So you’ve decided you want to become a physician assistant, and soon you’ll be sending out PA training program applications. Letters of recommendation can be a pivotal part of the process, so you have some things to keep in mind to maximize your chance of acceptance. The following checklist should help avoid critical mistakes.

1. Start tracking your letters down early. You should start asking references if they are willing to write you letters of recommendation early because it takes time to secure an agreement from writers, it takes time for your references to actually write their letters and submit them, and generally speaking, the earlier your application is complete, the better your chances of getting in. This is particularly true if you apply through CASPA.

2. Use references that will have broad appeal. Most schools will have you apply via the Central Application Service for Physician Assistants (CASPA). CASPA requires you to obtain three letters of reference. Once received, CASPA will distribute the same three letters to each school to which you are applying. For this reason, you should choose references that will have appeal to the widest range of schools. If you are concerned about appealing to the specific requirements of a particular school, you can speak to these in your essay, or in a secondary application, which you may complete later in the application process.

3. Clinical references are usually better than academic references. In most cases, schools prefer to learn about your clinical experiences than you academic performance. This means seeking out references who have supervised you or worked closely with you in a clinical (patient) setting. It makes sense, because this information speaks directly about your potential as a PA. The only exception is if you have a weak academic background (low grades or your coursework is more than 3 years old). In this case, you should consider getting one letter from the instructor of a class that you did well in, preferably in a science prerequisite.

4. Seek out letters of recommendation from people you are sure support you. It may sound obvious, but many people don’t. Find someone who truly likes you, and who supports your decision to apply for PA training. If you are unsure, ask them: “I am going to be applying to physician assistant schools, and I’m beginning to think about my letters of reference. Would you feel able to support me by writing a letter of reference if I asked you to?” If their response is anything less than an enthusiastic “Yes!” then consider finding someone else.

5. Use the electronic submission method if at all possible. Electronic submissions are easier on you, your reference, CASPA, and the schools you hope to attend. Simply provide CASPA with the name, title, degree, and email address of your reference, and how he or she knows you. Let your references know in advance when you will be submitting their information so they can gauge when the letter will need to be written. Once they have completed their letter they will email it to CASPA. Exception: if you are submitting a letter from an admissions committee. Letters from committees count as a single letter and must submitted as hard copies, on institution letterhead.

6. Waive your right to review your letters of recommendation. CASPA gives you the option to waive your right to review your letters, and you should. Not waiving this right signifies that you may wish to view them yourself, and implies that you aren’t confident that they speak well of you. This is a little like asking a potential employer not to contact your previous employer – a definite red flag to an applications committee.

7. When complete, send a thank you card to your letter writers (and maybe even a small gift — Starbucks gift cards are appropriate). This is just good manners. It shows your appreciation and keeps you in their good graces should you need to reapply next year.

Once your letters of recommendation are completed and submitted, you can cross this item off your extensive to-do list and breathe a little easier. Good luck!

  • Jacquirosa June 17, 2011, 2:29 am

    QUESTION! I hope you can answer this:
    I am already in process of filling out my application through CASPA and have 2 questions:
    1) I already clicked that I want to SEE my reviews.  It’s not that i don’t trust them, or else I wouldn’t have picked them, I just want to see it later if I want to!  It’s about rights, not questions….so after reading your suggestion to click this, I tried looking to change it and I can’t – what should I do?

    2) I also read on a different section here that you say to write in your essay about why you are a good candidate for THAT school – well I am applying to 9 schools all through CASPA, which is just ONE essay.  SO – how do I make each school feel special even though there are 9 different ones with a possible 9 different values, missions, etc etc.

    • Paul June 18, 2011, 5:04 am

      As for #1, I doubt there’s anything you can do. You could try calling CASPA and asking them if there is any way that they can change it manually, but I think it’s a long shot. I wouldn’t worry too much about it – it’s probably not a major issue – just let it go.
      #2 Your point is a good one. Generally, you write the essay so that it has general appeal, since it is for ALL the schools you’re applying to. I would avoid details and statements that might nix you from consideration at any school if possible. Either way, if you write a killer essay, you will have a chance later via an interview or a school-specific secondary application – or both – to tailor your message to individual schools.

      If have a STRONG preference for a particular school, you might tilt slightly it their way so that it has extra appeal to them, but know that this is a bit of a gamble. I didn’t, but everyone’s situation is different.

  • Antoinette August 21, 2011, 8:23 am


    I’m applying to the PA program and the deadline is dec 1. I have asked only one doctor so far for a letter of recommendation. I’m unsure and very nervous about asking others. My question is, when do you advise I ask other people and when should I have my application in by?

    Thank You!

    • Paul August 21, 2011, 11:19 am

      Don’t be nervous about asking for letters – you need them! Just make sure that you’re asking people who know you reasonably well and can say positive things about you. I think it’s good to have one or two backup letters, so I don’t see any reason that you should wait before asking others. If you think one may write a more positive letter than the rest, it might make sense to wait a little longer for it. Supervisors from healthcare-related jobs and professors can right letters too.

      As for completing your application, the schools have different deadlines, so it depends which ones you are applying to. But in general, the earlier the better. I think aiming to get it in at least a month before the deadline of the school that interests you most is a good goal.

  • Katherine August 25, 2011, 3:05 pm

    I was wondering if it would be a good idea to ask my director where I am currently employed to write a recommendation. I work for a Healthcare organization, but I’m not clinical. More data/coordinator. I have known her for about 2 years. She is very accomplished and supports me.


    • Paul August 25, 2011, 4:19 pm

      Do you have other potential letter writers who can speak to your clinical and/or academic ability? It’s great that you have someone who supports you, but it won’t count for much if they can’t speak well to these areas, as they are the two areas that PA schools scan for. If you don’t have anyone like that to write for you, there are ways to find them, like volunteering in a clinic/ER, getting an EMT certificate, etc.

  • york September 12, 2011, 12:34 pm

    Just curious if a Dentist would make a good candidate for my third letter of rec. I worked with him for many years and he knows me well. The other letters would be from a science professor and a hospital supervisor for who I interned with.

    Thank you

    • Paul September 12, 2011, 6:17 pm

      My opinion: a dentist is “just okay” to “kind of weak.” Science prof and hospital sup are great. Another instructor, perhaps? Or someone you’ve shadowed with more than once or twice? Search your brain – you probably are forgetting someone who might be ideal. If a dentist is the best you come up with, it’ll do. But I’d push for another strong reference.

  • LMcKay September 14, 2011, 1:36 pm


    Someone recently asked me to write their CASPA reference letter and I want to do a great job. I think this person would make an excellent PA but want to make sure that, because I know them as a non-clinical colleague, and not a professor, that I am addressing the best possible topics in my narrative. I am not the best person to address either academic topics or clinical/patient care topics. Are there any specific area’s or topics that I should be certain to address, beyond just the typical work ethic, dedication, professionalism type stuff?

    • Paul September 14, 2011, 3:30 pm

      Those areas are good. I also think some nod to teamwork and communication skills would be good. PA schools want to generate PAs who are able to work closely with physicians and communicate effectively, since the PA/MD relationship is a partnership in the truest sense.

      Also, you may already have written letters of reference, but if not, I think that providing anecdotes or examples of the candidate’s conduct is a more compelling way to share positive traits that just a list of them alone.

