Why Reference Letters are Important and How to Pick Your Referees


Every medical school has a different philosophy when it comes to evaluating applicants. Some schools, like Queen’s and Western, look at your GPA and MCAT scores first, and pretty much guarantee you an interview if you meet certain cutoffs. Some schools, like the University of Toronto, look at your entire application package first before granting an interview: GPA, MCAT, personal essay, biographical sketch, and reference letters.

As with any medical school, you will get complaints about the process. Personally, I think it’s great that the medical schools have such different philosophies on admissions, so that many great candidates with different backgrounds are likely to get in somewhere. But when it gets more personal, and your application package isn’t as competitive at a certain school, it’s understandable for people to be a bit frustrated.

As an example, some applicants have voiced frustration with the fact that UofT’s medical school admissions places a greater weight on reference letters than some other schools. The most common argument is that there is a lot of variance involved with reference letters since it is out of the applicant’s control, in terms of how well the referees are able to write. So it is very possible that an applicant is fantastic, but his or her referee just lacks the skills, experience, and knowledge to put those ideas well onto paper.

In this article I want to analyze this common frustration, and then give my argument for why I think a medical school (or scholarship organization, summer program, etc.) might value reference letters.

Variance Exists Everywhere – Deal with It

I’m not going to deny that there is variance when it comes to reference letters. Considering the letters are supposed to be confidential, it’s quite possible that no matter how hard your referee tries, he/she could end up writing a letter that is relatively poor compared to the average, simply because he/she isn’t used to writing stuff like this. For sure, there is some skill involved in writing a strong reference letter, and it takes experience and knowledge to do that.

The problem with this complaint is that it’s essentially founded on the ideas of variance, chance, and luck. If you’re going to be upset with variance, then logically, you should be upset with the entire medical school application process.

For instance, it’s true that some applicants are naturally better writers than others. Should we throw out the personal essay too? Or, let’s analyze that fact that most applicants don’t get the same interviewers, which also leads to a lot of variance (as I’ve written extensively on before). Should we scrap the interview process too?

The fact is that most things in life, whether medical school related or not, consist of some things out of our control. Sometimes you just need to be lucky.

That being said, one question we can ask is whether a component of the admissions process has an unacceptably high amount of variance. While we can’t eliminate variance or chance, we should always try to reduce it whenever possible. And this is a question that needs to be asked for every component of the process.

Unfortunately, I don’t have the knowledge or experience to say whether there is too much variance in the use of reference letters. I would like to think that the admissions committees have seen enough reference letters over the years to recognize the type of variance involved, and adjust their selection process accordingly (and likewise with other aspects of their admissions process).

The Second Factor: How Strongly a Potential Referee is Likely to Support You

I’d imagine that most applicants have only been on one side of the reference letter process – that is, have had reference letters written for them but have never been in a position to write reference letters for others. As the founder of SMARTS, I have had to write my fair share of reference letters for some of our student volunteers over the past few years. By now having been on both sides of the fence, I’ve come to understand an extremely important concept that I don’t think many applicants realize about reference letters.

There are essentially two factors that affect the strength of your reference letter. The first factor is something we already know, and that is somewhat uncontrollable: the skills of the referee in writing a good reference letter. However, there is a second factor that most applicants don’t really realize, and I don’t think put enough thought into when choosing potential referees.

You see, many applicants just assume that anyone they could reasonably ask is going to write them the most fantastic reference letter. They assume that just because they asked for a fantastic letter, they are going to get one. The reality is that this is simply not the case. How good of a reference letter you can get also comes down to how strongly your referee feels about supporting you.

For example, when I’m asked to write reference letters for SMARTS student volunteers, I can honestly say that not all students get the same quality of letter from me. If you’re a student who I don’t work with on a personal basis, not only is it hard for me to fill up a letter with content and impossible for me to comment on your personal qualities, but I don’t have a strong enough personal connection with you to feel the urge to write you the best letter possible. The result is a letter that is much more formal and sparser in detail – I’d be lying if I wrote otherwise. In such a case, it would have made much more sense to ask a teacher or other supervisor who has seen your work in action, and can comment on personal qualities in a detailed fashion.

On the other hand, if you are a SMARTS student volunteer who I know personally and have seen in action on a regular basis, not only can I write much more detailed about you, but I end up writing a ridiculously fantastic letter. Why? Because of the personal connection we have developed, I personally want you to succeed and want to do anything possible to help.

So What Do Reference Letters tell Medical School Committees (or other judging committees)?

The importance of the reference letters is that they tell medical schools about how other people think about you, and how good of a physician they think you’d make. It’s easy for you to write a personal essay claiming to be a fantastic person – but of course they expect you to do that. And of course your opinion of yourself is going to be positively biased. You might say that you are a fantastic leader, communicator, and team player – but where is the proof? The closest thing to objective proof that the judges have are your referees.

Extremely strong reference letters show medical schools that there are actually people, other than yourself/your family, who genuinely believe you would make a great physician. If someone else can write a letter advocating for you so strongly, logic says there must be something really good about you. And unless they lack a ton of integrity (and are just making stuff up), referees are generally not going to write you absolutely fantastic letters unless they really believe you deserve one – I mean, do you really think that first year biology professor who only knows you from class really cares to write you an outstanding letter? I mean, why would he care whether you get into medical school or not? Why would he waste his time getting the letter “just right”? Furthermore, strong letters show that you can form meaningful personal relationships with other individuals.

I’d imagine that any referee would approach the letter writing process like I do. If they know you well, are impressed by you, and honestly desire to support you to the best of their ability, they will spend their time writing the best letter possible. But if they barely know you or aren’t particularly impressed by you, it’s a bit naive to expect a really strong letter.

So What Does this Mean for Picking My Referees?

In short, this means that you should pick referees who know you very well and who you know want to support you.

Don’t just pick someone because they have a really prestigious title. The person’s title makes up a few words, but what he/she writes makes up the entire page – which part do you think the judge is going to focus on and remember?

I know when I picked my medical school referees this year I followed those two exact criteria. I picked people who I knew for at least a few years, who I felt were impressed by me, and who I knew genuinely wanted to support me in my endeavours.

If you do that as well, I think you will be getting your best reference letters possible.

  • Noah

    Hi Joshua,

    I know that many schools want reference letters from actual doctors but since I don’t know any do you think letters from pharmacists that I worked with at Shoppers Drug Mart suffice?