Wednesday, March 19, 2014

Letters of Recommendation & Physician Assistant School

Letters of Recommendation & Physician Assistant School
Last Updated: 08/03/2015

As a pre-PA student, you should have someone review your completed letters of recommendation to determine if they are strong enough for admission, utilizing resources such as The PA Platform, which provides pre-PA assessments, supplemental application reviewing, letter of recommendation reviewing, and mock interviews. When in doubt, ask!

Savanna Perry, PA-C, is the founder of The PA Platform and started PA school at the Medical College of Georgia in May of 2012, now known as Georgia Regents University, graduating in August of 2014.  She has assisted with multiple interviews and knows what it is like to be on both sides of the interview process. She works at a Dermatology office outside of Augusta, GA and has come to love the PA profession even more while learning all of the advantages of becoming a PA. She has always enjoyed helping other people to achieve their dreams, and that is her primary goal with her site!

Please use referral code: DoseOfPA for a special discount on The PA Platform for any service(s).

If you’re new to applying, there are many important factors that can go into a letter of recommendation (LOR) or reference. I’ll discuss a little bit about each one below.


  • First off, you should know that you cannot submit a recommendation letter until the CASPA cycle opens, which is usually in mid April. The earlier you ask, the better! It will give them more time to write it and you won’t ever miss a deadline for applying.
  • Always ask the recommender if they feel they can write you a good or positive recommendation letter demonstrating your strengths and give them details of what to include. You never want to ask a recommender if they’ll simply write you a letter. Chances are they will, but they may not have good things to say. Be specific.
  • Be aware that some schools actually prefer that you don’t get letters from PAs because they often don’t know you well enough to make remarks about who you are. Other programs will require that you know a PA for a certain amount of time before asking them for a letter. Remember that this should be dealt with on a case-by-case basis. Consult your programs. If you’re ever in doubt, always go with the person that knows you best. This may not always be the PA you shadow or work with.
  • Recommendation letters are only good for one CASPA cycle, so if you’re not applying for a year, you might want to wait and ask them later. If you won’t see them again for a long time, ask them to write the letter now and hold onto it until you’re ready to apply. This way, they won’t forget important specific attributes they remember about you.
  • Make sure your program allows personal health care providers to write recommendation letters. Some programs might advise against this or not allow it at all. If you have experience shadowing or working with them, I would suggest using them as a reference. If you do not, I would suggest finding another recommender in your clinical experience.
  • Always read the fine print on CASPA: once you save the references name on CASPA an e-mail will be sent to them requesting the letter. Thus, it is important to ask before ever listing them on the CASPA website. You don’t want them to receive a notification about giving you a reference before you’ve asked.
  • References will receive an e-mail containing instructions about how to complete the recommendation. They must write a narrative about you (reference) and then rank you in different categories such as: reliability, professionalism, care, maturity, etc.
  • Requests from CASPA for letters never expire, but always send an e-mail to your reference saying it was sent (after you have saved their information in CASPA) and remind them not to delete it.
  • If one of your references has never responded to your request and you’re waiting more than a week or so, you’d probably be best asking someone else. Always have more candidates for letters lined up than you need, incase one cannot write you a letter for whatever reason.
  • Co-written letters of reference are not allowed because CASPA is not set up to receive a letter by more than one person. In the situation where you have multiple writers, you might have to choose between them and decide who knows you better and would write you a better recommendation.

Resources to Give Your Recommender(s):
This is a potential list of resources you can offer your recommenders to help with writing your letter. Keep in mind that this is probably more inclusive than you need to provide, but it serves as a reference for resources you might have, but have not thought about including.

  • Current resume or curriculum vitae (CV)
  • Cover letter explaining your interests and goals
  • A copy of your personal narrative
  • A current headshot of yourself
  • A copy of your transcript(s)
  • Any resources you’ve obtained while working (clinical or non-clinical)
    • An award for being student worker of the year
    • A letter from a charge nurse stating your excellent clinical skills for responding quickly to a hospital code
  • A publication you’ve received for your research
  • A list of 3 words that describe you (to use in the letter) and examples or anecdotes supporting each from your clinical and non-clinical life. See Personal Attributes of a Quality PA below.
  • An e-mail containing information from the resources above that you want highlighted in your letters
    • Your favorite or best volunteer work, or the number of hours you’ve volunteered
    • Your clinical experiences and what you got out of them
    • Your goals for becoming a physician assistant and how you have decided you want to become a PA

Personal Attributes of a Quality PA (Student):
This actually ended up being one of my scenarios at a school interview. We were placed in groups and asked to discuss the qualities of what we thought made a “good PA.” There was no right or wrong answer, and the question was completely left open ended. I challenge you before reading this section to write down what you think makes a good PA. Once you’ve finished, continue reading and see if what you wrote down matches any of the characteristics listed or if they are similar. Chances are, most of them will be. It just shows that knowing things like this can help you not only in essays, not only for finding out the type of PA you want to be, but for interviews and recommendation letters as well.

