More often than not, we have asked for more reference letters than we actually need. This often results from us doing electives in various specialties and locations (and various preceptor at each location) just so we have a safety net or surplus of reference letters in case we needed them. When we sit down and think hard about our top choice specialty, there are very few reference letters we need and the problem is that we are not 100% sure which ones to submit. The truth is, we can never be 100% sure, but when I was submitting my application there were a few rules that I set for myself, which became quite popular among peers over the years.

First, follow the official rules. If it says “maximum three letters”, you must resist the urge to submit more to tell them how strong an applicant you are. If you submitted more than the maximum, your risk appearing careless for not reading the rules properly and may display a lack of self-control. Alternatively, if it says “three letters are required” that would be the minimum requirement. Although there is no maximum, it is likely better to submit no more than five letters . This is a reasonable number to best support your application without increasing the workload too substantially for the admission committee. This is by no means a hard and fast rule, but it is a recommendation.

Second, I would consider the specialty you are applying for and which schools they are. If it is a small specialty, everyone probably knows each other somewhat within the field. The strength of the letter is probably more important than whether it is from a big name or not. If it is a large specialty, then the reputation and credibility of your reference matters a lot more. Reference letters serve the purpose of helping the committee better understand and evaluate your application. In other words, the reference letters are “referrals” or “word of mouth”. Therefore, committee members are more likely to trust colleagues whom they have heard of before or personally know. Having said that, you should use the letters from the same school that you are applying for. Again, the committee tends to trust people they know.

You may consider submitting research letters for academic programs. On the other hand, some programs train community physicians primarily and you should use clinical letters whenever possible. It is best to consult senior colleagues about the intricacies of various programs.

In addition, I would also take into consideration the amount of time you spent working with the preceptor. Working on a four-week elective, or even a one-year longitudinal shadowing and two-week elective, of course generates a letter that is stronger than a two-week elective alone.

In essence, you should not make an overall ranking list of reference letters, but rather pick and choose the appropriate ones to tailor to the needs of each specific program. The two things you need to consider are:

1. does the letter say something positive about me (or even better, the program wants me)?
2. does the committee trust the reference?

Don’t stress too much about reference letters because they are out of your hands. Prepare your best for the application and interviews. Interviews are an especially important component and you have to do whatever you can to make the committee want you. If you are hardworking, genuine, collaborative, and pleasant to work with, the match results will be positive.