Letters of Intent for Residency Match: Process + How To Guide

A letter of intent (LOI) for residency is a message you send to a residency program expressing your intention to rank it first on your National Resident Matching Program (NRMP) Rank Order List. While letters of intent are permitted under NRMP rules, some specialties and residency programs discourage post-interview communication, so it's important to check their guidelines before sending one.

The residency match process involves plenty of important decisions, from completing your ERAS application and attending interviews to creating your Rank Order List (ROL). As you approach Match Day, you may be wondering whether sending a letter of intent to your top-choice program could help your chances.

In this guide, I'll explain when a residency letter of intent makes sense, how to write one, and what to consider before sending it. You'll also find a template and sample letter to help you get started.

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What Is a Letter of Intent for Residency?

A residency letter of intent is typically a short, formal message (one page or less) letting a program director know that their program is your first choice. It's your opportunity to explain why you feel the program is a great fit for your training and career goals and to share your intention to rank it first on your Rank Order List (ROL).

You'll generally want to wait until after your residency interview to consider sending one. By then, you've had a chance to get to know the program, meet the people you'd be working with, and decide whether it's truly your top choice.

While an LOI is a sincere expression of your intentions, it isn't a legally binding agreement or an NRMP requirement.You should only send one if you're confident about your first-choice program and you've confirmed that its communication policies allow it.

Learn More: Couples Match for Residency — A Comprehensive Guide

Letter of Intent vs Letter of Interest

Letters of intent and letters of interest sound similar, but there's one important difference: how strongly you're expressing your preference.

Letter of intent: Tells a residency program that it's your first choice and that you plan to rank it number one on your ROL.
Letter of interest: Lets a program know you're genuinely interested without committing to rank it first. Depending on the program's policies, you might send one before or after an interview.

Keep in mind that neither letter guarantees a better chance of matching, and not every program welcomes them.

Should You Send a Letter of Intent?

Whether you should send a residency letter of intent depends on your specialty's recommendations, the program's communication policies, and how confident you are about your first choice.

If you're wondering whether an LOI makes sense for your situation, here's what I recommend:

Situation	Recommendation
The program welcomes letters of intent	Consider sending one if you're confident it's your first choice.
Your specialty discourages post-interview communication	It's generally best to avoid sending one.
The program explicitly prohibits letters of intent	Don't send one. Respect the program's communication policies.
You're still deciding on your top program	Give yourself time to make your decision. There's no need to rush into sending an LOI.
You have a significant application update	Check whether the program accepts application updates separately from letters of intent.

My advice is to focus on sending a letter only when it's appropriate and you have something meaningful to say. A thoughtful LOI can communicate your enthusiasm, but it's not a requirement for a successful Match. If your specialty or preferred program discourages these letters, you can confidently skip this step.

How to Write a Strong LOI

If you've decided to send a residency letter of intent, the goal is to keep it personal, specific, and concise. You don't need to repeat everything in your application. Instead, focus on why the program is your first choice and what makes you a great fit.

Here are my top tips for writing a thoughtful, effective residency letter of intent:

Address the program director. Use their name and professional title, unless the program provides different instructions for correspondence.
Introduce yourself and state your intentions. Include your full name, mention when you interviewed, and clearly explain that you intend to rank the program first.
Explain why the program is your top choice. Highlight specific aspects of the training, faculty, clinical experiences, or program culture that align with your goals.
Make it personal. Think about what stood out during your interview. Maybe you connected with a faculty member, appreciated the program's approach to teaching, or have meaningful ties to the area. A few thoughtful details can make your letter feel much more genuine.
Share any meaningful updates. If you've received a major award, published research, or had another significant accomplishment since submitting your ERAS application, you can briefly mention it if the program welcomes updates.
End with a sincere thank-you. Reaffirm your enthusiasm for the program, thank the director for their time and consideration, and keep your closing brief.

Aim for one page or less, and remember that a thoughtful, straightforward letter is usually more effective than one filled with generic praise.

