The Physician Assistant Life

Secrets of Successful PA School Letters of Recommendation


Whether we like it or not, other people's opinions matter.

A good letter of recommendation can make your day; a great letter of recommendation can change your life.

Whether it is a dating review on Tinder, a restaurant recommendation on Yelp, a movie review on Rotten Tomatoes or an open request for holiday vacation recommendations on Facebook, we look to our friends, colleagues, and specialists in the field for advice on how to make better choices.

"A good letter of recommendation can make your day; a great letter of recommendation can change your life"

Now don't get me wrong, I am not saying you should let Megan McCrorie ditching you at your high school winter formal establish your self-worth (that wasn't nice Meghan!). But the opinions of those we admire and respect, the ones whom we look to for guidance, the ones who will give us the cold hard truth in all instances – that matters!

Studies show that we value the opinions of our close network of like-minded individuals above other sources and with the availability of social proof and endless rating systems there has been a shift away from trusting the experts and more toward trusting the opinions of the many.

Just look at the sales figures for the latest summer blockbuster action pic!

Choice Overload

Recommendations play a very big role when we are faced with choice overload. Required to make a decision among 100's or 1000's of similar products with similar features and similar price points where does one begin?

For example, when faced with the seemingly simple task of replacing my broken iPhone 6 case I jumped on in order to make a "quick and easy" purchase. I love my current case and figured I would simply get a similar version.

Well, you can imagine how that went down.

Ninety minutes later I was still browsing through the endless array of case options, features, colors and Amazon recommended accessories. How about a new car charger? Dual USB adapter? Lightning cables ? The list goes on and on! Needless to say, it has been two weeks and I still don't have a replacement case. Maybe I will just keep my old one!

And what do we do when we get really stuck?

If you are like me,  you read the reviews! And it is often here that we make our final purchase decision.

Nowhere is this truer than when PA school admission directors are searching among 1000's of PA school applicants.

CASPA - The Amazon Marketplace for PA School Applicants

CASPA is the Amazon marketplace for PA school applicants. Like trying to find that ideal iPhone 6s case or perfect pair of sound isolating earbuds, PA schools have a need to fill.

They have vacant seats in their PA program and they want to find the best, brightest, financially responsible, capable, compassionate, forward thinking, well-prepared, resilient, like-minded candidates to fill their rosters.

The admissions directors place your application in their cart, click to preview, browse through a couple of pages and then if there is any doubt, they scroll down to read reviews.

Or, in this case, your letters of reference.

Secrets of Successful PA School Letters of Recommendation

What are you looking for in a letter:

It is likely that you will not see your letter, your letter writer is submitting a digital letter of reference.

On the CASPA application there is a page where you will submit the name title and email address of the 3-5 people you will be asking to include letters of recommendation to.

CASPA will send an email to your letter writers indicating that they have been selected to submit a letter of reference on your behalf.

Four guidelines to Letters of Reference for PA School


When gathering your letters of recommendation focus on these 4 traits:

  1. Someone who has known you for some time
  2. Someone who practices in some field of medicine
  3. Someone who has seen how you interact with patients
  4. Someone who supports you as an applicant

Try to pick someone who has known you for some time

It is better to get a letter from someone you have known longer than someone you have known for a shorter period of time.

One of the questions asked of the letter writer is how long have you known the applicant? How well could they assess you if they have met you only once or had you in the office for just 2-3 hours of shadowing?

The most desirable is someone who has been witness to your patient care experience. This could be a physician, PA, NP, DO, etc. who have witnessed you work with patients.

You can use nurses and clinical managers although these references may not be as strong as the former. Ideally they want to see a letter from someone who knows what you are getting into and is enthusiastic about you.

Practices in some field of medicine

If you don't have a lot of healthcare experience this can be a hard one and you may not be able to produce a letter from someone who has seen you working with patients in a clinic.

If this is the case you are going to chose someone who knows you well and can speak to them about a domain that is relevant to the PA profession such as your ability to communicate effectively or your science ability.

Who should your letters of recommendation come from?


There is ideal and there is real, what most of us have to work with is something in-between.
If you have decided to apply even though you don't have a ton of experience your options may be more limited and that is fine.

You work with what you've got. There is ideal and there is real, what most of us have to work with is something in-between.

