ERAS Letters of Recommendation: 2027 Rules for IMGs

ERAS Letters of Recommendation: 2027 Rules for IMGs

ERAS letters of recommendation are the documents your clinical supervisors upload on your behalf, and for the 2027 residency application season the upload process itself has changed: letter writers now submit through the AAMC Letter Writer Portal, which replaced the old Letter of Recommendation Portal (LoRP). The mechanics are unforgiving. You can collect as many letters as you like, but you can assign a maximum of four to each program, and a letter assigned to a program you have applied to cannot be replaced. With MyERAS submissions for the 2027 Match opening on 2 September 2026 at 9 a.m. ET, this guide from the travel4med Editorial Team walks you through the rules, the timeline and the IMG-specific decisions.

What Are ERAS Letters of Recommendation?

ERAS letters of recommendation (LoRs) are evaluations written by people who have supervised your clinical or academic work, submitted electronically into your MyERAS application and assigned by you to individual residency programs. They are one of the most heavily weighted parts of the application: in the NRMP's 2024 Program Director Survey, 84 percent of program directors cited letters of recommendation in the specialty among their most important factors for selecting applicants to interview.

Do not confuse this document with the letters you used earlier in your training. A reference letter from a medical elective abroad is addressed to a host hospital or your home university; an ERAS letter is addressed to no one in particular and follows strict technical rules. It is also not the residency personal statement, which you write yourself. An ERAS letter is always someone else's voice: independent evidence about how you actually work.

The Big 2027 Change: A New Portal for Your Letter Writers

For years, "LoRP ERAS" was the phrase every applicant learned, because the Letter of Recommendation Portal was where authors uploaded their letters. That era is over. For the 2027 season, ECFMG's guidance for letter writers points to the AAMC Letter Writer Portal, which "provides letter writers with the ability to electronically submit LoRs directly to the MyERAS application on behalf of an applicant."

Three practical consequences follow. First, send your writers the current portal link, not an old LoRP walkthrough from a previous cycle. Second, authors can sign in with an AAMC account or a guest account, so a consultant in Colombo or Kathmandu can upload without any US institutional access. Third, letters from a previous season are not lost: MyERAS shows an "Imported" status for letters carried over, and its History section lets you import them into your current application.

One more 2027 caveat: a few specialties, including Emergency Medicine and Obstetrics and Gynecology, now collect applications through ResidencyCAS rather than MyERAS. If that affects you, check ECFMG's ResidencyCAS support pages, because your letters will follow that platform's process instead.

How Does the ERAS Letter Process Work Step by Step?

The process is a fixed sequence, and every letter goes through it separately. Here is the full path from request to assignment, based on the AAMC's 2027 MyERAS Applicant User Guide.

1. Create a letter entry in MyERAS. Enter the author's name and email, label the specialty the letter is intended for (only you, your Designated Dean's Office and the author can see this label, not programs), and state whether it is a standardized or narrative letter and whether it fulfils a department chair requirement.
2. Decide on the waiver. You choose whether to waive your right to view the letter. If you waive it, you cannot see or obtain the letter under any circumstances.
3. Confirm the entry. Only confirmed entries generate a Letter Request ID. Be careful: a confirmed entry can no longer be edited, and fixing an error means creating a brand-new entry.
4. Send the Letter Request Form to your author. MyERAS lets you download it as a PDF or email it directly with a personal message. The form contains the unique, single-use Letter ID and a URL the author can use to upload without typing the ID at all.
5. The author uploads the letter. The file must be a PDF of 1 MB or less. Every uploaded letter is watermarked with the uploader's name and the date and time of upload, and you get an email notification when it lands.
6. Assign the letter to programs. Only uploaded letters can be assigned, up to four per program. Assignments to programs you have already applied to cannot be changed afterwards.

Behind the workflow sits a division of labour that IMGs should understand, because ECFMG acts as the Designated Dean's Office for international graduates.

How Many Letters of Recommendation Do You Need for Residency?

You may assign up to four ERAS letters of recommendation per program, and that is a hard system limit, not a suggestion. There is no official minimum in MyERAS itself; individual programs set their own requirements on their eligibility pages, and many ask for three letters, sometimes with conditions such as a letter from a department chair. That is exactly why the MyERAS letter entry form includes a department chair checkbox.

For IMGs the practical question is rarely "how many" but "which four". A sensible working set is larger than four: most applicants gather five to seven letters so they can assign different combinations to different programs and specialties. The specialty label you attach to each entry exists for precisely this purpose. Quality beats seniority every time. A detailed letter from a physician who supervised you daily says more than a vague paragraph from a famous professor who met you twice, and program directors can phone the writer, which is why the contact details on the letterhead matter.

Who Should Write Your ERAS Letters as an IMG?

Choose writers who have watched you take histories, examine patients, present cases and take feedback, because that is what a residency program is buying. For most IMGs the strongest set mixes letters from US clinical experience with the best clinical letters from home or abroad. Many programs state a preference for letters from US-based physicians, and advising offices generally treat recent, specialty-relevant letters as more valuable than older or generic ones; treat that as consensus guidance rather than a published rule, and check each program's own wording.