  • Leadership
  • Professionalism (maturity)
  • Enthusiasm
  • Trustworthiness
  • Honesty
  • Motivation
  • Determination
  • Compassion
  • Perseverance or tenacious
  • Inquisitive
  • Confidence
  • Tolerance
  • Meticulous
  • Adaptability
  • Empathetic
  • Humble (humility)
  • Dependability
  • Altruism
  • Goal-oriented
  • Self-directed
  • Team player
  • Great communication skills (oral and written)
  • Intellectual ability
  • Critical thinker
  • Interpersonal skills
  • Awareness of criticism

In order to get credit, personal attributes should be justified with specific examples, artifacts, or anecdotes. For example, it is not adequate to say, “I am a leader.” Candidates should demonstrate their leadership through specific examples. Likewise, recommendations should not say, “The candidate is enthusiastic.” Instead, the evaluator should give specific examples of how a candidate demonstrated his or her enthusiasm.

Choosing Your 3 Letters of Recommendation:
CASPA only allows you to pick three recommenders for your application. Thus, it is crucial to choose them carefully. This list is by no means all-inclusive, but should help you discern between the three types of letters most PA programs are looking for. As always, check with your program’s individual requirements before choosing.

  1. Someone who can attest to your clinical abilities (a clinical supervisor) and your knowledge of the PA profession (at least ONE from this list)
    1. A physician assistant you have shadowed or worked with (preferred)
    2. A nurse practitioner or physician (allopathic or osteopathic)
    3. A nursing supervisor (charge nurse) in the unit you work in
    4. A chiropractor or Doctor of Podiatric Medicine (DPM) is fine if you can get a letter from another provider
    5. A supervisor from a medical mission trip
    6. A distinguished fellow of AAPA
    7. A preceptor of clinical background
  2. Someone who can attest to your non-clinical work ethic, but if you must, you can choose one extra from the list above in lieu of this one as long as they specifically refer to your work ethic
    1. A senior executive or supervisor from a non-medical job that can talk about your work ethic
    2. A program instructor (PI) from a research laboratory
    3. A graduate student you worked with in research
  3. An instructor or advisor that can attest to your academic performance in coursework
    1. An science instructor that can talk about how you performed in class
    2. A health advisor, an academic advisor, or department chair at your school that you know personally and can attest to your academic performance
    3. A teaching assistant (TA) or graduate student from a course in which you excelled, if they are teaching in lieu of the professor
    4. A non-science instructor

Who NOT to Ask for a Letter of Recommendation:
  • Friends
    • High school principals
    • Coworkers that do not supervise your work
  • Family
    • Your mom or dad
    • Any relatives, even if you work with them
  • Professors that you haven’t had contact with in a while or professors you had for non-science coursework

At the end of the day, it’s not about the credentials or title your writer has. Rather, it’s about the relationship you two have (including length) and the content of the letter. You want the writer to convey what you’ve done (with examples) and who you are and why you will be a great asset to any PA program. They should be able to write about your strengths and weaknesses.  If you’re having a supervisor from work or a preceptor write a letter, you might ask that they include the number of hours (or years) you’ve worked or shadowed. Some schools might require this. Try not to grab all of your letters from the same place (i.e. workplace) because you want them all to say similar things, but you don’t want them to have the same examples. Try to vary where you are getting your letters from and you’ll seem more well-rounded.

If you are a reapplicant, you’ll want to inform the reference (regardless if you’ve used them before) of the changes you’ve made to your application since last year. Be detailed. Tell them how much more HCE you’ve obtained, where you’ve obtained it, and what you learned from it. If you just started a new job, tell them what you intend to learn from it. Tell them how you improved your academic performance or knowledge of the PA profession since the last cycle. Did you shadow more PAs or other providers? Talk about what you learned in those experiences. Always send them a new personal narrative (free of errors!). As CASPA has stated, letters of recommendation cannot be saved from cycle to cycle or carried over. You’ll need to re-enter information for references if you are choosing to use them again. Lastly, always ask that your references never use the same exact letter from a previous cycle. Always give them an updated copy of your resume or a CV. You can also give them any letters from work or awards you’ve received since your last letter.