      You deserve a medal for going the extra mile on your applicant’s reference letter. Most people wouldn’t bother to ask this question!

  • Robert November 19, 2011, 2:15 pm

    I have been honored to be asked for a letter of recommendation for a person I believe to be an outstanding candidate. My background includes an administrator for a famous municipal hospital but that is not where I worked with this individual although I am well aware of her ability to work with other members of the clinical team and as well as the other qualifications which would make her an excellant PA. My question is: Do I mention my previous background as the basis for evaluating her in comparison with others

  • Soni March 8, 2012, 8:48 am

    Thank you for all the helpful advice!

    I know that CASPA allows for 3 references, but what if I have ~5 in mind? I know some schools allow to send “extra references” via regular (snail :p) mail. Would this be beneficial, or should I only send the 3? It’s confusing because some schools want two professor recs, while others just want one.

    • Paul March 8, 2012, 9:44 am

      Hi, Soni! You’re right; CASPA will only accept 3 letters. If other schools have different requirements, you should fill those with whatever letters you have that you didn’t use for CASPA. But would discourage you from sending more than the requested number of letters. Admissions committees get busy and extra data just bogs them down. But definitely, send the best ones you have.

      • Soni March 8, 2012, 10:41 am

        Hi! Thanks for the quick reply.

        Ya, it’s just a little difficult to decide which 3 would be the best choices, because even to submit via CASPA, all the schools want the letters from different people i.e. 1 prof, 1 work, 1 community vs. 1 prof, 2 work vs. 1 PA, 2 prof….etc

        I just want to have a combo that would be ideal for all the schools I’m thinking of applying to.

  • Christopher Bradshaw May 15, 2012, 10:12 pm

    I am a Human Nutrition major and know one of my nutrition professors would write me a really strong recommendation letter. However, CASPA only allows three. I currently have one from my medical director at a practice I work at and another from a doctor at the same practice who is good friends with a PA Program Director of my number one choice school. I would really love to use the nutrition professor. Would that count as my Science Professor? Or should I find a core science professor who may not write one as strongly?

    • Paul May 16, 2012, 8:46 am

      An interesting question. Since they would write a strong letter, and you ARE a nutrition major, I think I would use them. You might do well to call schools and ask, though, just to be on the safe side. Every school’s priorities are different.

  • Ilona May 16, 2012, 12:40 pm

    I am currently working on my application and would love to get some advice. I have a lor from a PA I work under, as well as from my physiology professor. Who should my third letter be from…the medical director of the clinic I work for (same place as the PA letter), from a hospital staff worker where I volunteered for 2 years, or my youth pastor (could really speak about my character)? Should I send additional letters to the schools…do they even look at them?

    • Paul May 16, 2012, 5:55 pm

      I would not use your youth pastor. Of your other two choices, I would go with whomever you believe would write the best letter in support of your candidacy. CASPA will not accept additional letters, but they’re good to have in case one of the schools you are applying to requests extras as part of their secondary application. I wouldn’t spend too much time getting them – you’ll have a chance if the want them – but most likely they won’t want them.

      • ilona May 16, 2012, 6:07 pm

        Thanks! …also, if the MD and PA letters come from the same place would that be acceptable?

  • Saul June 5, 2012, 12:12 pm

    I can get a letter from a pa i’ve shadowed, my supervisor in a medical related job, and my ap 1 and 2 instructor. Should this suffice? I believe I can get more? Should I? Can I have too many letters? My deadline is . 15th.

  • K July 3, 2012, 9:52 am

    I am somewhat in a bind after realizing that the PA (the only PA who I know personally) I had planned on asking to write my letter is a bit disorganized and might not follow through… I have two great letters: one from a professor and one from the head of my neuroscience lab that I worked in as in undergrad. What is your opinion? Should I take the gamble with the PA (scary!)? Or should I try a nurse or physician who I have known for a long time but knows much less about the life of a PA?

    • Paul July 3, 2012, 11:07 am

      The PA would be best. Try saying something like this to him/her:

      “Hi, John. I’m Not sure if you’re aware, but I’m in the process of applying to physician assistant school. I would really like your support in the form of a letter of reference, but I’m torn, because I know you have so much on your plate, and it’s really important that it get done according to the application requirements [code for “on time”]. How would you feel about doing something like that? Do think you would have time?”

      If he/she says yes, then your job is to MAKE IT TOTALLY SIMPLE FOR THEM. You organize it, write him regular emails or notes about where it is in the process and what you need from him/her.

      Then, just to be safe, approach a fourth reference and line it up just in case.

  • Audrey July 18, 2012, 5:07 am

    I’ve got 2 references already completed–a PA I’ve shadowed and my Physiology professor. I’ve got a choice for my third: my Anatomy lab instructor, or a friend of my parents who knows me well and has had metastatic cancer for many years and has spent a good part of her life these last years in hospitals, oncology clinics, etc. working closely with doctors, nurses and PAs. She’s actually who encouraged me to become a PA. She’s very articulate (a corporate tax attorney by profession) and thinks highly of me. What do you think of this (unconventional) choice for a reference?

    • Paul July 18, 2012, 10:09 am

      Admissions committees know that friends aren’t objective. For this reason, they don’t care for such letters.

      I’m not saying you can’t do it, but it’s a risk. Do you know this person in any professional or student/instructor capacity? If so, you could lean on that (as long as it’s true).

    • Asha June 24, 2013, 12:39 pm

      I’m just curious, after seeing some posts from people sending rec letters from PAs they shadowed, how much time did you spend shadowing the PA? Did you have a history with them before? I just think about how I’ve shadowed multiple PAs and spent no more than a day, maybe two, with them; plus, it’s shadowing so it’s not like they got to see me using any clinical skills. How can they really speak to your abilities after spending such a short amount of time together and not seeing what you’re capable of? And how do you ask someone that doesn’t really know you to write a letter?

      • Paul June 24, 2013, 5:48 pm

        You raise a good point.

        The ideal letter of reference comes from someone who meets all the following criteria (few do):

        – PA or MD
        – Has known you for a long time
        – likes and trusts you
        – has seen you work and think critically
        – recently
        – who writes well

        Few are lucky enough to have a letter from someone who fits all these. But it’s what you shoot for.

        Sure, you can use a letter from someone who is less than enthusiastic about you, or hasn’t known you long, writes poorly, etc. But the letter won’t be as important a factor in your application if you do, and that’s a risk.

  • Kathleen July 18, 2012, 11:05 am

    Hi Paul,

    I work in an in hospital therapy clinic, so my clinical experience has come from this environment. The people I feel that support me the most and will give me the best reference’s are Physical/Occupational Therapists, is this appropriate for PA programs? I will also have a 3rd reference from an Ortho PA that I’ve shadowed as well as the 2 from PT’s.

    Thank you!

    • Katie June 5, 2013, 10:25 am

      Hi Kathleen,

      I was wondering what ever happened with your LOR situation. I only ask because I am applying to PA school this year and am in a nearly identical situation; my clinical experience comes from a physical therapy clinic, and I’m considering asking two therapists for LOR as well as one from a professor. Did everything pan out for you okay? Did you use two PTs as references?


  • Brittany July 29, 2012, 8:16 am

    I am finishing up my summer break between freshman and sophmore years, during which I spent several weeks shadowing a PA. He told me that he does not write letters for students, but I can write one that he will sign. What do you think I should do? Is it too early for me to even be concerned with LORs since my CASPA application is so far away? Should I just ask him for contact information so I can reach him a few years down the line when I am ready to apply for PA school?