The formal requirements come from ECFMG's letter writer guidance and are easy to brief your writers on. The letter should sit on professional letterhead, institutional or personal, that includes an address, phone number and email so a program director can verify it. It should open with a general salutation such as "Dear Program Director" and must not be addressed to a named program. And it has to reach the portal as a PDF no larger than 1 MB, which usually means black and white, no active hyperlinks and a modest scan resolution.

Waive your right to view the letter unless you have a strong reason not to. A waived letter reads as candid, and the system enforces honesty in both directions: every upload is watermarked with the uploader's name, so a program can see whether the author or the applicant uploaded the file.

Can You Use Letters From a Medical Elective Abroad?

Technically, yes. The AAMC Letter Writer Portal's guest account means your supervising physician from a clinical elective in Sri Lanka, Nepal, Bali or Zanzibar can upload a letter without any US affiliation, provided it meets the letterhead, salutation and PDF rules. If that doctor supervised you closely in your target specialty and can write concretely about your clinical work, such a letter can be a genuine asset, especially early in your letter set while you build US-based options.

Be honest about what it is not. An elective abroad does not count as US clinical experience, and a letter from abroad is not a US letter; programs that expect US letters will still expect them. The elective's value is real but different: hands-on skills, specialty exposure and a supervisor who knows your work well enough to write more than a template. If a residency application is on your horizon, plan the elective so a strong letter is a designed outcome, not an afterthought: one supervisor, several weeks, visible responsibility. Our medical electives abroad guide covers how to structure that.

Want an elective that produces a letter worth assigning? travel4med arranges structured, supervised clinical placements abroad where you work with the same senior physicians for weeks at a time, which is exactly what a specific, credible letter requires. Book a free consultation to time a placement around your application year.

The 2027 Letter Timeline: Ask in August, Not September

The dates are fixed and public. The 2027 ERAS season opened on 4 June 2026, residency applicants may begin submitting MyERAS applications to programs on 2 September 2026 at 9 a.m. ET, and programs may begin reviewing applications on 23 September 2026, according to the AAMC's 2027 ERAS timeline. ECFMG began issuing 2027 residency tokens to IMGs on 24 June 2026.

Letters can be uploaded and assigned throughout the season, but the guide adds a warning worth taking literally: programs are not guaranteed to view or review letters assigned after your initial application to them. A letter that arrives in November may simply never be read. Work backwards from that and the arithmetic is blunt.

Asking in mid-August gives a writer two to three weeks to draft, format and upload before submissions open, with margin for the inevitable resend when the first PDF is 4 MB of colour scan. Asking in late September asks them to beat a review process that has already started.

Common Letter Mistakes That Cost IMGs Interviews

• Recycling one Letter Request Form for several writers. Each form carries a single-use Letter ID tied to one entry; duplicating it breaks the upload and delays the letter.
• Confirming an entry with a typo. Confirmed entries cannot be edited, only replaced with a new entry, which means a new form and a fresh email to a busy consultant.
• Letters addressed to a specific program. ECFMG's guidance is explicit: general salutation only. A letter naming one program looks careless when forty programs read it.
• Not briefing the writer on format. No letterhead, missing contact details or an oversized file are the three most common reasons a letter stalls at upload.
• Assigning in a rush on 2 September. Assignments to applied programs are final. Decide your letter-to-program mapping before submissions open, exactly as you plan signals and your program list.

Your letters interact with the rest of your file. Programs read them alongside your ECFMG certification status, scores and personal statement, so aim for a set that tells one consistent story about the kind of resident you will be.

Frequently Asked Questions

Sources

• AAMC — "Letters of Recommendation," 2027 MyERAS Applicant User Guide (students-residents.aamc.org, accessed 12 August 2026): https://students-residents.aamc.org/applying-residencies-eras/publication-chapters/letters-recommendation
• AAMC — "ERAS Timeline," 2027 MyERAS Applicant User Guide (students-residents.aamc.org, accessed 12 August 2026): https://students-residents.aamc.org/applying-residencies-eras/publication-chapters/eras-timeline
• AAMC — AAMC Letter Writer Portal (aamc.org, accessed 12 August 2026): https://www.aamc.org/services/aamc-letter-writer-portal
• ECFMG — "ERAS: For Letter of Recommendation (LoR) Writers" (ecfmg.org, last update 18 May 2026): https://www.ecfmg.org/eras/letter-writers-index.html
• ECFMG — "Support for ResidencyCAS Residency Application Services" (ecfmg.org, accessed 12 August 2026): https://www.ecfmg.org/eras/residencycas.html
• NRMP — "Results of the 2024 NRMP Program Director Survey" (nrmp.org, 2024): https://www.nrmp.org/match-data/2024/08/charting-outcomes-program-director-survey-results-main-residency-match/