Advice from Andrew Rodican’s Book:
“When it comes to obtaining great letters of recommendation, there's a valuable lesson to be learned from those in the military. Both enlisted and officer personnel write their own evaluations and simply present them to their supervisors for approval and signature. You can try this with your references as well. This is a great way to ensure that your letters meet all criteria. If a supervisor (i.e., your reviewer) does not agree with any of your comments, he or she can make changes--but that usually doesn't happen. If you are concerned that your referee is too busy to do an effective job, or maybe doesn't have the best writing skills, you can write the letter of recommendation and simply present it to him or her for evaluation and signature.” Keep in mind that writing the letter yourself is an option only if your recommender has agreed to it. Rodican brings up a good point about busy recommenders and recommenders that might be foreign to the English language. You might get a better letter writing it yourself.

Errors in Letter of Recommendation to CASPA:
Always ensure that your recommender has your full name spelled correctly. Also, ensure that they are aware of the correct spelling of physician assistant!

If your recommender makes a typo in the letter, don’t freak out. It’s not the end of the world. At the end of the day, do you think an admissions committee would really reject or not interview you because of a typo in a recommendation letter that you aren’t even supposed to have access to? Fact of the matter is that they won’t put a hold on your future because of a typo. If it was me, I would never want to become a part of that program if they did. If the recommender realizes their own mistake and wishes to go back and add information or change a misspelled word, they may do so by contacting CASPA customer service.

If you accidentally made a mistake while entering the recommenders information, you can always delete a reference and re-add them using the same e-mail address. Be aware that after you’ve saved their information once, it has already sent them an e-mail requesting the letter, but if you send them a second request, they need to fill out the letter in the second e-mail. This is crucial. If they fill out the information in the first e-mail they’ve received, the reference will not be received.

Waiving Your Rights to See the Recommendation:
Waiving your right to view a recommendation letter will carry more weight than if you do not waive your right. It is also the standard to waive your right. The reasoning is because if a writer knows you are able to view the letter, they are more likely to feel obligated to write a favorable letter. If your right is waived, the writer will be more honest because they know you won’t have access to it. Personally, I feel that if you are too scared about what a recommender will say and you feel the need to not waive your right, then you are asking the wrong person for a recommendation.

This is not always the case for every program and most students that do not waive their right have reported success with obtaining interviews and acceptance to programs across the nation. Keep in mind that even if you choose not to waive your right, it doesn’t necessarily mean you’ll ever see your letters. It just means that you may ask your recommender for a copy after it has been submitted.



  1. Hey Paul,

    If a school requires you to have a letter of recommendation from a science professor, would a public health professor count? Or do sciences only count for biology, chemistry, and physics?

    1. I think so, but I would ask. I think science professor is referring to basic core science coursework, so I am unsure. Each school defines this differently, so ask the program you are applying to to be sure.

    2. thanks! I've been checking back regularly to see if you replied haha.

    3. I did research in a biochemistry lab as an undergraduate. Do you think a letter from my Principle Investigator be okay?

    4. Hi Alexa,

      I think a letter from a principle investigator would be great, as long as your other two can attest to your abilities as a clinician and your academic success.

  2. Replies
    1. Thanks Jmaa, I've just been really busy in school lately. I'll try to get a new post out soon.

  3. Hi Paul,
    Would that be a wise decision to have all the recommendation letters from science professors?

    Thank you!

  4. Hi Paul!

    I have been religiously taking in all your advice for the past year and a half and it's finally that time! My question is, is it really that frowned upon to get two recommendations from the same clinic? I work in a GI Clinic with several healthcare providers (2 MDS, 1 PA and 1 NP). I already have one academic recommendation and plan to get a recommendation from the PA at the GI Clinic and the last one from the MD who owns the clinic and who can attest to my work ethic.

    Thank you for your advice in advance :)

    1. Hi,

      I don't think its frowned upon at all. I think your rec letters will be great! Also, would you mind trying to contact me via LinkedIn or Google Plus? I'd appreciate hearing from you.

  5. Hi Paul,
    I have no experience in clinical work at all. but have been working in customer care and have lab tech experience . I aslo have a bachelors in business administration.I am 49yrs. Do you think applying for PA will be a waste of time and money?

    1. Not at all! I think you'll have to get some clinical experience in order to apply and you'll need good grades in the prerequisites, possible GRE, and shadowing. I think anything is possible if you put your mind to it. You just have to make a plan, stick to it, and stop telling yourself your age is a factor. You're 49 and the average life expectancy is 86! You have plenty of time to accomplish your goals! Go out and get em!

  6. Hello Paul, my mother is a preceptor and I am her medical assistant in her private office. Would a Recommendation letter from her would still be a conflict of interest?