    • Brittany July 31, 2012, 6:06 am

      I just “googled” the FAQ at CASPA you mentioned. I got this directly from their website: “CASPA NO LONGER ACCEPTS PAPER LETTERS OF REFERENCE. All references must be completed electronically”. Any suggestions?

      Thanks again,

    • Paul July 31, 2012, 9:19 am

      Hi, Brittany –

      Well as you and I both noticed, CASPA has made it official: they are only accepting electronic letters of reference from this point forward. It’s a frustrating change for some, but on the whole, I think this is way overdue. But what to do in your situation? I think I would let it go. It’s early enough for you that you will have other experiences with PAs and MDs from which to get a letter – probably even a better one, from the sound of it. Besides, you want a letter that is 1) current, and 2) from a provider who has spent enough time getting to know you.

      Discouraging, I’m sure, but in the long run, this is probably for the best.

  • Ashley July 30, 2012, 8:17 pm

    Hi, I was wondering if the letters of recommendation have to be sent at the time of submitting CASPA application. I want to send my app before the third week of August but won’t have all my letters in by then. Also, I have not been able to find a PA to shadow and don’t have a letter of recommendation from one but I have been an MA for a year and have one from an MD. Will that suffice?

    • Paul July 30, 2012, 11:41 pm

      Here’s the answer, directly from CASPA:

      Q: Can I e-submit my application before my references are received by CASPA?

      A: Yes. Once you have successfully filled out your application, you can e-submit it to CASPA at any time. However, your application will not be processed until CASPA has received all of your official transcripts, at least two letters of recommendation and your payment.

      An MD will suffice, but I think it’s advisable to have a PA letter. If you don’t have one at the point that you need to have them in, then you better go with it, particularly because even if you meet a PA to shadow now, you won’t get much time with them.

  • Evie August 7, 2012, 11:39 pm

    I asked my nurse manager and two professors to write me a letter of recommendation. I initially decided NOT to waive my right to view the letters. After reading this article, I realized that I’ve made a huge mistake. I quickly logged into my CASPA account. The problem is my nurse manager had already submitted the letter so I couldn’t change it .However, I was able to waive the other two letters since they were labeled as “incomplete”. I know “clinical experience” is an important aspect of the admission process. Am so nervous that this might raise red flags or hurt my chances of gaining admittance into the program. Please help? I honestly don’t know what to do.

    • Paul August 8, 2012, 9:36 pm

      Don’t sweat it. 1) it’s done and can’t be undone, and 2) it’s not a major factor – it’s more like window dressing.

  • Kaitlyn September 18, 2012, 7:36 pm

    I am hoping to apply to PA schools by December 2012. Is it too late to start now? If not, I was wondering who would be the top three strongest references in which PA schools would prefer:

    – a Nurse Practitioner whom I intern for 4 hours a week (would it be a bad idea to have an NP serving as a reference?)

    – a doctor in the Radiology Department who hired me to tutor /baby-sit for her son and daughter for half a year everyday (she may not have seen me in clinical settings but she knows my aspirations/goals, organizational skills, intellect, ability to supervise her kids, etc.)

    – an instructor (LVN) for my CNA program (he has seen me both in clinical and classroom settings)

    – a Registered Nurse whom I have interned for in the Emergency Department (she was not my supervisor, but she was one of the nurses I helped on the floor doing vitals and patient transferring)

    – a Dentist (I have worked with him for 5 years both as a dental assistant and as an office assistant – he is extremely familiar with my work ethics, capabilities, and aspirations).

    – a Physiology Professor (he didn’t know me as well because it was a large-sized class; however, he did agree to write me a letter of rec if I needed one).

    I know these are not the greatest references, but I was wondering if you were to choose the top three strongest, which would those be? I appreciate any help, suggestions, words of encouragement, etc! Thank you. I feel so lost in this PA application process.

    • Paul September 18, 2012, 8:26 pm

      From the choices you have listed, I would pick your instructor (one academic is good) if you did very well in the class, the dentist – you have worked with him and he is familiar with your patient skills, and the NP. I don’t think an NP is a bad reference. You’re not using her because you want to become one, but you are using her because 1) she knows you, and 2) she is very familiar with what you will be doing as a midlevel provider.

  • Lindsey January 11, 2013, 9:28 am

    Hello. I worked in a hospice as an education coordinator. Most of my time was spent doing community education rather than clinical / patient contact. I did have LIMITED patient contact. The Medical Director of the hospice will be writing the L.O.R. and wondered if she should highlight my patient interaction, even though that wasn’t what I spent most of my time doing (and really excelling at). In other words, I was a great community educator, but will the committees care about that? Or should she only discuss my patient interaction?

  • Ligaya March 18, 2013, 6:50 pm

    So I’m graduating from undergrad this December and am planning to work as an EMT for a couple of years or more to gain experience and to save up a bit for PA school. Should I even bother asking for recommendation letters from professors (from science classes I did well in) here? The fact that their letters would be around 2-3 years old…I’m not sure if that would suffice for PA schools. Thanks for your help, Paul.

    • Paul March 24, 2013, 6:29 pm

      Ligaya – as of this year (2013) CASPA no longer accepts paper letters of reference. This means that for someone to write a letter of reference on your behalf, it will need to be submitted electronically to CASPA while you have an application pending.

      My suggestion: if you really need their letter, and can’t come up with one as good that is recent, ask the reference to please write a letter for you and save it, or send it to you directly by email. Then when you are ready to complete your CASPA application (say, 1-2 years later), you can have them copy and paste the original letter into the CASPA letter of reference section of your new application.

  • Kellie April 4, 2013, 5:18 pm

    Hi there!

    Like many who have commented, I am also torn between who to chose for my letters of reference. I have a very strong academic letter coming, but the clinical reference is what I am struggling with. I did my masters thesis work with an ER physician who knows me well and I am co fident that she would write a good letter in my behalf. But we worked strictly in a public health field together and she did not see me in a clinical, patient care environment. I have been a paramedic for four years traveling with the Denver broncos and know that the owner of the company I work for would write me a great letter to advocate my patient care as bedside manner abilities. He has seen me in action and has even worked aligaide me on high acuity injuries. However impressive his CEO/CFO/critical care paramedic titles are, is he the best of the two?

    Thank you so much for your help!

    • Paul April 4, 2013, 9:38 pm

      The best letter would (I think) be from your clinical work with the Broncs. It’s hard to decide sometimes, but they need to know how you are with patients and providing health care. Is there any reason you couldn’t use both? Most schools require 3 letters…

      • Kellie April 8, 2013, 6:01 am

        There isn’t any reason! I had two academic letters lined up and I was trying to decide between the MD (clinical research advocate) and the Paramedic (patient care experience). Would it be more beneficial to have both the MD and Paramedic and an academic letter? Rather than one of the two and two academic letters? I was mostly worried about the title, as many forums suggest an MD, DO or PA to write the letter.

        Thank you so much for your response!

  • Ashley April 10, 2013, 12:50 am

    I have a question if someone could answer that would be greatly appreciated. I have asked four people to write me a letter, from most personal to least are my supervisor at a clinical job, a nurse/supervisor at a different job, a PA, and finally a professor. Do you think I need one from a professor when the other letters will be more personal? If so, which one should I get rid of? Thanks

    • Paul April 10, 2013, 1:02 pm

      I would think that three clinical letters would be okay if your GPA is solid. Otherwise, an academic letter might be a good idea.