For more writing tips, check out our guide to writing letters of intent. Although it focuses on med school admissions, many of the same principles apply to residency letters.

When to Send a Letter of Intent

If your preferred residency program welcomes letters of intent, mid-January through early February is generally a good time to send one. By then, you'll likely have completed your interviews and had time to consider which program is truly your first choice.

For the 2027 Main Residency Match, rank order lists open on February 1, and both applicants and programs must certify their lists by March 3, 2027, at 9 p.m. ET. Sending your letter well before that deadline gives the program an opportunity to review it before finalizing its rankings, although there's no guarantee it will influence their decision.

My advice is to start thinking about your letter once you've finished interviewing and narrowed down your preferences. Give yourself enough time to write a thoughtful draft, review it for clarity, and ask a trusted mentor or advisor for feedback.

For more guidance on navigating the Match, watch our webinar below with Dr. David Flick on matching with your ideal residency program.

Should You Send Multiple Letters of Intent?

No, you should only send a residency letter of intent to your first-choice program. An LOI communicates that you intend to rank a particular program number one, so sending that same promise to multiple programs would be misleading.

While a letter of intent isn't legally binding, it's still important to be sincere. Residency programs value professionalism and honesty, and you don't want to risk damaging your credibility by making conflicting commitments.

That doesn't mean you can't express interest in more than one program. Letters of interest allow you to share your enthusiasm for multiple residency programs without promising to rank any of them first. Depending on the program's policies, these may be appropriate before or after an interview.

Keep in mind, though, that letters of interest aren't guaranteed to improve your chances of receiving an interview or matching. Some specialties and programs discourage unsolicited communication altogether, so always check their guidelines before reaching out.

Related: IMG-Friendly Residencies

Additional Ways to Improve Match Chances

A letter of intent is just one possible part of the residency application process, and it isn't necessary or recommended for every applicant. Whether you're still preparing your application or getting ready to submit your rank order list, here are a few ways I recommend putting yourself in the strongest position for the Match:

Build a strong ERAS application. Make sure your ERAS application highlights your clinical experiences, accomplishments, and commitment to your chosen specialty. Strong letters of recommendation from physicians who know your work can also help programs get a better sense of your strengths.
Write a thoughtful personal statement. Use your residency personal statement to share your interest in your specialty, relevant experiences, and career goals. If you're tailoring your statement to a particular program, focus on what makes it a good fit rather than simply expressing enthusiasm.
Use your residency program signals strategically. If your specialty participates in program signaling, use your available ERAS program signals to express interest in programs you're genuinely excited about. The number of signals varies by specialty, so review the guidelines before submitting your application.
Prepare for your residency interviews. Your interview is an opportunity to show programs who you are beyond your application. Research each program, practice answering common questions, and come prepared with thoughtful questions of your own. Check out my residency interview preparation tips to get started.
Rank programs in your true order of preference. When creating your rank order list, include every program where you interviewed and would genuinely be willing to train. Don't try to predict which programs will rank you highly. The NRMP matching algorithm is designed to prioritize your preferences, so rank programs in the order you actually prefer them.
Understand your options if you don't match. Hopefully, you won't need it, but it's worth familiarizing yourself with the Supplemental Offer and Acceptance Program (SOAP). SOAP gives eligible applicants who are unmatched or partially matched an opportunity to apply for unfilled residency positions during Match Week.

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Residency LOI Template

Here’s an LOI template that is not filled out. After this, you’ll find a sample LOI that I have composed.

Dear [Director of the Program],

Thank you so much for the opportunity to interview at your program this past December. I was so thrilled to have this opportunity, meet the faculty and residents and see the program in action. I am writing this letter to express my sincere interest in the program and that I will be ranking it as my top choice residency.

[Paragraph about why the program is a good fit from a clinical sense.]

[Paragraph about why the program is a good fit from a research sense (if appropriate).]

[Paragraph about the people you met, as well as why the city is a great choice for you.]

