Updated
Residency Letter of Interest: When to Send It, What to Say
A residency letter of interest is a short email telling a program it is one of your top choices, without promising to rank it first. For 2026-27, most specialty guides say not to send one before an interview invite: your ERAS signals do that job. After you interview, NRMP rules let you tell a program you are interested, but some specialties discourage it and several programs say it will not change your rank. Check the program's own policy, keep it under 150 words, and send it before the March 3 rank list deadline.
What a letter of interest is
It is an email to the program director, sometimes copied to the coordinator, that says you want to train at the program and gives one or two reasons only that program has. It can go to more than one program. Here is how it compares with the two other letters applicants send:
- Letter of interest: The program is one of your top choices, and why. Send to: Any program you would be glad to match at, where letters are welcome.
- Letter of intent: You will rank this program first. Send to: One program, and only if it is true.
- Thank-you note: Thanks for the interview, with one detail from the conversation. Send to: The people you met, right after the interview, where notes are welcome.
Ready to tell one program it is first? Read our residency letter of intent guide. For notes right after the interview, see residency interview thank-you emails.
When it helps in 2026-27
Signals changed where a letter of interest fits. The AAMC says “A program signal only indicates the applicant's interest at the time of application.” It adds that “their interest could change throughout the cycle, after interviews, life events, or interactions with a given program.” A letter after your interview is how you say where you stand now. Season dates come from our residency interview season guide.
- From September 2, with your application. Your ERAS signals are the letter of interest. Most specialty guides say to show interest this way, not by email.
- After September 23, while invites go out. Write only for a real reason: a major update to your application, a couples match change or a question the program's website does not answer.
- After you interview. This is where a letter of interest fits, if the specialty and the program welcome it. It tells a program you remain interested without promising to rank it first.
- Before March 3, 2027. Send it in time to be read before rank lists are certified. After that, a letter can no longer matter.
Some specialties also set when you may reach out. The pediatrics recommendations say applicants “should not initiate communication regarding interviews prior to the earliest interview release date (October 5, 2026).” Anesthesiology says “It is not recommended to use letters of interest prior to receiving an interview offer.” For how many signals your specialty gets, see ERAS program signals.
What each specialty says for 2026-27
From each specialty's 2026-2027 program director guide. The program's own instructions come first.
| Specialty | Before an invite | After the interview |
|---|---|---|
| Anesthesiology | Not recommended. Use signals | Welcome, not used for ranking |
| Dermatology | Don't contact programs to express interest | Don't send |
| Diagnostic radiology | Not encouraged. Signals preferred | Not required, programs usually say |
| Emergency medicine | Not suggested. Ask an EM advisor first | Not required or suggested |
| Family medicine | Major application updates only | Discouraged |
| OB/GYN | Each program says | Each program says |
| Pediatrics | Use your signals | Discouraged, except updates or questions |
| Plastic surgery (integrated) | Unlikely to help. Ask a mentor | Against ACEPS policy |
| Psychiatry | Generally discouraged | A simple thank-you only |
| Radiation oncology | Only with a specific question | Only with a specific question |
| Urology | Discouraged. Signals instead | Follow-up questions only |
Anesthesiology: in the guide's words
“It is not recommended to use letters of interest prior to receiving an interview offer.”
“If an applicant would like to send a thank you note or a letter of interest, they are welcome to do so.”
“this correspondence will not be utilized to influence interview/rank list outcomes.”
Anesthesiology guide, 2026-27 · Anesthesiology interview questions
Dermatology: in the guide's words
“applicants are asked to refrain from contacting programs to express interest or provide application updates prior to interviews, except in truly exceptional circumstances”
“should not be sent to programs.”
Dermatology guide, 2026-27 · Dermatology interview questions
Diagnostic radiology: in the guide's words
“Generally, pre-interview and letters of interest are not encouraged.”
“Signals are largely the preferred method for showing interest in a program.”
Diagnostic radiology guide, 2026-27 · Diagnostic radiology interview questions
Emergency medicine: in the guide's words
“There is no requirement nor suggestion that letters of interest outside of the ResidencyCAS application be sent to programs.”
“applicants are advised to speak to a specialty-specific advisor before sending communication.”
Emergency medicine guide, 2026-27 · Emergency medicine interview questions
Family medicine: in the guide's words
“Applicants may wish to notify programs of major updates to their application materials that occur after the initial application is available for review”
“Applicants are discouraged from sending letters of interest or intent to rank.”
Family medicine guide, 2026-27 · Family medicine interview questions
OB/GYN: in the guide's words
“Programs may specify their preferences on their individual program website or in ResidencyCAS.”