  • David April 22, 2013, 8:19 am

    Hi Paul! I need help choosing who to ask for recommendations.

    – A Philosophy Professor who I am pretty close with. I did well in his class and he knows me pretty well as a person (my dreams and aspirations)

    – A Internal Medicine Doctor whom I have known for 10+ years because he attended my church. I also shadowed him at his clinic this past summer for about 90 hours.

    – Hopefully I can find a PA to consistently shadow this summer and ask him/her. This would be an obvious yes.

    – My pastor’s wife who is a Cardiologist at Cleveland clinic. She has known me for about 4 years and I am planning to visit and shadow her for a bit. She knows my character and personality very well.

    Should I wait until I find a PA to shadow before I make any decisions to choose my 3 Rec’s?

    • David April 22, 2013, 8:20 am

      I’m also going to be working as an EMT-Basic this summer. Should I ask my supervisor to write me a letter as well?

      • Paul April 23, 2013, 11:54 pm

        Yes, definitely. If you can get it so you can read it, then you can decide to use it or one from someone else. But yes, get letters from any program or medical job you are in. When it comes time to interview, you will have more options. Keep in mind that CASPA letters of reference are now ALL ELECTRONIC. So ask them to write you a letter on paper, but have them save the file so that they can use it if you call on them when you apply. Explain to them why and how important saving the digital document is – otherwise, their letter cannot be accepted.

    • Paul April 23, 2013, 11:52 pm

      If you wanted to change one, you might switch something for the philosophy professor. I tend to think having a non-medical letter from someone who knows you will is okay, but you can probably do better.

  • Mik April 22, 2013, 9:00 am

    Hey everyone,
    I’m in the process of applying to PA school. I got a question regarding LOR’s. I graduated from school 1 year ago and all my letters were written at that time. Now caspa requires all letters to be submitted electronically and letters I got are all hard copy. Now, I don’t know what to do. Should I look for new people to write me a letter? This is total disaster…
    Any advice would be greatly appreciated.

    • Paul April 23, 2013, 11:56 pm

      I would contact the people who wrote for you originally – it was only a year ago, so you shouldn’t have much trouble. Be sincere and tell them your dilemma – they will probably either have the document on their hard drive or be willing to rewrite it for you.

      I actually lost a paper letter of ref (back when they were still accepting paper ones) and I called the prof and just apologized and he wrote the letter all over again.

      (I don’t recommend you do anything like that, but it turned out okay!)

  • Jason April 23, 2013, 9:28 pm

    I was wondering who is best to ask letters of recommendations from? PA’s, NP’s, MD/DO, or Nurses?
    I work in a small Hospital(ER tech) and at a clinic(MA), so i know all the staff relatively well. the PA that works with me in the ER is writing me one and so is the DO from the clinic. The nurses know me the best since i work in tandem with them everyday.
    who do the admissions committees prefer LOR from? Do titles mean anything?

    • Paul April 24, 2013, 12:03 am

      I think 2 MDs/DOs and 1 PA OR 2 PAs and 1 MD/DO is best. I would avoid letters from nurses – they are in a very different field and their letter would probably lack weight in the minds of the admissions committees.

  • Jocelyn April 24, 2013, 11:22 am

    Hi Paul- I will be reapplying this cycle and I’m wondering if I need to get 3 new letters of recommendation or if I can reuse some of the letters from last year? Also, I have a lower sGPA and would like to have a rec letter speak to my ability in the sciences. Would it be better for me to have the PI I did basic science research for full-time write me one? Or my biochem professor that doesn’t know me very well but I did get an A in his course?


    • Paul April 24, 2013, 9:42 pm

      I think you need to go with your gut. Who do you think would write a better letter on your behalf?

      Then use that writer.

  • Pam April 26, 2013, 1:56 pm

    I have requested a PA and a medical doctor that I have worked with for references, for the third reference, I am torn between an orthopedic surgeon, who I have worked with as a PT and a social worker who was also my coworker at the hospital. The surgeon knows me professionally, but I feel like the social worker would write a better reference. Which would be weighted more.
    Thank you

  • Luisa April 29, 2013, 10:28 am

    Hi Paul,
    I am gathering up my 3 letters of recommendation for the upcoming 2013-2014 CAPSA cycle. I have served as a mentor/one to one coach for the National Psoriasis Foundation for over a year now. I had my volunteer coordinator write a letter of recommendation for me, also the PA that i have been shadowing. My Genetics professor offered to write me a letter of recommendation. I also had in mind my academic advisor for my graduate program. Any suggestions? Thank You

    • Paul April 29, 2013, 2:01 pm

      If you are deliberating between your genetics professor or your academic advisor, here are the criteria I would use to decide:

      1. Who knows you best?
      2. Who is the most supportive of your application?
      3. Who do you think would write the best letter? Hint: it’s usually whomever is the most articulate in conversation
      4. How well did you do in your genetics class?
      5. The qualifications of your prof vs. your advisor (PhD vs MS vs some other credential)

      You’ll notice that I don’t necessarily give any more credit for a writer who has a science background than I do for a non-science background. What matters is 1) how well the will write, and 2) how they feel about you.

  • Alina May 14, 2013, 6:38 am

    Can you give me any tips for recommendation letter for what they should Emphasize more on it or where I can find helpful information that PA schools are looking for when they read a letter. Thank you very much.

    • Paul May 14, 2013, 10:54 pm

      If I understand you correctly you are wondering what to have your letter of reference writers talk about in your letter, is that it?

      You can’t really tell them what to write, but you can steer them. Emphasize that they want to get a feel for what potential you have as a PA. What have they seen in the areas of:

      science/academic ability

      Overall, they want to read from a referrer that they believe you would be a great PA who has something to offer the field.

  • Lin May 22, 2013, 11:38 am

    Hi Paul – I really appreciate this blog – Its is dissolving many of my anxieties. I am in the letters of recommendation stage. I have two of my references accounted for. The third reference that I would like to submit to CASPA i want to be just as strong as the other two, but I have limited options:
    a) my current employer is an RN and I have been working for her facility for 5 months part-time as an RA/CNA
    b) my pastor of my church, who has known me for 7yrs, and my work with children ministry and womens health programming at the church
    c) a PA I shadowed a few months back, whom I have kept in touch, but was only allowed to shadow for a 1/2 day due to legalities with the facility.
    I think all three would have the potential to write great recommendations, but which would have the best appeal to the review committee?
    Thanks in advance for your help.

    • Paul May 25, 2013, 6:07 pm

      That’s tough, Lin.

      You want to choose a letter of reference writer who will bring balance to your letters. Three academic letters that are great isn’t as good as one academic, one work, and one volunteer letter that are all just good.

      I don’t know who wrote your other letters, so it’s hard to say. My guess would be #1 above – they are medical and they are familiar with you. A pastor is non-medical (and some readers will be weird about anything religious), and 1/2 of a day for the PA isn’t long enough to give an objective, enthusiastic and knowledgeable review of your skills and strengths.