    1. Sorry, I think that would definitely be a conflict of interest as far as your work ethic. She would probably still be good for a reference of your character.

  7. Hi Paul,

    I have a bit of different background; I do direct care in behavioral therapy, and have recently moved into a position that is akin to social work. I do have five years of experience in intake in a blood lab and the ER, however, this experience is not considered direct care. I'm mildly concerned that I am lacking physical clinical experience, so I was planning to shadow a dr for a short period of time as a scribe, etc to maybe round it out. Should I be doing something else to make myself more competitive? Do you think they will view my pysch background as a limitation or something unique that will round out a class/How can I make sure I help them see it that way?

    1. Hi Erica,

      Sounds like you have some great experience on your hands - perfect in my eyes for PA school. If you have a solid amount of experience, I would definitely apply after you have some shadowing, volunteer, and patient contact experience. I think your experience definitely adds to your application and will make you shine in comparison to your peers.

      Make sure you also have solid grades (GPA) and GRE score if applicable. Good luck!!

  8. Hi Paul,

    I am submitting my PA application in the next few days. One of my references has a "completing" status on CASPA. Do you know if the schools will have access to the reference if I submit now and the reference is completed after I do so?

    1. Hi Erin,

      I think that means they are currently in the process of completing it. As in, they've started it but have not yet completed it. I'm not entirely sure if they'll have access, but last time I remember that if you have completed 2/3 you were able to e-submit.

  9. Hi,
    I have one school I'm applying to that requires four LOR's to be submitted to CASPA, all the others say three. Will I get to choose which 3 out of the 4 that will be submitted get sent to those schools that only want three?

    1. If it requires 4 - I think you're only allowed to submit 3 to CASPA, so they'll probably have to reach out to you for the fourth.

    2. You can enter a maximum of 5.

    3. Sorry, that's new since when I applied. We were only allowed to submit 3. I'm not exactly sure how that works. I think you'd just attach 4 with the first 3 being the ones you want all programs to see/receive? That would make sense to me.

  10. Whew. I have to breathe. I began my application when the CASPA cycle opened this year, but then I just kinda walked away once I saw that I needed a rec from a MD, NP, or PA. Now that I finally have such a titled professional to write my letter, I'm like really scared and nervous. This just got real.
    I keep re-reading your advice that it's not about the writer's title or credentials. I've always known who my last 2 references would be, but now that it's more real I'm beginning to doubt the helpfulness of their letters based on their titles. You're right, though, that the quality of my relationship with them matters more.
    It's incredible how nerve-racking this process can be.

    1. It really is about the quality of the relationship and it shows through the letter. It's amazing because the quality of the applicant sometimes means more than the letter itself. For instance with my application (not meaning to toot my own horn here), several programs saw that I originally didn't have a letter from an MD/DO/PA and asked why I submitted one from a charge nurse. I gave them an honest reply and they respectfully asked for one from a PA, which I provided, and we moved on from there.

  11. Hi Paul.

    I am 45 years old with a BS in Business and a MEd in Instructional Design. I currently volunteer in my local ER, and have experience working with a Dietitian in a rehabilitation hospital setting back in the early 90s. I also have 15 hours of PA shadowing done (which further fanned my passion for this field), and am in the middle of taking my science pre-reqs. I have a diverse background because my career went in a completely different direction, but I have always had a love for medicine. Grades will not be a problem. and I have demonstrated leadership, empathy, trustworthiness, professionalism, critical thinking, and so on. With my work experience and character, I can probably hit just about every personal attribute that makes a quality PA. I have always been around doctors, nurses, and other health professionals simply because of my family and friends so the passion for the PA profession is there. My current high paying job is what is going to help me pay for school, and jobs like CNAs and EMTs are saturated in my state. In your experience, have you seen well rounded, non traditional students get accepted to PA schools with little to no clinical experience?

    1. Is it possible? Yes. Especially for a motivated student such as yourself. Is it rare? Yes. Don't give up and stay passionate. Keep volunteering and get as much experience as you can before you apply. Visit programs, talk to directors, students, and faculty and ask about other non-traditional applicants. Good luck to you - I think you'll make a great PA one day!

  12. I believe the doctor , WHOM I WORKED FOR - FOR A YEAR, Wrote my LOR and he misspelt my name numerous times in my LOR. My application has already been submitted to 12 schools, and i just found out that he did that!! I m not sure what else I can do... I got rejected from two schools so far and I am nearly positive its because of that. I am really disappointed and I cant believe this happened.
    Also, In the LOR , He didnt say recommends me to attain my masters in physician assistant studies, or recommend me to become a PA, instead he wrote that he recommends me to CASPA ...???
    I just cant believe he wrote that. AND I dont know how i could even correct this problem... if even correctable since my apps are already sent and i spent so much money on all of them!

