreciation and Close Professionally

End with a gentle reaffirmation of your gratitude and a clear but polite nudge:

I’m very grateful for your time and support. Please let me know if there is any additional information I can provide that would make the process easier.

Thank you again for helping me with this important part of my residency application.

Closing options:

• “Best regards,”
• “Sincerely,”
• “With appreciation,”

Include your:

• Full name
• Medical school
• Preferred email and phone (optional)
• AAMC/ERAS ID (if relevant)

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Sample Follow-Up Email for a Residency LOR

Subject: Follow-Up on Letter of Recommendation – [Your Name]

Dear Dr. [Last Name],

I hope you are doing well. Thank you again for kindly agreeing to write a letter of recommendation in support of my [specialty] residency application. I truly appreciate your time and support.

As a reminder, ERAS opens for programs to review applications on September 25, and my goal is to have all of my letters submitted by September 10 so that my application is complete when programs begin their review.

I’ve attached my updated CV and personal statement in case they are helpful as you prepare the letter. Since our rotation together, I have [briefly mention any new achievement, role, or experience that reinforces your candidacy], which further solidified my interest in [specialty].

Please let me know if there is any additional information I can provide that would make this process easier. Thank you again for your support—I am very grateful for your mentorship.

Best regards,
[Your Full Name]
[Medical School], Class of [Year]
[Email Address] | [Phone Number]
[ERAS ID (if applicable)]

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What to Do If You Don’t Hear Back After Following Up

Even with a well-crafted follow-up, faculty may not respond right away. High clinical volume, personal circumstances, or simple inbox overload can delay replies. Use a structured escalation approach.

Step 1: Send a Second Gentle Reminder

If you don’t receive any response within 7–10 days after your first follow-up:

• Send a brief, even shorter reminder.
• Acknowledge their busy schedule.
• Re-highlight the deadline.

Example:

Dear Dr. [Last Name],

I wanted to briefly follow up on my previous email regarding the letter of recommendation for my [specialty] residency application. I know this is a very busy time, and I truly appreciate your willingness to support me.

My goal is to have all letters submitted by [date], so I just wanted to check in and see if there is any additional information I can provide.

Thank you again for your time and support.

Best regards,
[Your Name]

Step 2: Consider an In-Person or Real-Time Check-In

If possible and appropriate:

• Catch them briefly before or after clinic, rounds, conference, or a scheduled meeting.
• Keep the interaction very short (30–60 seconds).
• Example script:

“Dr. [Last Name], I just wanted to quickly check in about the residency letter you kindly agreed to write for me. My target submission date is [date], so I wanted to see if you needed any additional information from me. I really appreciate your help.”

Follow up that conversation with a same-day email summarizing any clarifications.

Step 3: Know When to Pivot to Another Recommender

If, despite reasonable follow-up strategies, you still have:

• No response at all after:
  • Two follow-up emails, and
  • One brief in-person or real-time attempt (if feasible), or
• Signs of reluctance, such as:
  • “I’m not sure I have enough time to write a detailed letter.”
  • “I don’t remember your performance well enough.”
  • “I might not be able to meet that deadline.”

…it may be safer to seek an alternative recommender.

When and How to Seek a New Recommender

Red Flags That It’s Time to Move On

• Persistent lack of communication despite respectful follow-up.
• Explicit hesitation about writing a letter or meeting your timeline.
• Very late in the season with no sign the letter is being written.
• Vague or generic feedback suggesting they can’t provide a detailed, personalized endorsement.

Remember:
A slightly less “prestigious” recommender who knows you well is almost always better than a big-name faculty member who can only write a generic letter—or might not submit one on time.

Choosing a Replacement Recommender Strategically

Ideal alternate recommender candidates include:

• Attendings who worked closely with you on a core rotation or sub-internship.
• Faculty who supervised a significant clinical project, research, or QI initiative.
• Program or clerkship directors who observed your performance over time.
• Fellows or senior residents who know you well and can co-sign with an attending (depending on your institution’s norms).