For all of these reasons, the program is my absolute top choice for residency. I would be absolutely thrilled to match here! If there is anything more I can provide the committee, please do let me know.

Sincerely,

Student

Sample Letter of Intent for Residency

Below is a sample LOI so you can get a good idea of what one looks like.

Dear Doctor Cornelius Smith,

Thank you so much for the opportunity to interview at your program last December. I was so thrilled to have this opportunity, meet the faculty and residents, and see Johns Hopkins in action. I am writing to express my sincere commitment to joining Johns Hopkins as a resident physician, as well as my intent to rank your program as my number one choice for residency.

Throughout my medical school education and clinical experiences, I have been drawn to General Preventive Medicine at your program due to the specialty’s unique challenges, opportunities for growth, and potential to make the most meaningful impact on the most patients’ lives. Your program’s reputation for excellence aligns perfectly with the electives I’ve taken, the research projects I’d like to be involved in, and my professional career goals.

During my interview day at Johns Hopkins, I was captivated by the cohesive and driven atmosphere among faculty, residents, and staff. Your robust curriculum, diverse patient care, and opportunities for research activity will provide me with the training and resources I need to become a well-rounded and competent preventive physician.

Did I mention I love Baltimore? The culture is unmatched, yes. But Johns Hopkins is so perfectly placed for massive impact in underserved populations. I am passionate about being a small part in a larger story of restorative healthcare justice.

For all of these reasons, Johns Hopkins is my absolute top choice program for residency. I would be absolutely thrilled to match here! I am always available to provide any additional information or answer any questions you may have. Thank you once again for your time and consideration.

Sincerely,

John Hopkins, Jr.

FAQs

Yes, in some cases, sending a letter of intent could do more harm than good. Some residency programs prefer not to receive additional communication after interviews, so it's important to respect their preferences. You'll also want to be sincere about your intentions and avoid promising more than one program that you'll rank it first.

Before sending an LOI, I recommend taking a look at your specialty's guidance and the program's communication policies. If letters of intent aren't encouraged, there's no need to send one. You can feel confident knowing you've already had the opportunity to make a strong impression through your application and interview.

No, residency programs don't generally require letters of intent, and some actively discourage them. You won't be at a disadvantage simply because you chose not to send one, although individual programs may have different communication expectations.

If you're unsure whether an LOI is appropriate, check the program's website and your specialty's recommendations before reaching out.

Sending a letter of intent isn't guaranteed to improve your chances of matching. Some programs may appreciate hearing that they're your first choice, while others prefer not to receive additional communication after interviews.

Ultimately, your qualifications, interview performance, and how well you fit with the program will play a much bigger role in the Match process. My advice is to think of an LOI as an opportunity to express your enthusiasm rather than something you need to send to improve your chances.

For the 2027 Main Residency Match, residency programs must certify their rank order lists by March 3, 2027, at 9 p.m. ET, the same deadline applicants must meet.

Programs can begin creating their rank lists on February 1, 2027. If you're considering sending an LOI, make sure it's permitted and send it well before the certification deadline.

If you have an important update to share, like a new research publication, major award, or another meaningful accomplishment, it may be worth reaching out to the program. Just make sure they welcome additional communication before sending anything.

If you've already sent your letter of intent, my advice is to hold off on further follow-ups unless you have something significant to add. You want to keep the program informed without overwhelming them with messages, so be thoughtful about when you reach out and follow any instructions they've provided.

Get Guidance from a Physician With AdCom Experience

A letter of intent (LOI) is an optional part of the residency application process. An LOI indicates that you ranked a certain program #1 on your rank list in early February.

Note that some programs do not accept LOIs, so always check the specific program’s terms and guidelines before sending.

Also, LOIs are not required by any residency program. If you can’t decide between 2-3 programs, don’t stress — you don’t have to send an LOI.

Our students and advisors have found that a letter of intent can make a small difference in acceptance, which is a huge deal when you’re competing against other highly qualified candidates for a limited number of spots.

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