  • Lin May 30, 2013, 10:40 am

    Thank you Paul – I have decided to request a reference from #1 as this employer would have my most recent clinical experience evaluated. My other two references are from MDs, one whom was my professor, and the other is a mentor whom I have done limited shadowing and volunteer work with. I will likely add a fourth letter to address additional clinical experience directly to the school, perhaps from my medical missions supervisor (missions trip in mid-Aug – fingers crossed!) Thank you for helping me! I really appreciate it!

  • alex May 31, 2013, 2:12 pm

    I just started collecting these letters and one source said they would rather I write my own letter and then just let them review it and I’m kind of at a loss as what to write or even if this is such a good idea writing my own letter. Any ideas on this?

    • Paul May 31, 2013, 5:55 pm

      There is no rule about this, although some would find it unethical.

      In truth, it is becoming more and more common. I’ve written letters of reference for students when I taught psychology, and writing GOOD ones takes time, something more professors are short on. Practically speaking, it’s not against the rules; the source will review and edit/approve it as they see fit. IT. If you would like some guidance, you might ask if they could spend 10 minutes with you going over an outline before you write it – what they see as your strengths and gifts? Then write a good letter and run it by them. If you’re going to do this, write a letter that is very positive, very truthful, and very well written.

      Here is a resource on how you might go about it.

      As with any ethical dilemma, do it only if you are ethically comfortable with it. Some are, and some aren’t.

  • Brad May 31, 2013, 4:23 pm

    Hi Paul, thanks for the site! If you don’t mind advising me regarding recommendations, I’d appreciate it. As of now, I’ve secured a professor, and supervisor (I’m a Rehab Aide) but I’m unsure about the last allotted recommendation. My two options are:

    -An NP that knows me very well (mother of my best friend growing up) but that I have no clinical connection to.

    -A PA who I’ve shadowed a few times (maybe 15 hours worth) in the OR. He’s a great guy and would probably write me one if I asked but he doesn’t REALLY know me and it makes me uncomfortable asking him that kind of a favor.


    • Paul May 31, 2013, 6:44 pm

      I think you need to keep looking or develop a relationship with the PA so that he knows you – maybe shadow him some more?

      You really can’t send a letter that has a family relationship of any kind – schools rightly assume that they will be biased.

  • Andrea June 29, 2013, 12:42 am

    Hi Paul!

    First off, I would just like to say thank you for such great advice! I really appreciate all of your help!

    My question for you is similar to the questions of many people above. I am struggling to decide which letters of recommendation to submit. I work as a unit secretary and a scribe, both in the same ER. Several of the doctors have expressed their excitement to write me a letter of recommendation. My boss for the unit secretary (the medical director for the ER) has also told me that he would be happy to write me a LOR and he is an RN. Although I have not asked, I think most recent professor from A&P would be willing to write me a LOR. I got an A in the class and I know he was happy with my work in his class, but I don’t feel like he knows me anywhere near as well as the people I work with. Would you suggest me asking the professor for a LOR, and then 1 doctor and my boss (the RN)? Or the professor and two doctors? I also did volunteer work with Engineers Without Borders (I served as the interpreter for the group). Would you suggest I ask one of the engineering mentors for a LOR instead of one of my clinical/academic references?

    Please help! I need your expertise!

    Thank you,


    • Paul July 1, 2013, 8:08 pm

      Thanks! I think a diversity of letters is best. I would go for 1) a doctor or PA, 2) a professor, and 3) your boss. You want to show that you’re strong in all settings.

  • Reagan July 1, 2013, 10:00 am

    Hello Paul!,
    Your website has been a godsend for me in this application process. I have an odd question I would love some advice on. I sent off my CASPA application last night with letters of recommendation from two doctors and a nurse practitioner. My final application is for a school that doesn’t accept a CASPA app. I can use the same letters for this last application but wondered if it may be stronger to get a letter from my current employer? I’ve been working front desk/insurance/medical assisting in a midsize chiropractic office for the last 2 1/2 years…would it look bad to have a letter from a chiropractor?

    • Paul July 1, 2013, 8:44 pm

      It might be okay, but I think two physicians is a safer choice. Some in allopathic medicine (“traditional”) have biases against complementary medicine, specifically chiropractic. And you never know who’s going to be reading your essay first…

  • Chris July 26, 2013, 9:47 am


    Thanks for the blog, it has been an eye opener. I’m in a tight spot and could use some advice. I was planning on applying to PA 3 years ago, right after I got my bachelors degree, but other opportunities led me into a non-medical profession. Now I’m applying for the 2013-2014 cycle, but it’s been too long for me to ask my professors for LOR’s they’ve seen thousands of students since me. I worked as a phlebotomist for a year 2 years ago and my supervisors loved me, but again it seems to long to request an LOR.

    I’m a mentor for youth and can get an excellent LOR from my supervisor. I’m starting to shadow again, but I doubt any PA will be able to give me an excellent LOR’s after spending just a few hours shadowing, should I ask the PA’s anyway? Any other suggestions?

    • Paul July 26, 2013, 7:48 pm

      I don’t think it’s too late to ask them. Go in person to their offices and reintroduce yourself. Tell them you did well in their class and that you know it’s been a while but you are wondering if they could support your application with a letter of reference. Odds are at least one of them will remember you enough to write a letter. Be sure to bring a copy of your resume and a cover letter reminding them just who in the hell you are.

      GO IN PERSON. If you don’t they’ll just say “Sorry, but I’m too busy,” or “I really don’t remember you.”

      Short of that, do your best to get one from your supervisor – they will definitely remember you.

      Try to get one from a PA you will shadow.

      If that fails, go with your mentoring supervisor.

  • Darren August 10, 2013, 12:37 pm

    Paul, first I need to begin by thanking you for being an absolute gem to the Pre-PA community. The time you take to answer these questions do not go unnoticed, especially by myself.

    I’m essentially 95% done with my CASPA for the 2013-14 cycle. However, I’ve got 1 more recommendation left. The two are below:

    1. Doctor who I’ve worked with for 5 months in a small medical office. I am confident that she has written me a good letter; she even assured me so.

    2. My CNA Instructor who is also my Clinical Supervisor during our days rounding in the hospital. We are extremely close and I’m confident to say that I’m one of her favorite students in the program. It is an 8-week accelerated program.

    The third? Well… like many of the other commenters above, I’m still struggling on getting a PA to write me a LOR. I’ve shadowed 3 PAs:
    – PA #1: Shadowed last summer of 2012 for 16 hours. Wrote me a LOR for last cycle (I was rejected to all schools.) Wasn’t as strong, I’m assuming. [I’ve asked her to write me another LOR 4 days ago. No response yet.]
    – PA #2: Shadowed 3 weeks ago. Her personality is stoic, and is only somewhat curious about my academic/work background. After 3 weeks of not being able to reach her, she told me of a possible opportunity to shadow her during a surgical operation this Monday. [Never brought up LORs]
    – PA #3: Shadowed 2 weeks ago. His personality is more approachable, and is only somewhat curious about me, like #2. Hasn’t gotten back to me for 2 weeks and I’m becoming very apprehensive. (I feel like he could even be ignoring me.) [Nonetheless, just now I sent him a text since I have his cell# with what you said above about being “torn that he has a lot on his plate, but I need an LOR”].

    My questions for you:
    – Should I even put all this effort just to get a PA I’ve shadowed to write me a LOR? Will having an MD suffice? Most schools seem to not have a REQUIREMENT to get a PA LOR… right?
    – If so, which PA(s) out of the 3 should I pursue to write me an LOR?
    – Any suggestions if you were in my shoes?

