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Soliciting Letters of Recommendation

by Patrick C. Alguire, MD, FACP
Director, Education and Career Development, ACP

Unless you are beginning a solo practice, most job opportunities are associated with an evaluative component. Once again, you will be the target of scrutiny. Typically, the evaluation of your abilities is conducted in two ways: by personal interview and by letters of recommendation. This section will deal with how to solicit letters of recommendation that will be most helpful in your quest for the best possible position.

The first decision is how many letters? Customarily, two is sufficient, but occasionally the organization requesting letters may want more or less than two. If that is so, they will make it perfectly clear. Supply only what is requested. Failure to do so sometimes sends an unwanted message that either you cannot follow instructions or are over-compensating for some (yet to be discovered) personal weakness. As a corollary, do not submit a letter of recommendation until asked to do so; premature disclosure of this resource will make you appear too anxious or desperate for the position.

Next, you need to determine who will write the letters. Informative letters are generally written by those who have first-hand knowledge of your abilities and potential. For the most part, this is limited to the faculty in your training program. This does not necessarily mean that the Medicine Chair or Section Chief will be the best authors of your letters, unless they posses special knowledge of your qualifications. A five-sentence letter from the Chair will not be as helpful as a one-page letter from an associate professor or community-based teaching physician who worked closely with you over a long period of time. Occasionally, your potential employer will specifically request a letter from the Medicine Chair or Section Chief, and this request should be honored, but otherwise stick with the people who know you best.

Allow sufficient time for your advocates to write a good letter. Make an appointment to discuss your letter: don't trust anything so important to a causal hallway conversation. Do not request a thoughtful letter that is needed by the end of the week. If possible, give your letter writers at least three weeks notice, but at the same time, make absolutely sure they are aware of your deadline. It's usually a practical idea and considered good form to follow up your request with a thank you card and a personal reminder of where the letters should be sent and when they are needed. This is appreciated by busy faculty and preceptors who often have multiple other responsibilities.

How can you pick someone who will write a good letter? Happily, there are several options. You can ask your program director to review your evaluation file with you. Look to see who wrote the most outstanding evaluations, paying particular attention to those accompanied by supportive written comments. This faculty person is likely to write a good reference letter. Occasionally, if faculty know that you are interviewing for a position, they will spontaneously offer to write a letter, and this ordinarily is a very good indication of a supportive letter. If the signals remain unclear, you can request a letter in such a way that it increases your chances of getting a good letter. For example, consider this method of soliciting a letter: "Dr. Brown, do you think you could write a very supportive letter of recommendation for a practice position I am considering for next year?" When requested in this fashion, your needs are clear, and you have left the door open for Dr. Brown to demur if a very supportive letter will not be forthcoming. This is much preferable to: "Dr. Brown, will you write me a letter of recommendation?" In this situation, Dr. Brown may well agree to write a letter, but it may be mediocre, and then both you and Dr. Brown are boxed in with no alternatives.

Can you influence what is in your letter? Not only can you, but it is in your best interest to do so. There are three things you can do to create a better letter, and all three will be appreciated by the person writing the letter. First, provide the writer with a copy of your CV or resume. This information can be used to add the detail to the letter not otherwise evident from previous interactions with you. Second, highlight on the CV or resume, or include in a cover letter, special attributes or qualifications you think might be emphasized in the recommendation. This might include special training in a procedure, extra-languages, administrative skills, or other competency that enhances your desirability as a new employee or partner. Finally, it is perfectly legitimate to meet with your program director and copy portions of your evaluation file for your reference writers. Remember, very few faculty have access to your evaluation file, and providing information that confirms and strengthens their good opinion of you will result in a stronger letter.

Your last obligation is to follow up with your letter writers and let them know if their efforts in your behalf have been successful. Keep them informed about the job and your plans. You never know when you may need their help again.

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