One Academic Letter from an instructor or professor of a prerequisite science:

  • Someone who taught you one of the "big 5 sciences": anatomy, biology, microbiology, physiology, or chemistry. This is someone who can attest to your academic ability specific to the field of science and medicine.

You definitely need a letter from a medical provider where you have volunteered or worked:

  • A provider is the universal term for an MD, PA, NP, DO or anybody who cares for patients somewhat independently. Of course the ideal letter is going to be from a PA but this is not always possible. When I applied to PA school I did not have a letter from a PA, was this a big deal? I don't know I still got into PA school.

A letter from another provider from another discipline or supervisor in a medical setting:

  1. If you received a letter from a PA in #2 you can choose another provider such as an MD, DO, NP, RN who knows you personally and has seen you work directly with patients.
  2. If you don't have another provider you can choose a clinical director, charge nurse you worked under, volunteer coordinator or direct supervisor.
    1. I received a letter from from the supervisor of the medical records department where I worked. She ended up writing me a wonderful letter. You can see a couple of my letters here.
Summary of Ideal situation

Summary of the ideal situation: 

  • Academic letter + 2 provider letters (ideally one from a PA)
  • Academic letter + provider letter + health care work supervisor

What should they demonstrate? Dependability, honesty, and intellectual curiosity!

How good do your letters of reference need to be?


You want the best letter you can get, you want a letter from someone who glows and raves about you. Why?

Anybody who reads letters of recommendation assumes that they will be writing for you because they believe in you, and letter writers who don't know you well will speak in "glowing" platitudes.

What is a glowing platitude?  A platitude is a remark or statement, especially one with a moral content, that has been used too often to be interesting or thoughtful.

Here are a couple examples:

  • Platitude: Stephen has a positive attitude and works well with others
  • Glowing recommendation: I don't ever remember him saying an unkind or angry word. He is the most positive person I have worked with in my Laboratory Medicine career of 25 years.
  • Platitude: Stephen has a strong worth ethic and has experience working in the healthcare field
  • Glowing recommendation: He works hard, but has a balanced life with leisure activities.  I'm impressed with his career development as a student... working in Healthcare information (1.5 yrs), laboratory (1.5 yrs), and a summer camp with special needs children.  he has since trained as an EMT, has a patent pending for a physical therapy machine, and worked at a Blood Bank center. All of these experiences give him a broad base of knowledge for a healthcare career as a physician assistant.
  • Platitude: I think this person would be a good fit and would be capable of performing the relevant duties.
  • Glowing recommendation: I am really sad to see this person go, but you are so much the better for it because they need to be in this field and I am enthusiastic about them.

Moral of the story:

  • Pick someone who is enthusiastic about you!
  • You want someone who can write well and will take the time to write well about you!

How do you go about getting letters or recommendation?

This can be tough, one way is to scout out early who you may want to write your letter and then do your best to impress.

Are you taking a human anatomy course and have a wonderful professor who you feel could provide an excellent reference?

Then do your best to show up early, attend or lead extra study sessions, create study groups, offer to assist the professor in lab setup or clean up. You don't want to be a "kiss ass" you want to be helpful, show that you are a hard worker, a leader, a dedicated student and make yourself stand out. Then at the end of the course, if all seems well, you can gently ask for a letter of recommendation.

Are you working or volunteering? Well, if you are not you should be. Then be the wonderful person you naturally are. Show up on time, offer to help out wherever you can, don't worry about pay, work for free, or pay them :-), always keep a positive attitude, grab every learning opportunity available... again the goal is not to shmooze, it is to be yourself. I know you are a passionate, caring person who obviously is highly motivated and goal oriented. Don't be afraid to take initiative... After 12 months or more of hard work and effort, the letters will be flowing!


  • We are not looking for good letters we are looking for amazing letters!
  • The letters should shout from the mountain tops that they would be stupid not to take you.
  • Quality of letters almost always trump where they come from, in other words don't get so caught up on the ideal letter writers that you choose a less enthusiastic writer in place of someone who adores you but sits outside the "ideal" category.
  • If you are applying a second time ask for new letters or if you know it was a great letter ask the same references to submit the same letter a second time.
  • Don't ever ask for letters from family!
  • Don't ask for letters based on credentials from people who don't know you well. I have had people ask me for letters after a couple of email exchanges through this website. This is not a quality letter and will not work in your favor. It also makes me extremely suspect as a letter writer.