    Thank. you. SO. much!

  • Peter December 5, 2013, 11:21 am

    I was wondering if it was a bad thing to have too many recommendations I see the required is about 3 for most schools and I have 5 possible recommendations should I only select 3?

    • Paul December 7, 2013, 4:21 pm

      For CASPA schools, you are required to have three references, and only three. There is no way to submit more. If you are applying to a non-CASPA participating school they might let you submit more, but 3 is usually a good number. I suggest you choose either your best 3 or the 3 that fit each particular school’s preferences.

  • Jim December 12, 2013, 9:44 am


    Like many people on here that have written to you I’m in the same predicament in choosing the best people to write my lors. I’ve read so many blogs and forums and have asked for advice but Im still hesitant on who I should ask for my letters.

    Here are my options:
    A pa in cardiology at the local hospital where I volunteer that I’ve shadowed the past 3 months for a total of about 40 hours. The pa I feel doesn’t know me too well although I do ask lots of questions while shadowing the workload doesn’t allow for long winded convo about myself or future aspirations besides becoming a pa.

    The director of volunteering at the same local hospital. I have volunteered there the last 7 months and I feel he pretty much knows my work ethic and loyalty to serving and helping people in anyway I can. I volunteered in the icu. I kind of feel that he wouldn’t be able to speak on my clinical experience because he never was really in the icu just coordinated all the volunteers

    A nurse in the icu where i volunteer that has really become invested in my journey to becoming a pa these path few months, he has seen my dedication to volunteering and also introduced me to the pa that I now shadow. He also has taught me different many techniques he uses in nursing

    Also the charge nurse where I volunteer would be willing to write me a lor too but doesn’t know me as well

    The supervising nurse at the rehab center that I’ve worked as a Cna these past 5 months. Not sure how strong a letter from a nurse would be but she sees me day in and day out at work and probably could be best speak on my ability, performance and potential in the health care setting. Shes told me many times how impressed she has been of my work ethic and dedication

    My graduate professor, I’ve taken her for 3 of the most difficult courses in the program and have gotten As in all 3 of those courses. Knowing her she’d probably write the best of all 3 just because she takes pride in everything she does for her students

    My program coordinator who doesn’t know me so well but I got an A in the only course I took with him and would probably be a strong person to have writing my letter since he is the coordinator

    And finally the DON at the rehab center that I currently work as a Cna whom I’ve only met twice but both times were very positive and she would probably be excited that I was applying but once again she doesn’t know me so well

    I want to choose the best 3 that know me but since I am competing against so many candidates I want to choose the best three that give me the best chance of receiving an interview

    Any advice would help, thank you so much for what you do

    • Paul December 17, 2013, 10:56 pm

      Hi, Jim! Tough decisions, all. I think in the end you need to go with what you picture as being the strongest letters. Based on what you’ve shared, the RELEVANCE seems highest for the PA you are currently shadowing (cardiology), the prof you did so well with (3 A’s) and that leaves one more which could go several directions. I would stress that it makes sense to ask each (particularly the very busy cardiology PA) how they feel about the task. Let them know you really would like a letter for them if they are 1) in a position to give you a solid reference, and 2) able to write a strong letter. These are definitely two different things, as you seem well aware. I find that a 5-10 minute conversation 1 on 1 with a potential reference can clear up how helpful that person would be if they were to write for you. You would do well to have the 1 academic letter, and at least one provider (MD, PA, or NP). The third can be something else, but another provider is probably best. But as you also seem well aware, it’s rare to have just what you need. Do your best and go with what you have.



  • Steve December 17, 2013, 1:08 pm

    If my science gpa for all PA requirements is great but my overall gpa is not as outstanding should I consider getting one of my science teachers to write a recommendation even though my science gpa was good?

    • Paul December 17, 2013, 11:00 pm

      Generally, you want a reference letter from science types more than anything. Since these are your better grades, yes – by all means go with one or more of those. Play to your strengths whenever possible.

  • Mike January 8, 2014, 8:24 am

    Hi Paul!

    I have shadowed 3 PA’s, each for about a month in length each. Should I try to get all of them to write me letters of recommendation and just use the best one for my CASPA application? I will also be trying to get letters of recommendation from my EMT captain and a Bio Professor, who I believe will both participate.

    • Paul January 8, 2014, 10:36 pm

      I prefer diversity of reference letters. So I would choose the best/most enthusiastic of your PA contacts, and add it to the prof and the EMT captain. They each have very different perspectives from which to speak to your awesomeness.

  • Rasha January 30, 2014, 3:50 pm

    Hi Paul. Thanks for this great resource.
    I have two letters already lined up for me: 1) from a microbiology professor whom I took micro with as well as two semesters of research in his laboratory and 2) a PA I have shadowed for over 25 hours.
    My last letter, in my mind, should be from the person who has overseen my patient care. I have around 1500 hours from a nursing home that I worked at part-time for 3 years. However, I floated from shift-to-shift, and most of my supervisors were nurses, LPNs, and the main nurse has since left the establishment as well as most of the nurses who supervised me. None of them even knew me well enough to write me a letter that I would trust.
    I also have hours as a therapeutic recreation aide at a nursing home where I have been working at for the past 6 years. My supervisor is a therapeutic recreation director and has been in healthcare (nursing homes) for over 24 years. She is eager to write me a letter and I am confident it will be a great one in favor of my character. She is very familiar with my interactions with patients and has always been my “#1 fan”. She can attest to my communication skills, patience, and my many, many interactions with patients. I am just worried that the admissions committee would be looking more for a letter from someone who has overseen my patient care hours.
    Additionally, my older brother is a PA, and his best friend, also a PA, who has known me for years, has offered to write me a letter saying he knows my character and my passion and believes I would make a great PA–though he has not overseen me in the clinical setting nor have I had the chance to shadow him.
    So, my questions are, my recreation supervisor an OK resource? if not, should I use my PA family friend?
    Thanks in advance for any input you have!!!

    • Paul February 2, 2014, 11:29 am

      I see your dilemma. I think I would use the recreation director. Your other two letters sound strong and this would be from a different perspective. It would be fine to ask this person to try (as possible) to focus on the clinical things as much as possible. Patients you have worked with and the medical setting itself. In the meantime, you should try to establish a relationship with a PA or MD whom you can spend a little time with. Could you shadow your brother’s friend? I say this so that you will have that next time around, should you not get in this year. It’s always best to have an extra iron in the fire, working on this application while you better one for next year.

      Let me know how it goes!


  • Jessica March 4, 2014, 7:33 am

    Hey Paul!
    Awesome resource! Just wondering about the strength of my LORs. I was going to use a PA I’ve shadowed for about 20 hours, a professor which I’ve taken a class with and a seminar with (and wrote me a LOR for a previous internship application), and a nurse who taught my CNA certification class (which was a night class that lasted about 6 months including clinicals). Also, I have about 350 hours from an assisted living facility and I’m trying to get a job as a CNA in a hospital once I graduate in May so I can up my hours before I apply. I think 1,000 hours would be strong but I don’t think I will accumulate that many before I apply. I know they take into consideration that I would be working before matriculating but I’m still insecure about not having enough hours to be competitive. What do you think about this? And finally (sorry this is long), my GRE score was above average, I scored about 70th percentile in both sections and got a 4 in writing. How important is this in the application process? Should I retake it?
    Thank you in advance for your help!

