How to Write a DO Physician Letter of Recommendation
For DOs writing for osteopathic school: what AACOM says schools look for, the 3 things only your letter can show, and an annotated constructed sample.
How to Write a DO Physician Letter of Recommendation
A DO's letter for osteopathic school should be one page that does what no other letter in the file can: show, from what you watched, that the applicant understands what osteopathic practice adds and engaged with it. AACOM lists "knowledge of osteopathic medicine" among the qualities DO schools look for.
Our view is blunt. A DO who writes a general physician letter, all compassion and work ethic, has spent the one slot in the file that could prove that understanding. Schools such as Campbell and Kirksville accept a letter from a physician who is either a DO or an MD, so a DO letter earns its place only when it says something an MD letter could not.
Every AACOM, AOA, Liaison and school page quoted below was opened on November 7, 2026.
What osteopathic schools say they look for
AACOM's admissions requirements page lists the personal qualities osteopathic medical schools look for. The last three are the ones a DO's letter is placed to speak to:
Are motivated to pursue a career in osteopathic medicine
Possess knowledge of osteopathic medicine
Have shadowed an osteopathic physician
The same page says "requirements vary from school to school." Two of them show the pattern: Campbell says "One letter must be from an osteopathic physician (DO) or an allopathic physician (MD)", and Kirksville's checklist lists "Evaluation II: Physician (DO or MD)". The 22-school version is in which DO schools require a DO letter. For you as the writer, the point is the same at every school: when a DO letter sits where an MD letter would also have been accepted, readers can see whether it adds the osteopathic part.
The words the profession uses
The American Osteopathic Association's Tenets of Osteopathic Medicine, which the page says "were approved by the AOA House of Delegates as policy", read:
The body is a unit; the person is a unit of body, mind and spirit.
The body is capable of self-regulation, self-healing and health maintenance.
Structure and function are reciprocally interrelated.
Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation and the interrelationship of structure and function.
Do not quote the tenets in the letter. The committee knows them. Use them as a test while you draft: can you name one moment when the applicant saw one of these ideas in your practice, and show what they did with it?
Three things to put in a DO letter
These are our recommendations, built from the AACOM qualities above and from what a DO is placed to observe.
- The osteopathic moment, and what the applicant did next. A visit where you used a structural exam or OMT, or treated a complaint by looking past the site of pain. Then the applicant's response: the question they asked, what they read, what they raised the following week. The behavior after the moment is the evidence. Your treatment is only the setting.
- Conduct with patients. One incident, described plainly: what happened, what the applicant did, what followed. Write it the way you would write a chart note.
- A comparison with a count. "I have hosted 14 premedical students in six years" lets a reader place "one of the two strongest". Without the count, the superlative tells them nothing.
Open with the facts that frame all three: how long, in what setting, how many hours or clinic days, and what you saw directly. The sibling page on letters from a doctor the applicant shadowed covers how to state hours and what a shadowing host cannot vouch for.
The countercase: if the applicant shadowed you for two afternoons and an MD supervised them in a clinic for a year, the MD letter is the stronger physician letter, and you should say so to the applicant. If your practice gave the applicant no osteopathic moment to see, do not invent one. Write a short, accurate letter about what you did see, or decline. How to decline writing a recommendation letter has wording for that conversation.
Constructed example: the generic paragraph and the DO paragraph
Constructed example, written by us, not a real recommendation letter. Context (invented): Rafael Strickland shadowed Dr. Leticia Moravec, DO, in a family medicine practice.
The weak version:
Rafael is a bright, compassionate young man who would make an excellent osteopathic physician. He shadowed me this summer and showed great interest in osteopathic medicine and OMT. He embodies the osteopathic philosophy of treating the whole person.
The revised version:
On his third day, a warehouse worker came in with low back pain after lifting at work. I examined his spine and pelvis and treated him with OMT. Afterward Rafael asked why I had examined the patient's hips for a back complaint. The next week he arrived having read about the structural exam and asked whether the patient's job would undo the treatment. That question led me to discuss changes at work with the patient at his follow-up visit.
The weak paragraph makes three claims ("bright", "great interest", "embodies the philosophy") and supports none. Any DO could write it about any student. The revised paragraph shows the applicant seeing the first tenet, the body as a unit, in practice, going away to learn more, and coming back with a question that changed the next visit. That is what "possess knowledge of osteopathic medicine" looks like when someone else observed it.
Constructed sample DO letter, annotated
Constructed example, written by us, not a real recommendation letter. It is 296 words, inside one page.
Dear Admissions Committee,
I am a family physician (DO) and have practiced at Riverbend Family Medicine for 11 years. Rafael Strickland shadowed me for 62 hours over nine clinic days between June and August 2026. Everything below comes from what I saw in clinic. I did not supervise his academic work.
