Author information pack
Your Paper Your Way
We now differentiate between the requirements for new and revised submissions. You may choose to submit your manuscript as a single Word or PDF file to be used in the refereeing process. Only when your paper is at the revision stage, will you be requested to put your paper in to a 'correct format' for acceptance and provide the items required for the publication of your article.
To find out more, please visit the Preparation section below.
The editors of The American Journal of Medicine® welcome concise articles devoted to internal medicine and its specialties. Articles must be contributed solely to The American Journal of Medicine® and they become the property of the publisher. Statements contained therein are the responsibility of the author(s). The publisher reserves copyright and renewal on all published material, and such material may not be reproduced in any form without the written permission of the publisher.
• Submission Guidelines at a Glance
• Manuscript Submission Checklist
• In the cover letter and on the title page, indicate the type of manuscript you are submitting: Clinical Research Study, Review, Images in Dermatology, Images in Radiology, Diagnostic Dilemma, ECG Image of the Month, Advancing High Value Health Care, Brief Observation, Clinical Communication to the Editor, Letter to the Editor, Commentary, Medical Humanities, Clinical Effectiveness, Personomics, or AAIM Perspectives. Suggestions for potential reviewers are welcome. Case reports focusing on one patient should be submitted as Clinical Communications to the Editor. Research studies that involve fewer than 100 subjects should be submitted as Brief Observations. Note that we have combined the article types of Editorial and Commentary into a single category: an article that might be considered an Editorial should now be submitted as a Commentary. The editors reserve the right to change the article type. Please refer to the specific word limits, formatting guidelines and instructions for each article type before submission.
Address manuscripts to Joseph S. Alpert, MD, Editor-in-Chief, The American Journal of Medicine, 3615 N. Prince Village Place, Suite 181, Tucson, Arizona 85719. All submissions should be formatted for US letter (8.5 X 11 inches). All manuscripts must be submitted through the Journal's online submission and review system at http://www.ees.elsevier.com/ajm.
You can use this list to carry out a final check of your submission before you send it to the journal for review. Please check the relevant section in this Guide for Authors for more details.
Ensure that the following items are present:One author has been designated as the corresponding author with contact details:
• E-mail address
• Full postal address
All necessary files have been uploaded:
• Include keywords
• All figures (include relevant captions)
• All tables (including titles, description, footnotes)
• Ensure all figure and table citations in the text match the files provided
• Indicate clearly if color should be used for any figures in print
Graphical Abstracts / Highlights files (where applicable)
Supplemental files (where applicable)
• Manuscript has been 'spell checked' and 'grammar checked'
• All references mentioned in the Reference List are cited in the text, and vice versa
• Permission has been obtained for use of copyrighted material from other sources (including the Internet)
• A competing interests statement is provided, even if the authors have no competing interests to declare
• Journal policies detailed in this guide have been reviewed
• Referee suggestions and contact details provided, based on journal requirements
For further information, visit our Support Center.
• Accepted manuscripts may be published in the print version of The American Journal of Medicine or in AJM Online. Abstracts for the online version of AJM will be printed in the Journal, but the full text will appear online with the other articles from that issue. Online articles are fully searchable through Science Direct, and other services.
• A cover letter, signed by the first author and corresponding author, should accompany the manuscript. It should include the name, mailing address, telephone and FAX numbers, and email address of the corresponding author.Ethics in publishing
Please see our information pages on Ethics in publishing and Ethical guidelines for journal publication.
Potential conflicts of interest for all authors should be discussed in a separate document. An electronic cover letter from the corresponding author is acceptable. Authors of research articles should disclose any affiliation with any organization with a financial interest, direct or indirect, in the subject matter or materials discussed in the manuscript (eg, consultancies, employment, expert testimony, honoraria, retainers, stock) that may affect the conduct or reporting of the work submitted. If uncertain as to what might be considered a potential conflict of interest, authors should err on the side of full disclosure. Because reviews and editorials are based on selection and interpretation of the literature, the Journal expects that authors of such articles will not have any financial interest in a company (or its competitor) that makes a product discussed in the article. Information about potential conflict of interest will be made available to reviewers and will be published with the manuscript at the discretion of the editors.
Declaration of interest
All authors must disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding. Authors must disclose any interests in two places: 1. A summary declaration of interest statement in the title page file (if double-blind) or the manuscript file (if single-blind). If there are no interests to declare then please state this: 'Declarations of interest: none'. This summary statement will be ultimately published if the article is accepted. 2. Detailed disclosures as part of a separate Declaration of Interest form, which forms part of the journal's official records. It is important for potential interests to be declared in both places and that the information matches. More information.