    • Paul March 7, 2014, 12:38 am

      i don’t put much weight in the GRE, and I don’t think that most PA schools do either. 70th percentile is fine, so I wouldn’t put your time into more studying for that test.

      It really depends what schools you apply to and what other applicants they get. Some applicants will have 10K hours, and some with 200. In the end, the quality of the hours (and by extension the variety) seems more valuable to me. Strive for the best exposure to medicine that you can find.


  • Charles C March 8, 2014, 7:00 pm

    I work in a medical clinic that has an MD, a DO, and a Naturopathic Doctor. The Naturopathic doctor is likely the one out of the three who can write me the best letter. Should I have him do it? My other 2 letters are from my Anatomy teacher and my former volunteer supervisor.

    • Paul March 10, 2014, 11:29 pm

      I don’t think I would. You are applying to study allopathic medicine, and naturopathic medicine is different, if not antithetical to allopathic medicine. Besides, in non-naturopathic circles the respect for naturopaths is less than stellar.

  • Bee March 17, 2014, 5:00 pm

    I work for a hospital as a technical assistant and phlebotomist, and I’m trying to determine who I should ask for a letter of rec. I don’t know if I should ask my immediate superior who is a “team lead” and supervisor of a small portion of the lab, or my supervisor above her, who also knows me well and for a longer period of time. Both would write good letters; I just don’t know if one would look better to a committee.


  • ADJEI MENSAH March 24, 2014, 4:49 am

    in need of a sample of that great letter of recommendation.

    • Paul March 24, 2014, 1:28 pm

      Are you looking for a sample of a letter of reference about a person you feel is worthy of becoming a PA or a sample of a letter asking someone to write a letter of reference on your behalf to become a PA?

  • Leslie March 29, 2014, 9:08 pm

    Hi Paul, I am about to apply to PA programs when CASPA opens this April and am going through a list in my mind of who I could ask to write LOR for me. I worked as an ER scribe for 2 years (ended that job last summer) and therefore became close with several physicians and am confident that I could get 3 excellent letters. My concern is that I don’t have variety and think all my letters will be very similar and therefore not effective at making my application stand out. Should I try to contact an old professor? I graduated 2 years ago and fear that a simple email will not jog their memory of me. I don’t have the option of going on campus either as I have moved out of state!
    Any suggestions??

    Thank you!

    • Paul March 30, 2014, 9:56 am

      I would only go to the trouble of asking one of your former profs to write for you if you are 1) sure that you can get them to remember you (you should include a photo of yourself to help jog their memory – that generally works) and 2) are SURE that they would write a very strong letter. When they can’t remember you well, you risk ending up with a letter that is somewhat generic and less than enthusiastic. You might also add to that list a third item – that your GPA was a less than stellar, in which case a letter from a prof can serve to reassure them of your commitment to academics.

      Failing those things, you should stick with the physicians with whom you have worked, particularly if they know you well and like your work.

  • RPP April 1, 2014, 6:52 am

    Hi Paul,
    I have a professor right now who I believe would be happy to write me a LOR, but I’m a little concerned because English isn’t his first language and sometimes his grammar is a little off. Do you think that’s a problem?
    Thank you!

    • Paul April 6, 2014, 2:12 pm

      Hmmm. I think I would avoid that. You don’t want to give them any reason to look at you askance. If you can find another one, then I suggest that you do that.

  • Rebecca May 7, 2014, 5:10 pm

    I am trying to figure out who I should request to do my letters of recommendation. I do have a strong academic background (GPA 3.87), so I plan to do at least two clinical references but I am wondering if I should just do clinical references for all three? My options are as follows:
    1. Several PAs, NPs, and MDs that I worked with when I worked at a student clinic while in college. These people have know me the longest (almost two years), but my job at the health center was very limited. I just vitaled patients, not much else.
    2. A PA whom I shadowed for a little over a month and also taught my injections and drawing blood. I have known her for about a year now.
    3. Several MDs that I worked for as a medical assistant for eight months.
    4. A PA that I have worked with for about three months. I am working as a medical assistant, but not directly under the PA I am considering asking. I have not known him long, but feel it may be a good choice because the clinic we work at is for underserved/uninsured populations.
    5. I do have one former professor in mind I could ask whom I took several classes with. Although, it has been a while since I was in his class and I feel the above mentioned people know me much better.

    I’m at such a loss. Please help!

    • Paul May 11, 2014, 1:07 pm

      Rebecca – I think your instinct is good. Your GPA pretty clearly demonstrates your academic ability. I think in your case, it makes sense to have three clinical letters. So choose from your list those who are the most enthusiastic and articulate, as their letters will read best.

  • Celina May 31, 2014, 8:48 am

    Paul, I am trying to figure out what to do in regards to my letters of recommendation.

    I have a 3.85 overall GPA but my science GPA is a 3.25 and I am concerned about whether I should get a professor’s LOR. I am not very close with any science professors but am very close with my music professor. Should i still ask a professor who doesn’t know me well to write me a LOR?

    I already have a LOR from a MD.
    For my 3rd LOR, I am wondering if I should get my boss to write me one ( who is very articulate and very supportive of my decision to become a PA) or if I should get one from a PA that I shadowed briefly and does not know me very well,
    Please help.

    • Paul June 4, 2014, 7:12 pm

      I would advise against a letter from a music professor. For your other letter, your boss is a better choice then a PA you don’t know if your work with him relates to medicine in some way. If not, you may need to keep digging.

  • Nina June 4, 2014, 4:41 am

    Hi Paul,
    I have asked my anatomy and physiology professor to write me an LOR since my science gpa is average. I did very well in his class. I also asked my previous supervisor to write me a letter. I used to work as a medical assistant 3 years ago at an urgent care for almost 4 years during undergrad. This will cover the clinical setting. I still have a good relationship with the urgent care team and the supervisor agreed to write me an excellent letter. Now I am torn between my third one. I work at a large cancer institute for the past three years. I work with PAs, NPs, and a DO. I have good relationships with all of them. I decided to ask my principle investigator (DO) as she is the director of the program I work for and has seen me work critically and well with the PAs and mid-level providers. Do you think I should ask one of the PAs I work with instead? I feel like they would both write supportive letters. Oh and I almost forgot to mention that this is not in a clinical setting, although I do walk in and out of the clinic and interact with the clinical team but just not directly with the patients. Let me know what you suggest.

    Thank You!

    • Paul June 4, 2014, 7:08 pm

      A DO is fine. You would ideally like a letter from someone who has seen you work with patients. But it sounds like your other letter may cover that. No, PA isn’t any better than DO for letters, IMHO.

  • Andrea July 5, 2014, 3:42 am

    Hi Paul,
    I am struggling to decide which references I should choose for my application. I graduated college almost seven years ago. My GPA is only 3.27 and so I feel that I need someone to speak for me academically but I have not remained in contact with professors from undergrad. After college I completed a high ranked dietetic internship and I know that the director of that program, the lead pediatric clinical dietitian, could speak to my academic abilities as well as clinical to an extent but I completed that program in 2009. Is it too old? Also, I am currently a Peace Corps volunteer and the director of my program is more than willing to write a letter. I am a health volunteer but my work isn’t clinical and I’m not sure if I should focus more on my clinical contacts from my years working as a clinical dietitian over my Peace Corps experience. Any thoughts? Thank you!