On his third day, a warehouse worker came in with low back pain after lifting at work. I examined his spine and pelvis and treated him with OMT. Afterward Rafael asked why I had examined the patient's hips for a back complaint. The next week he arrived having read about the structural exam and asked whether the patient's job would undo the treatment. That question led me to discuss changes at work with the patient at his follow-up visit.
Rafael is quiet with patients and lets them finish. When a patient with diabetes became frustrated about her diet, he stayed with her while I stepped out. She told me afterward that he had asked about her shift schedule instead of telling her what to eat. He was on time for every session, and after each clinic day he sent me a one-page summary of what he had seen and what he wanted to read about.
I have hosted 14 premedical students in the past six years. Rafael is one of two who connected what they watched to osteopathic principles without prompting, and the only one who followed a patient from one visit to the next.
He has not seen enough medicine for me to judge clinical skill, and I do not comment on it. On his understanding of osteopathic practice, his conduct with patients and his reliability, I recommend him without reservation for osteopathic medical school.
Sincerely,
Leticia Moravec, DO
Riverbend Family Medicine, phone, email
What each paragraph does:
- Paragraph 1 gives duration, setting, hours and the limit of what the writer saw. Every later claim is read against it.
- Paragraph 2 is the DO-only paragraph: an osteopathic moment, then the applicant's own follow-through.
- Paragraph 3 gives one patient incident and one habit, both observed.
- Paragraph 4 compares with a count: 2 of 14 hosted students.
- Paragraph 5 states what the writer cannot judge and then endorses at a stated strength. It is a measured judgment, which is what the reader can use.
What to leave out
- The tenets, recited. Show one in action instead.
- A list of what OMT is. The reader is an osteopathic school.
- Clinical skill you did not see. A shadowing applicant has watched, not treated.
- Grades and MCAT. The school has them.
- Your title doing the work. "As a DO, I strongly recommend" says who you are, not what you saw.
Submitting the letter
For a letter sent through AACOMAS, the applicant enters your email, you get a request from Liaison Letters, and you may be asked for relationship answers, short essays and ratings as well as the upload. AACOMAS says "completed evaluations cannot be removed or replaced", so upload the final version. The whole process, including the Interfolio route and what it changes, is in AACOMAS letters of evaluation: portal and Interfolio. For the rest of the DO application, see what AACOMAS is and how it works.
Checklist before you upload
- First paragraph: how long, where, how many hours or days, what you saw directly.
- One osteopathic moment, with what the applicant did afterward.
- One patient incident in plain words.
- One comparison with the number of students you have hosted.
- A sentence on what you cannot judge, if the applicant only shadowed.
- A closing endorsement at the strength you mean.
- Letterhead, signature, date, under one page.
Questions about DO letters
Does a DO letter have to mention OMT?
No school page we opened requires it. What AACOM lists is "knowledge of osteopathic medicine". OMT is one way to show it. A moment where you treated the whole patient, or examined structure to explain a complaint, works as well if the applicant engaged with it.
Can an MD write the physician letter for a DO school instead?
At Campbell and Kirksville, yes: both pages accept a physician who is a DO or an MD, and Campbell adds that a DO letter "is encouraged." Other schools differ; see which DO schools require a DO letter.
How long should a DO letter be?
One page. The sample above is 296 words. Length matters less than whether each paragraph carries something observed; how long a letter of recommendation should be covers the general case.
Can I write for an applicant who only shadowed me for a day?
You can, but say exactly that in the first paragraph and keep the letter short. If another physician knows the applicant far better, tell the applicant. A physician letter written as an assessment shows what a longer relationship lets you say.
Get a free review of the letter
Get a free Quick Review of your recommendation letter against GradPilot's medical school letter of evaluation rubric before you upload. It checks whether your osteopathic paragraph describes an incident with the applicant's own action in it, and whether your closing endorsement is as strong as the evidence above it. Other letter types are on the recommendation letter review page.
More letter guides for medical school writers are in the medical school essays hub, including the general guide to writing a medical school letter of recommendation.
Sources
Retrieved November 7, 2026. None of these pages names a cycle year for the quoted text.
- AACOM, Admissions Requirements: personal qualities list; letters required; requirements vary.
- American Osteopathic Association, Tenets of Osteopathic Medicine: the four tenets, approved as AOA policy.
- Campbell University School of Osteopathic Medicine, Doctor of Osteopathic Medicine admissions: DO or MD physician letter; DO letter encouraged.
- A.T. Still University KCOM, Application Checklist: "Evaluation II: Physician (DO or MD)".
- Liaison, AACOMAS Applicant Help Center: Evaluations: completed evaluations cannot be removed or replaced.
Review the Letter Before It Is Submitted
See how the letter reads against the rubric for its destination.