• The cover letter must attest that the manuscript represents original work and that it is not under consideration for publication elsewhere. The cover letter should also state that all authors meet the criteria for authorship and that the authors will sign a statement attesting authorship, disclosing all potential conflicts of interest, and releasing the copyright should the manuscript be accepted for publication.
Submission of an article implies that the work described has not been published previously (except in the form of an abstract or as part of a published lecture or academic thesis or as an electronic preprint, see 'Multiple, redundant or concurrent publication' section of our ethics policy for more information), that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder. To verify originality, your article may be checked by the originality detection service Crossref Similarity Check.
• Each author must have participated in the writing of the manuscript, and have seen and approved the submitted version. Further, each author should have been involved in the conception and design of the study, or the analysis of the data.
• Potential authors who have questions about these issues should contact the editorial office at email@example.com.• All correspondence between the Journal's editorial office and the authors will be sent to the corresponding author only.
Article transfer service
This journal is part of our Article Transfer Service. This means that if the Editor feels your article is more suitable in one of our other participating journals, then you may be asked to consider transferring the article to one of those. If you agree, your article will be transferred automatically on your behalf with no need to reformat. Please note that your article will be reviewed again by the new journal. More information.
This journal offers authors a choice in publishing their research: open access and subscription.
For subscription articles
Upon acceptance of an article, authors will be asked to complete a Journal Publishing Agreement (for more information on this and copyright, see http://www.elsevier.com/copyright). An email will be sent to the corresponding author confirming receipt of the manuscript together with a Journal Publishing Agreement form or a link to the online version of this agreement.
Subscribers may reproduce tables of contents or prepare lists of articles including abstracts for internal circulation within their institutions. Permission of the publisher is required for resale or distribution outside the institution and for all other derivative works, including compilations and translations (please consult http://www.elsevier.com/permissions). If excerpts from other copyrighted works are included, the author(s) must obtain written permission from the copyright owners and credit the source(s) in the article. Elsevier has preprinted forms for use by authors in these cases: please consult http://www.elsevier.com/permissions.
Upon acceptance of an article, authors will be asked to complete an Exclusive License Agreement (for more information see http://www.elsevier.com/OAauthoragreement). Permitted reuse of open access articles is determined by the author's choice of user license (see http://www.elsevier.com/openaccesslicenses).
Retained author rights
As an author you (or your employer or institution) retain certain rights. For more information on author rights for:
subscription articles please see http://www.elsevier.com/journal-authors/author-rights-and-responsibilities;
for open access articles please see http://www.elsevier.com/OAauthoragreement.
Find out how you can share your research published in Elsevier journals.
Role of the funding source
Please identify who provided financial support for the conduct of the research and/or preparation of the article, and briefly describe the role of the sponsor(s), if any, in study design; in the collection, analysis, and interpretation of data; in writing the report; and in the decision to submit the article for publication. If the funding source(s) had no such involvement then this should be stated. Please see http://www.elsevier.com/funding.
Elsevier has established a number of agreements with funding bodies which allow authors to comply with their funder's open access policies. Some funding bodies will reimburse the author for the Open Access Publication Fee. Details of existing agreements are available online.
After acceptance, open access papers will be published under a noncommercial license. For authors requiring a commercial CC BY license, you can apply after your manuscript is accepted for publication.
This journal offers authors a choice in publishing their research:
• Articles are made available to subscribers as well as developing countries and patient groups through our universal access programs.
• No open access publication fee payable by authors.
• Articles are freely available to both subscribers and the wider public with permitted reuse.
• An open access publication fee is payable by authors or on their behalf, e.g. by their research funder or institution.
Regardless of how you choose to publish your article, the journal will apply the same peer review criteria and acceptance standards.For open access articles, permitted third party (re)use is defined by the following Creative Commons user licenses:
Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND)
For non-commercial purposes, lets others distribute and copy the article, and to include in a collective work (such as an anthology), as long as they credit the author(s) and provided they do not alter or modify the article.
The open access publication fee for this journal is USD 3750, excluding taxes. Learn more about Elsevier's pricing policy: https://www.elsevier.com/openaccesspricing.
