How to Write a Residency Letter of Intent in 2025 (Step-by-Step Guide)

After weeks of interviews and months of preparation, residency applicants enter the home stretch of the Match process. One final move that may strengthen your application to your top-choice program? Sending a residency letter of intent.

It’s not a requirement, but for many applicants, this professional and carefully crafted letter can reinforce their commitment to a specific program—and may give decision-makers one more reason to rank them highly.

Understanding the Match Process

Before diving into what a letter of intent is, let’s quickly recap how the Match works. Managed by the National Resident Matching Program (NRMP), the process connects applicants and residency programs based on mutual rankings submitted after interviews.

Here’s how it works:

Applicants rank residency programs using a Rank Order List (ROL)
Programs also rank applicants
An algorithm matches both parties based on preferences and availability

While the Match is designed to be fair and transparent, a well-written letter of intent can reaffirm your commitment and help clarify your intentions—especially if your top-choice program is highly competitive.

What Is a Residency Letter of Intent?

A residency letter of intent is a one-page letter addressed to the program director of your top-ranked residency program. It lets them know, in clear terms, that if you are offered a spot, you will accept it.

This letter is not a guarantee of a match, but it does give programs additional insight into your enthusiasm and commitment. It’s an ethical and professional way to signal interest and potentially increase your chances of being ranked highly in return.

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What Not to Do in Your Residency Letter of Intent

Don’t Send Multiple Letters

This isn’t a numbers game. You can only have one true first choice. Sending letters of intent to multiple programs is misleading and unethical—and could damage your credibility if discovered.

Don’t Send It to a Generic Email Address

Avoid emails like info@schoolname.edu. Search the program website for the name and direct contact of the Program Director, and email your letter with a clear subject line, such as:
“[Your Full Name] – Residency Letter of Intent”

Don’t Be Vague or Overly Wordy

Get to the point. This letter should be concise, professional, and tailored to the program. Skip unnecessary details and filler—your goal is to reaffirm interest, show alignment, and provide any key updates.

Don’t Send It Without a Clear Top Choice

If you truly don’t have a first-choice program, skip the letter. The letter of intent is only appropriate when you are 100% certain that the program you’re writing to is your top pick.

How to Structure Your Residency Letter of Intent

Opening Paragraph

Greet the Program Director by name.
Reaffirm your appreciation for the interview.
Clearly state that this is your top-choice program, and if matched, you will accept.

Middle Paragraph(s)

Mention two or three specific reasons the program is the best fit for your goals.
Highlight a meaningful interaction during your interview.
Emphasize alignment with the program’s values, focus areas, or curriculum style.

Final Paragraph

Offer a short update on any new developments since your interview (e.g., clinical experiences, research, leadership).
Thank the director for their time and consideration.

Keep it Professional

Your tone should be formal and respectful. Avoid casual language or emojis, and do not use bullet points. Stick to short paragraphs and limit the entire letter to one page.

Sample Residency Letter of Intent

Dear Dr. Thompson,

Program Director, Anesthesiology Residency Program – X University,

It was a pleasure interviewing with your team and learning more about the Anesthesiology Residency Program. I am writing to express my sincere intent to rank your program as my first choice. If I am offered a position, I will enthusiastically accept it.

My decision is grounded in three primary factors. First, your emphasis on ambulatory medicine strongly aligns with my career goals. Second, the program’s robust rotation schedule offers unparalleled exposure across subspecialties. Finally, during my interview, I felt an exceptional sense of belonging. Your team’s warmth and professionalism made a lasting impression.

Since our interview, I completed an internship with an anesthesiologist assistant, gaining deeper insight into procedural preparation and patient care coordination. This experience has further strengthened my commitment to this specialty and my desire to join your program.

Thank you again for considering my application. I deeply admire your program’s mission and would be honored to train at X University.

Sincerely,
Clark

When to Send Your Letter

Timing matters. The best window to send your letter of intent is in early February, shortly after interviews have concluded but well before the Rank Order List submission deadline. This gives program directors time to consider your letter while finalizing their lists.

Mark your calendar: Match Day 202X results will be released in March. Make sure your materials are in before program deadlines.

Final Thoughts: Making the Most of Your Post-Interview Phase

A residency letter of intent is one final chance to communicate your dedication and enthusiasm to your dream program. It won’t override the rest of your application, but when done well, it can make a positive impression that reinforces your candidacy.

And if you're still in your pre-med or pre-clinical years, remember—your experiences now can shape your future.

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