    1. YIKES. I sincerely hope that you were able to figure this one out. I'm sorry for replying so late as I was studying for my PANCE.

      I don't think a problem of this nature is really correctable. I think you needed to convey what exactly you were applying for to the doctor more clearly - as it appears to programs that your intentions were good, but it looks like your communication with him was terrible and that you didn't know one another well enough. Not saying this is your fault- I totally agree that it was a huge mistake on their part, but wow. I would imagine you are going to have to reapply next year.

  13. Hi Paul,

    I'm currently a senior at the cusp of graduating, but I have decided I'd like to take some time off to fully prepare myself for PA school applications. Since I'll be out of school for a while, how do you suggest we go about asking a professor for a letter of recommendation? Also, by science professors, is it specifically a professor from one of our pre-requisite courses, or can I ask a professor from say, my advanced nutritional sciences classes for a recommendation?


  14. Hi Paul,

    I read on CASPA that you can enter a maximum of 5 LOR. Will schools pick and choose which ones to evaluate or can you make note of which ones are for each school. For example, if a school only wants 2 letters will they only read the first two?

    Thank you!!
    A first time applicant

    1. Im a first time applicant as well applying this cycle and would like to know the answer for this.

  15. Hi Paul,
    I have been a dietitian in a specialized area (peds GI) in addition to running my own successful private practice. I have been practicing for 14 yrs, 11 of which are with the GI group and my practice. I have been involved in medical research that was published in medical journals, been a member of several medical advisory boards, paid speaker for pharma co..and so on. I feel that I will have a very strong application EXCEPT I am expecting that my GRE will probably not be wonderful seeing that my college math classes were 19 yrs ago! Do you think that my experience will make up for this? I do have a 3.8 GPA including in sciences.
    The program I am applying to is asking for 3 LOR (academic, professional, 1 of my choice). My professional ref will be from 1 of the MD's I have worked closely with on many projects in addition to pt care for the past 14 yrs. Here is my dilemma- NONE of my college professors are still at my undergrad univ and they probably wouldn't even remember me at this point! I have asked a medical school professor/researcher with whom I have worked very closely with for the past 11 yrs to be the academic ref. Will this suffice? For the personal choice- i could get one of our pa's, another one of our md's BUT I was thinking that having one of my long time patient's mother would be better. She can vouch for my compassion, interpersonal skills, work ethic, etc. Do you think this would be better than another professional ref? Also, I could send more than is required. Is this a good or bad move?

  16. Paul,

    I am currently filling out my PA application for the 2017-2018 program. I was reviewing your recommendations for who should write an applicants LOR. I have worked as a certified phlebotomist for the past year closely alongside a LPN and under the supervision of a PA. I also have a second job at night as a server a few nights a week to make some extra money. My PA has graciously offered to write a LOR. I am confused on who I should ask to write my second LOR. Should I ask my LPN, the owner of the private practice, or my general manager of my night job who can attest to my non-clinical work ethic as you have suggested. My third LOR will be provided by my academic advisor who was also my Microbiology professor. Please let me know which option would be best or should I provide more than 3 LORs.

    Thank you

  17. Hi Paul!

    I don't have a LOR from a PA on my application yet. I shadowed one at our University Health Clinic for 20 hours. While we were able to form a wonderful supportive relationship, I don't know that she would be able to vouch for me in such an important piece of my application. DO I even ask?


  18. Hi Paul!

    I don't have a LOR from a PA on my application yet. I shadowed one at our University Health Clinic for 20 hours. While we were able to form a wonderful supportive relationship, I don't know that she would be able to vouch for me in such an important piece of my application. DO I even ask?


  19. Hey Paul I was wondering what HCE route did you take... Im also feeling like Im missing my shot.. Im 24 (today is my bday actually!!) and I might not start school until 26! How old were you when you entered school?

  20. What a great article, dear author thank you very much for it! I would like to add that when I had a task to write a letter of recommendation for nurse practitioner school, actually I had a lot of problems with this issue, because it is really not easy to find all the necessary about this topic in the internet, and your article is right what I need. So I would like to thank you for it once more and also I would like to wish to you to write much more of such useful and helpful articles for everyone!

  21. Hi Paul.. my question is in regards to how many letters are "too much". I work as an ER tech and am close with all of the PAs and docs that work here, so I am wondering if submitting a 4th letter from them would be overkill? i have been told that by other applicants but not sure.


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