DO Letter of Recommendation: Which Schools Require It

DO Letter of Recommendation: Which Schools Require It

Of the 22 osteopathic schools whose admissions pages we read on November 7, 2026, none requires a letter from a DO only. 13 require a physician letter and accept either a DO or an MD. Six recommend a physician letter without requiring it, one requires a clinical provider who can be a PA or NP, one page contradicts itself, and one does not mention a physician letter.

So at these 22 schools the November task is a physician letter, not a DO letter. The DO matters as a preference: nine of the 22 pages say a DO letter is preferred, encouraged or recommended, and OU-HCOM encourages a letter from "a DO or other health care professional". That is a reason to ask a DO you know well, never a reason to stop applying because you do not have one.

Every school page in the tables below was checked on November 7, 2026, and each rule is quoted in the school's own words. Most pages state no cycle year; where a page names one, the table says so. A school not in these tables is a school we did not check, not a school without a rule. For letter counts by service, see how many letters of recommendation for medical school.

The baseline: what AACOM says

AACOM, which runs AACOMAS, sets no physician-letter rule of its own. Its admissions requirements page says: "All medical schools require letters of evaluation/recommendation." It adds: "Many programs have strict guidelines for submitting letters and requirements vary from school to school." (AACOM, Admissions Requirements) In its list of what osteopathic schools look for, AACOM includes students who "Have shadowed an osteopathic physician".

The service cap is separate from any school rule. AACOMAS says: "You can enter information for a maximum of 10 evaluations. If you want to submit more, send those additional evaluations directly to your programs." (AACOMAS, Evaluations)

School-by-school: the physician letter rule in each school's words

"Routes" lists only the submission routes the page itself names. "Not stated" means the page we read does not say.

Physician letter required, DO or MD accepted (13 schools)

Clinical provider letter required, physician not required (1 school)

Physician letter recommended, not required (6 schools)

The page contradicts itself, or does not say (2 schools)

Our arithmetic: 13 + 1 + 6 + 2 = 22 schools. The nine pages with DO-preference wording are ARCOM, Campbell, AZCOM, TouroCOM, WesternU COMP, WVSOM, Xavier, LECOM and CCOM. OU-HCOM's wording names a DO or another health care professional, so we do not count it.

If a list you found says ARCOM requires a DO letter, set it beside ARCOM's own page, which says "one from an MD will also be accepted." Check every school on your list the same way, on the school's own page.

Our view on the November DO letter

Our view: if you do not have a DO letter by November, get the strongest physician letter you can from a DO or MD who has watched you with patients, and put your knowledge of osteopathic medicine in your secondaries. A rushed letter from a DO you shadowed for one afternoon is weaker than a full letter from an MD who supervised you for a year. The basis: 13 of the 22 schools accept an MD letter for the required physician letter, no school in the tables requires a DO only, and the schools that describe the writer ask for one who has watched you work: TouroCOM wants a physician "who has observed you in a clinical/patient-based setting", and ARCOM a physician "whom you have worked with in a healthcare field."

The countercase: if a DO already knows your work, ask that DO. Nine schools state a DO preference in writing, and ACOM says "Submitting a letter from a DO is a way of demonstrating the applicant's understanding of and commitment to the osteopathic medical profession." If your list is weighted toward those nine, a DO letter is worth asking for, even late.

An MD letter in place of a DO letter

Every school in the first table accepts an MD for the required physician letter. What an MD letter cannot do is speak for osteopathic practice. Two schools show where that evidence goes instead:

• The secondary. OU-HCOM's required essay asks: "Describe what being an osteopathic physician means to you, and what qualities make a good osteopathic physician. What have you done to gain knowledge and experience of osteopathic medicine?" (OU-HCOM, Apply) The why DO essay with no DO shadowing guide covers how to answer that without a DO mentor.
• The physician's own form. VCOM's optional physician evaluation form asks any physician, DO or MD: "What traits indicate this applicant's success as an osteopathic physician?" (VCOM physician form, PDF) An MD can answer that from what they observed: how you listened, examined, explained and followed up.

If your MD writer asks what to include, forward them the physician letter of recommendation sample. If they only know you from shadowing, the letter from a doctor you shadowed page shows what that letter can honestly say.