Answers to common CASPA letters of reference questions (from the CASPA website)

  • Q: What is the difference between an evaluation, letter of reference, and a letter of recommendation?
    • A: Nothing. They are all the same thing.
  • Q: How many evaluations must you enter?
    • A: CASPA requires three letters of reference to be listed on your application in order to submit to CASPA, however, you may list up to five. These must then be completed through the CASPA reference website. CASPA will verify your application as long as two of  your evaluations are completed. Any additional references received by CASPA will be available to your schools immediately once they are completed.
  • Q: How long should the letters be?
    • A: The file uploaded by references may not exceed 5 MB (this is a pretty big file). The Evaluator Portal will not allow references to exceed this file size when uploading their assessment.
  • Q: Can I submit more than five references?
    • A: NO. You may not submit more than five references via CASPA, and CASPA can not accept any additional or substitute letters. However, you may want to contact the schools to which you are applying in inquire as to whether they will accept an additional or substitute letter. If so, you would send this additional letter directly to them.
  • Q: Why can I only have five letters? Why are letters restricted to 5 MB in length?
    • A: Restrictions regarding the length and number of references have been determined by the Physician Assistant Education Association (PAEA) and the CASPA Admissions Committee, which is made up of admissions officers from CASPA participating PA programs. These restrictions reflect the PA programs’ desire to receive concise assessments and allow a certain degree of standardization in the amount of consideration given to each applicant’s reference material.
  • Q: Can I have different evaluations sent to individual programs?
    • A: No. Each evaluation is sent to all programs that you applied to.
  • Q: Can I send letters of reference which are on file at Interfolio or a career center?
    • A: NO. All letters of reference must be completed via the CASPA reference website by the evaluator themselves.
  • Q: Does CASPA accept committee letters?
    • A: If you wish to submit a committee letter to CASPA, it must be a single composite letter written by ONE individual (usually an advisor) who will also complete the ratings section. This single evaluator must be listed on your application with the individual’s name. Do NOT label this letter as being from a group; i.e. “Thesis Committee.” The composite letter and ratings still must be submitted electronically through the CASPA Evaluator Portal, and must consist of ONE composite letter which fits within the  5MB upload limit. Do NOT upload a file containing multiple letters. Please note that a committee letter only counts as ONE letter of reference. CASPA applicants using a committee letter must still submit additional individual references, completed by evaluators who were not involved with the committee letter.
  • Q: What do I do if I want to change the person who is sending the reference or edit the information I entered?
    • A: Even after you submit your application, you may edit, delete, or replace references whose status is still listed as “new” or “incomplete.” Once a reference is “completed,” you may not make changes to that reference, regardless as to whether or not you’ve submitted your application.
  • 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.
  • Q: How can I view my letters of reference?
    • A: Even if you have not waived your right to view the reference, you still cannot access the reference via CASPA. If you have not waived the right to view your reference, this means that you may ask your reference for a copy of their recommendation, or, once you matriculate into a PA program, you may view the reference in their offices.
  • Q: Can CASPA forward my references to me, my evaluators, or schools not affiliated with CASPA? (i.e can I see what the reference said about me?)
    • A: NO. As per the Family Educational Rights and Privacy Act of 1974 (FERPA), CASPA may not release letters of reference to anyone other than your designated schools, including other schools or the applicant themselves.

For a complete list please visit the CASPA website - letters of reference

Want to see my letters of recommendation for PA school? 

Physician Assistant Application Letter of Recommendation Samples: Applying to PA School

Here are two letters of recommendation I received when applying for PA school. I am not posting them here as a way to fluff my feathers but merely to serve as an example of what I included as part of my actual PA school application. A great letter of recommendation weighs heavily in your favor, I believe this (and a passion filled essay) is the reason that I, an average student from a state university, was able to receive an acceptance letter over many Ivy league applicants with pedigree backgrounds and 4.0 GPA's. A great letter of recommendation must be earned. It comes when you provide a valuable service with the sole intent of doing your job, or providing your service for the benefit of others...[Read More…]


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