Pediatrics: in the guide's words
“Applicants should indicate interest in a program using ERAS preference signals.”
“Updates to provide to an application (e.g., new publication, award).”
Plastic surgery (integrated): in the guide's words
“this tact is unlikely to help an applicant (and risks annoying a program director).”
“These are against the policy set forth by ACEPS and should not be done.”
Psychiatry: in the guide's words
“reaching out early is generally discouraged.”
“No post-communication aside from a simple thank-you is recommended.”
Radiation oncology: in the guide's words
“Pre-interview communications are not encouraged unless there is a specific question about the program.”
Urology: in the guide's words
“Pre-interview communication is discouraged, whether that be directly from an applicant or from others advocating for an applicant.”
“Only urology applicants may initiate written contact regarding any follow-up questions they may have about a program.”
What programs say on their own pages
Many programs post a communication policy. These three are typical: questions are welcome, and letters do not move the rank list.
- University of Florida OB/GYN: “Any post-interview communications will not impact an applicant's ranking.”
- University of Rochester internal medicine: “There is no expectation for applicants to send thank you notes or e-mails. Such communications will have no impact on ranking decisions and may not routinely receive a reply.”
- Orlando Health OB/GYN: “No applicant will be given an advantage or preference based on their post-interview communication with the program.”
Look for a page called something like “post-interview communication” or an interview FAQ on each program's site before you write.
The NRMP rules
Under the 2027 Match Participation Agreement, before the rank list deadline: “Applicants may voluntarily communicate their interest to a program(s)”. The same rule says “applicants may not solicit verbal or written statements from a program(s) implying a commitment to rank the applicant.” Programs may tell you that you are viewed favorably and will be ranked. They may not ask how you will rank them, or make your place on their list depend on a letter. The rank list deadline is March 3, 2027.
What to put in it
An outline, not a script. Keep the whole email under 150 words.
- Subject line. "Letter of interest", your name and the program's name.
- Opening line. Say that the program remains one of your top choices. Don't write "first choice" unless you mean it and send it nowhere else. That is a letter of intent.
- Why this program. One or two specifics only this program has: a clinic, a track, a patient population, something a resident told you on interview day.
- Why you fit. One sentence linking those specifics to something you have already done or plan to do.
- What is new. A new publication, award or score since you applied, if there is one. Skip this line if there is nothing.
- Close. Thank them for their time and sign with your full name. Ask nothing about where you will be ranked.
Don't: asking for an interview after a rejection
Anesthesiology's guide says further communication asking for an interview should be avoided.
Don't: asking how you will be ranked
Under the 2027 Match Participation Agreement you may say you are interested, but you may not ask a program for a commitment to rank you.
Don't: writing where the program or specialty says no
Dermatology and plastic surgery ask applicants not to send them. Following the program's own instructions never counts against you.
Don't: emailing every program before invites
Several guides point to signals as the way to show interest before interviews. A mass email adds nothing your signals have not already said.
Don't: a long letter
Stay under 150 words. A few specifics beat a page about yourself.
The reasons you give in the letter are the same ones programs ask about on interview day. Our “Why this residency program?” guide shows how to build that answer.
“Why are you interested in our program?”
A strong answer names two or three things only this program offers, ties each to something you have done, and says what you would add there.
Sources: the 2026-2027 Program Directors Association guides, APPD pediatrics recommendations, NRMP 2027 Match Participation Agreement, AAMC program signaling and the program pages linked above. All checked October 27, 2026.
Frequently asked questions
What is a letter of interest for residency?
A short email telling a residency program that it is one of your top choices and why. Unlike a letter of intent, it does not promise to rank the program first, so it can go to more than one program.
Should I send a letter of interest before an interview invite?
Usually not. For 2026-27, anesthesiology, dermatology, diagnostic radiology, pediatrics, psychiatry and urology all say to show interest through ERAS signals or not to reach out before interviews. Write only for a major update or a real question, and follow the program's own page.
What is the difference between a letter of interest and a letter of intent?
A letter of interest says a program is one of your top choices. A letter of intent says you will rank it first, so it goes to one program only, and only if it is true.
When should I send a residency letter of interest?
After your interview at that program and before the NRMP rank list certification deadline on March 3, 2027, and only where the specialty and program welcome it.
Does a letter of interest help you match?
Rarely, if at all. Anesthesiology's guide says such letters will not be used to influence rank list outcomes, and programs such as UF OB/GYN say post-interview communication will not affect ranking. Your interview counts far more.
More residency interview guides
Other residency interview pages that applicants read next: