American Society of Plastic Surgeons
For Consumers

Obtaining References
Karen Vaniver, MD

Letters of Recommendation and Personal References

Let's face it- if you are the son or daughter of the world's most famous plastic surgeon, you probably don't need this section. Who you know may well be as important as what you know! For the rest of us, who have only our wits, accomplishments, dreams and desires, these documents serve as an entrée into the world of the employed plastic surgeon.

Letters of recommendation and personal references provide a personal view of whom you are, along with how well you do what you say you do. Be clear on where you are trying to go -- if you hate teaching, have never written a scientific paper, and cannot imagine other people doing your surgery, then academia is probably not the place for you. Similarly, if promoting yourself, balance sheets, and hiring staff make you nauseated, you may wish to reconsider private practice.

In any world, these documents serve to provide subjective views of your knowledge, clinical judgment, and competence. More importantly, they address your work ethic, personality, character, leadership skills, stress management skills, and ability to function as a team player. To our recruiter, the "fit" of an individual to the medical community is equally if not more important than his or her abilities. In our litigious society, letters of recommendation have lost some of their luster, as authors are less likely to be honest about negative concerns. Some hiring institutions may not use them at all. However, you should always be prepared to have your references checked.

Letters of Recommendation

Letters of recommendation should be supplied when requested. Generally, two letters will be requested, but it is a good idea to have three ready. Supply only the number of letters requested.

It is very important that the letters support your candidacy for the position for which you are applying. If you are a resident, your most powerful letter may come from your program director. However, there is a hidden risk here. Directors write evaluations every year. If you are a very good resident, but not a rocket scientist and opera singer as well, your letter may come off as average in a world where average is perceived as negative. If you have an outstanding relationship with a faculty member, they are more likely to write a letter that reflects sincere praise. Importantly, if you are applying for a position and have worked with someone who is known to your prospective employer, that is an incredibly valuable connection.

You may also wish to review your evaluation folder prior to requesting letters. Those individuals who have given you the most outstanding evaluations will probably write very supportive letters. Pay attention to the writing skills of those individuals-powerful letters are simple, concise, informative, and obvious in their support. When you request a letter of recommendation, be careful to request a "very strong" letter of support. Any individual who feels they are not capable of supplying such a letter will have a graceful opportunity to decline. These letters may end up in your file, becoming part of your permanent record. You may be looking for a new position in 10 years. If the program director has moved on, your letter may be the only record of that individual's opinion of you. You may send different letters to different potential employers. As closely as possible, match letters from individuals who are similar or known to prospective employers.

Once you have determined who will write your letters, make an appointment to speak with them personally. Bring a copy of your CV and copies of positive evaluation letters to your meeting. Highlight any special skills you may bring to the position. Be sure to let the person writing your letter know about the position you are seeking. This is much easier if you are clear on the direction you will pursue. Generic letters have very little color and very little meaning. The 23 papers you published in your lab year will not be nearly as meaningful to the Most Beautiful Cosmetic Surgery Center as the fact that you have meticulous surgical technique and manners. Be sure to provide as much time as possible to the author of your letter- 3 weeks, if possible. Follow up your request with a thank-you note including the due date as well as the address of the potential employer. Never assume everything is going like clockwork. If your letter has not been received in a timely fashion, make a polite phone call to the author's secretary. It is amazing what can be buried in a pile on someone's desk. Finally, I would recommend discreetly requesting a copy of the letter. You are always best prepared for an interview when you know what to expect.


Many prospective employers, particularly physician recruiters, will want to speak directly with your references, in place of, or in addition to, letters of recommendation. This may be perceived as a more honest forum for open critique. Most employers will require three references. These may be the same or different people than those who write your letters of recommendation. In some cases, you may not be able to choose your reference. If you once cut the pedicle in half of your program director's 22-hour composite free-flap, you may have to eat a little crow. In this situation, honesty and candor are the best policies. Ask a potentially negative reference how they will respond ahead of time. Not only may you be able to influence his or her answer, but you will also be prepared if your potential employer requests an explanation from you! Obviously, it is to your benefit to ask those individuals who know you well, think highly of your work, and have a personal or professional relationship with the potential employer. Again, request that individuals will be able to supply a "very strong" recommendation.

Before your potential new employer calls for references, notify the appropriate individual. Let them know the particulars of the position, and why you feel you are an excellent candidate. Find out the best day and time to call. If a recruiter continually calls, only to be told the individual is busy, they may interpret that as an unwillingness to discuss your application.

Even if you enter solo practice, you will require letters and references in order to obtain hospital privileges, licensing, society membership, and entry into managed care panels. Even though this is sometimes painful, it is an important process that you will repeat itself over and over again in your career. Approach it with equanimity, a positive attitude, and an open mind to constructive criticism. Remember, you will function best in a position where who you are and what you want best matches the job!