    • Paul July 6, 2014, 1:25 pm

      It’s okay to send a resume/CV to people who have known you to update them before having them write a letter for you. Have you no recent patient care experience? You should try to get at least one letter from someone who knows your current/recent work with patients. The rest should be whatever else you can get.

  • Kim January 6, 2015, 3:01 pm

    Hi Paul,
    Would it be okay to have a charge nurse who knows me well to write a letter? I have one from a biology professor ( my grades aren’t very high so I figures having a professor to talk about my strengths would be good) and a PA I work with at the same hospital as the charge nurse. I don’t really interact with my manager and she doesn’t know we very well so I figured asking my charge nurse who sees me on the floor and knows me better would be okay.

    • Paul January 11, 2015, 2:53 pm

      I think that’s okay. Better would be a work supervisor who is enthusiastic about you. Better still would be another PA. But go with what you have.

  • Brett January 27, 2015, 9:24 am

    Hello, Paul–Would you know what the email to the recommender says? I’m sure it’s fine, but I’d like to let the faculty making the recommendations know really precisely what to look for. Does it include instructions for the actual letter or just “go here to submit a letter.” Does it say in the email who put them down as a recommender? Help is much appreciated. Brett

  • Amanda April 2, 2015, 9:40 am

    Hello Paul!

    My pre-med adviser told me I should get one reference from her, a professor, and then a healthcare professional. She told me my public speaking teacher would be an excellent recommendation for a professor, and then my EMT operations supervisor would be good for the healthcare professional… Do you think this is a good bunch of recommendations? I plan to also shadow in the ER and I know the department head of the ER at the hospital could also write me one, but I’m not sure if I should replace any of the others who would probably know me better.

    Just want to know your thoughts! Thank you so much!

    • Paul April 5, 2015, 3:44 pm

      Those sound okay. But I would rather you replace the public speaking instructor with the ER department head. It’s just more relevant to what you’re going to be learning.

      Generally I encourage: 1 instructor, one supervisor (preferably from a healthcare job you’ve had), and one PA or MD whom you have shadowed.

  • Brigitte April 26, 2015, 12:27 pm

    Hi Paul!

    This is a wonderful website you run and has helped me immensely on my journey. I will be applying to PA school this cycle and am trying to choose my letter writers wisely. I have two from PAs in an ER setting and I am debating on the last one. I could go with an MD in dermatology that I’ve shadowed or my store leader at the Apple, Inc. Although my experience at Apple is non-clinical, there are so many aspects about working at Apple that I find to have contributed the better patient care I provide in the ER. Apple is really TEAM driven–we have daily meetings where we all put our hands in and shout, “TEAM WORK!”. We make sure to acknowledge, align, and assure our customers. And we find ways to make scary an overwhelming things manageable–hard drive failures where the only photos of a deceased relative where stored. We even strive to use analogies in our everyday interactions to make intimidating techincal terms more tangible. This empowers our customers to make informed decisions about the technology they purchase. All of which I find is also applicable to healthcare–the customer service and human element aspect of healthcare are things I’m very passionate about. So, although its not healthcare related, would it be a mistake to ask for a letter of Rec from Apple? (We are making strides as a company in the healthcare field, though, with our technology!)

    Thanks for your time, Paul! Look forward to hearing from you

    • Paul June 6, 2015, 9:06 pm

      I think it would probably not be a mistake, but clearly better to use an MD. You can always talk about your Apple experiences in your essay, since they do sound inspirational and reflect positively on your ability to work with others. But your supervisor there will be unlikely to be able to comment convincingly on why you should be a PA.

  • Olivia May 1, 2015, 6:40 am

    Hello. Two people who will be writing my letters will no longer be working for or affiliated with my university when they write them. Therefore, I don’t think they will be able to use our university’s official letterhead. Is it a problem if the letters are not printed on letterhead?

    • Paul June 5, 2015, 11:02 pm

      No. Letterhead, to my knowledge, is no longer used by anyone, since all letters of reference are now electronic. Even if it could be scanned into the electronic form somehow, it’s not necessary in order to make a good letter.

  • Rachel May 18, 2015, 1:15 pm

    First off, I love your website. I’m currently applying to PA school and have read almost every article!
    So this may be a dumb question but I have 4 great letters of recommendation (3 from DO/PA’s, 1 from organic chem professor) and I want to write them all thank you letters but I really am not quite sure what to say. I am just afraid that I will not sound professional enough. And besides “I appreciate your support” I am not quite sure what else to say.

  • Lisa October 7, 2015, 10:44 pm

    Hi Paul!

    Quick question, I am going to be applying next cycle and i am curious… if CASPA requires three letter of recs but then I notice supplemental applications also might require another, and I want to apply to about 10 schools does it mean I have to get a total of 10 + 3 letter of recs for all the schools?! That seems a bit intense to me. Please advise. Thank you so much!!!

    • Paul November 8, 2015, 12:11 pm

      Not sure I get your question. CASPA allows you to submit 4 letters of reference. Most schools only require 3, so you can decide which 3 of your 4 to send for each school. You should not need more than 4 letters, tops.

  • Stephanie January 24, 2016, 10:43 pm

    Hi Paul,
    Very helpful information you provide.
    I was wondering if it is ever too early to start your application process. I plan to submit my application begging August and some in December. Would it be a good idea to have my letters of reference submitted February? Also, would I be able to use the same letters of recommendation when applying August and December. I was told they are good for a full year but I am not too sure.

    • Paul February 4, 2016, 7:35 pm

      For CASPA schools, you can’t apply until April of the year before you would start. But if you mean should I apply now, or in three years, I don’t think there’s any reason to wait. If you get lucky, you’ve saved yourself time. If not, you’re no worse off.
      You should be fine using the same letters.

  • asha February 4, 2016, 5:51 pm

    I wondered what advice I could give to my letter-writers to include in their recommendations. What things should they write about? I’m sure adcomms get lots of ‘Applicant A is a great student/employee, is smart, is nice, would make a good PA’ so what are the basics that they should cover and what are the things that are going to separate me from the rest or at least draw positive attention to my application (and, hopefully, away from the weaker parts of my app).

    Thank you!

  • Claire February 23, 2016, 11:38 am

    Hi Paul,

    Thank you for this very helpful post! I am getting ready to go into the next application cycle, and have a couple questions regarding my letters of recommendation.

    I am definitely getting one from a PA I shadowed for several months, and I feel as though she is very supportive and understanding of the process, since she has been there herself.
    My second letter needs to be an academic reference. Here is my problem: I’ve been taking one class each semester for the last two years. Each semester I’ve had a different professor due to scheduling, so there hasn’t been much time to build a solid relationship there. In fact, the past two semesters both of my courses have been online, and the professor is very hard to get in touch with. HOWEVER, during my undergrad days, I developed a very strong relationship with my foreign language professor and took classes with him all four years. He is very well-spoken, and has actually written me outstanding letters for other endeavors. Would it be acceptable, in this case, to ask him for a letter? I feel like he can speak to my academic ability in a terrific way, as opposed to having a science-related professor I barely know slap together a “cookie-cutter,” generic letter.

    Finally, for a clinical letter of recommendation, is there an unspoken rule about how long you’ve worked with/for someone before asking for a letter?

    Thanks so much!


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