No physician letter in November: what still works

1. Add the evaluator now. AACOMAS lets you add new evaluations after you submit until you reach 10 (Updating Your Application), and completed ones cannot be removed, so adding a physician does not touch the letters you have.
2. Check whether a substitute counts. TouroCOM says that in place of the physician letter it will accept "a letter from a non-physician supervisor who has observed your interactions with patients or a letter from a DO or MD who has supervised you in a lab or professional setting". RVU accepts a PA or NP who supervised your clinical work. OU-HCOM's second letter can come from "a licensed physician (DO/MD), a supervisor, or another qualified professional."
3. Check the shadowing rule before you ask a shadowing physician. WesternU's secondary instructions say: "A letter from a physician that you have shadowed or worked with in a clinical setting is required, DO or MD, but DO is preferred." TouroCOM says: "virtual shadowing encounters will NOT be accepted."
4. Match the route to the school. RVU and NYITCOM take letters through AACOMAS only. A physician who uploads to Interfolio does not complete your file at either school.
5. Count backward from each school's date. AZCOM wants letters by "March 1st" and CCOM by "April 1st" (2026-2027 catalogs). Campbell accepts letters "at any time in the application process" and closes secondaries on "March 15", with no year stated. A physician letter requested in November is on time at all three if it is written by January.
6. When the letter lands, check each school's portal as well as AACOMAS. The late letter of recommendation guide covers landing times and status checks.

Constructed example: the ask email to a DO you barely know

Constructed example, written by us, not a real applicant's email. Context (invented): the applicant shadowed Dr. M. Castellanos, DO, for 16 hours over four clinic afternoons in October 2026.

Subject: Request for a letter of evaluation, osteopathic medical school

Dear Dr. Castellanos,

I shadowed you at Westbrook Family Medicine on four Thursday afternoons in October, 16 hours in total. I am applying to osteopathic medical schools this cycle, and several of them ask for a physician letter. Would you be able to write one based on what you saw in clinic? I know 16 hours is a short time, so if you would rather not, I understand completely. If you can, I will send my CV, a one-page summary of the patients I observed with you and what I asked you about afterward, and the AACOMAS request with a date of December 15. Thank you for your time either way.

Hollis Grady

The email body runs from "I shadowed" to "either way": 108 words. It states the hours, dates and setting so the physician can judge whether they can write, offers an easy no, and promises a summary that keeps the letter inside what was observed. It does not ask the physician to say anything about clinical skill.

Questions about DO letters

Which DO schools require a DO letter in 2026-2027?

None of the 22 school pages we checked on November 7, 2026 requires a letter from a DO only. Nine state a preference for a DO.

Can an MD write my DO letter?

At all 13 schools that require a physician letter, yes: each accepts a DO or an MD. RVU also accepts a PA or NP.

How many letters of recommendation do DO schools want?

It varies by school. ATSU-KCOM asks for two, NYITCOM for three through AACOMAS, and NSU-KPCOM for "2 or 4". AACOMAS takes up to 10.

Do I need to have shadowed a DO?

No page in our tables makes DO shadowing a condition of the physician letter. AACOM lists having "shadowed an osteopathic physician" among the qualities osteopathic schools look for, and TouroCOM says "it is highly encouraged, when possible, to shadow a DO". More letter guides are in the medical school essays hub, and the medical school letters of recommendation strategy guide covers who to ask across MD and DO lists.

Review the writing you send next

If your physician is still drafting, send them the free review of the letter: it reads whether the letter states the writer's relationship to you, uses observed examples and ends in a clear assessment. When the letter lands and a school invites updates, get a free Quick Review of your update letter before you send it. If your DO has agreed, send them how to write a DO physician letter of recommendation; it shows what the letter can say that an MD letter cannot.

Your physician will submit through Liaison Letters or Interfolio; AACOMAS letters of evaluation: portal and Interfolio walks the writer through both.

If you are weighing an NP, PA or resident against a physician, see whether an NP, PA or resident can write your letter.

Sources

Retrieved November 7, 2026, except where noted. Each school row links the exact page quoted.

• AACOM, Admissions Requirements (no cycle stated): all schools require letters; requirements vary; DO shadowing among qualities.
• Liaison, AACOMAS Evaluations (no cycle stated): 10-evaluation cap; extras direct to programs; completed evaluations not removable. Liaison, AACOMAS Updating Your Application (2026-2027 cycle on page): new evaluations can be added after submission.
• School admissions pages (22), linked in each table row: ACOM, ARCOM, ATSU-KCOM, Campbell CUSOM, KCU, LMU-DCOM, Midwestern AZCOM and CCOM (2026-2027 catalogs), NSU-KPCOM, Touro Nevada, TouroCOM, WesternU COMP (requirements page and secondary instructions Rev. 4/20/2026), WVSOM, Xavier XUCOM, RVU, Burrell, LECOM, NYITCOM, OU-HCOM, Touro California, VCOM, TCOM.
• OU-HCOM, Apply: required secondary essay prompt.
• VCOM, Osteopathic/Allopathic Physician evaluation form (PDF): optional form questions.