When approaching a new recommender:

• Be transparent but professional:
  • You can say: “Due to some timing uncertainties with another letter, I wanted to ask if you might be able to support my application with a letter of recommendation.”
  • You do not need to criticize or overshare about the original recommender.
• Provide them with:
  • Your CV, personal statement, and a short highlight list of things you did with them.
  • Clear deadlines (and ideally 4+ weeks’ notice, if possible).

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Following Up After Submission: Expressing Gratitude and Maintaining Relationships

Your follow-up strategy shouldn’t end when the letter is submitted. This is a crucial moment to reinforce professional networking and long-term mentorship.

Thank-You Messages After LOR Submission

Once you see the letter marked as “received” or “uploaded” in ERAS or your school’s portal:

• Send a personal thank-you email within a few days.
• Include:
  • Clear appreciation for their time and support.
  • A brief mention of what their support means to you.

Example:

Dear Dr. [Last Name],

I wanted to thank you sincerely for taking the time to submit a letter of recommendation on my behalf for [specialty] residency. I truly appreciate your support and the opportunity to have learned from you on [specific rotation or project].

Your mentorship has been an important part of my medical school experience, and I’m grateful for your help as I take this next step in training.

With appreciation,
[Your Name]

Updating Recommenders on Your Match Outcome

After Match Day:

• Send a brief update email to each recommender:
  • Share where you matched.
  • Express how their support contributed to your success.
  • Keep the door open for future connection.

Example:

Dear Dr. [Last Name],

I wanted to share the good news that I matched into [Program Name, Specialty, City]. I am very excited for this opportunity and wanted to thank you again for your letter of recommendation and your mentorship throughout this process.

Your guidance has meant a great deal to me, and I hope to stay in touch as I begin residency.

Best regards,
[Your Name]

This small step strengthens your professional network and demonstrates maturity and gratitude—qualities that mentors remember.

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Frequently Asked Questions About Following Up on Residency LOR Requests

1. How long should I wait to follow up after requesting a letter of recommendation?

A reasonable timeline is:

• Wait about two weeks after your initial request to send your first formal follow-up, unless the deadline is very near.
• If there is still no response, send another reminder about 7–10 days later.
• Always build in enough buffer time before ERAS or program deadlines to pivot if needed.

2. How many follow-up messages are appropriate before I consider asking someone else?

In most situations:

• Two to three follow-ups (spaced out over a few weeks) plus, if possible, one brief in-person or real-time check-in are appropriate.
• If you still have no response and the deadline is approaching, you should proactively identify an alternate recommender to protect your application.

3. What if my recommender expresses doubts about writing a strong letter?

Take this as valuable, honest feedback. If a recommender says:

• They don’t know you well enough.
• They’re unsure they can be strong or specific.
• They are too busy to write a quality letter.

You should thank them for their honesty and respectfully seek another recommender. A lukewarm or generic letter can be more damaging than no letter from that person at all.

4. What information should I include in a follow-up email to make the process easier for my recommender?

In your follow-up email, consider including:

• The purpose of the letter (specialty and type of programs).
• The deadline (and your preferred earlier target date).
• Your updated CV and personal statement as attachments.
• A brief bullet list:
  • Rotations or projects you did with them.
  • Specific strengths or memorable cases they might recall.
• Any new achievements since you first requested the letter (publications, leadership, exam scores, etc.).

5. Is it necessary to send a thank-you note after my LOR has been submitted?

Yes. Sending a thank-you note is a vital part of professional etiquette and effective communication. It:

• Shows genuine appreciation for their time and advocacy.
• Helps maintain a positive relationship for future mentorship, fellowship or job recommendations, and networking.
• Demonstrates professionalism and maturity, which mentors value highly.

An email thank-you is sufficient in most cases, though a brief handwritten note can be a nice touch if you know the person well.

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Strategic, respectful follow-up on Letters of Recommendation is not just about meeting residency application deadlines—it’s also about demonstrating professionalism, strengthening mentorship relationships, and intentionally building your professional network. By using clear communication, thoughtful reminders, and well-timed gratitude, you help your recommenders help you—and set yourself up for success in the Match and beyond.