Authors can share their research in a variety of different ways and Elsevier has a number of green open access options available. We recommend authors see our green open access page for further information. Authors can also self-archive their manuscripts immediately and enable public access from their institution's repository after an embargo period. This is the version that has been accepted for publication and which typically includes author-incorporated changes suggested during submission, peer review and in editor-author communications. Embargo period: For subscription articles, an appropriate amount of time is needed for journals to deliver value to subscribing customers before an article becomes freely available to the public. This is the embargo period and it begins from the date the article is formally published online in its final and fully citable form. Find out more.
This journal has an embargo period of 12 months.
Elsevier Researcher Academy
Researcher Academy is a free e-learning platform designed to support early and mid-career researchers throughout their research journey. The "Learn" environment at Researcher Academy offers several interactive modules, webinars, downloadable guides and resources to guide you through the process of writing for research and going through peer review. Feel free to use these free resources to improve your submission and navigate the publication process with ease.
Submit your manuscript in English. Authors who feel their English language manuscript may require editing to eliminate possible grammatical or spelling errors and to conform to correct scientific English may wish to use the English Language Editing service available from Elsevier's WebShop http://webshop.elsevier.com/languageediting/ or visit our customer support site http://support.elsevier.com for more information.
Submission to this journal proceeds totally online, and you will be guided stepwise through the creation and uploading of your files. The system automatically converts source files to a single PDF file of the article, which is used in the peer-review process. Please note that even though manuscript source files are converted to PDF files at submission for the review process, these source files are needed for further processing after acceptance. All correspondence, including notification of the Editor's decision and requests for revision, takes place by email, eliminating the need for a paper trail.
Please submit your article via http://www.ees.elsevier.com/ajm.
• Use the Style Guide of the American Medical Association as a reference.
• Limit use of acronyms or abbreviations to those that are generally accepted (eg, DNA, MRI, STD, HIV, units of measure, statisical terms, trial names.• Measurements of length, height, weight, and volume should be reported in metric units (meter, kilogram, liter) or their decimal multiples. Temperatures should be given in degrees Celsius. Blood pressures should be given in millimeters of mercury.
• Cite in numerical order every reference, figure, and table. (Order of mention in the text determines the number given to each.) Provide legends for all Tables and Figures• Acknowledgments, including grant support, should be placed at the end of the text.
• Include the manuscript number on all revisions and include it in all correspondence.AudioSlides
The journal encourages authors to create an AudioSlides presentation with their published article. AudioSlides are brief, webinar-style presentations that are shown next to the online article on ScienceDirect. This gives authors the opportunity to summarize their research in their own words and to help readers understand what the paper is about. More information and examples are available at http://www.elsevier.com/audioslides. Authors of this journal will automatically receive an invitation email to create an AudioSlides presentation after acceptance of their paper.
Submission to this journal proceeds totally online and you will be guided stepwise through the creation and uploading of your files. The system automatically converts your files to a single PDF file, which is used in the peer-review process.
As part of the Your Paper Your Way service, you may choose to submit your manuscript as a single file to be used in the refereeing process. This can be a PDF file or a Word document, in any format or lay-out that can be used by referees to evaluate your manuscript. It should contain high enough quality figures for refereeing. If you prefer to do so, you may still provide all or some of the source files at the initial submission. Please note that individual figure files larger than 10 MB must be uploaded separately.
There are no strict requirements on reference formatting at submission. References can be in any style or format as long as the style is consistent. Where applicable, author(s) name(s), journal title/book title, chapter title/article title, year of publication, volume number/book chapter and the pagination must be present. Use of DOI is highly encouraged. The reference style used by the journal will be applied to the accepted article by Elsevier at the proof stage. Note that missing data will be highlighted at proof stage for the author to correct.
There are no strict formatting requirements but all manuscripts must contain the essential elements needed to convey your manuscript, for example Abstract, Keywords, Introduction, Materials and Methods, Results, Conclusions, Artwork and Tables with Captions.
If your article includes any Videos and/or other Supplementary material, this should be included in your initial submission for peer review purposes.
Divide the article into clearly defined sections.
Please ensure the figures and the tables included in the single file are placed next to the relevant text in the manuscript, rather than at the bottom or the top of the file. The corresponding caption should be placed directly below the figure or table.
This journal operates a double blind review process. All contributions will be initially assessed by the editor for suitability for the journal. Papers deemed suitable are then typically sent to a minimum of one independent expert reviewer to assess the scientific quality of the paper. The Editor is responsible for the final decision regarding acceptance or rejection of articles. The Editor's decision is final. More information on types of peer review.
Use of word processing software
Regardless of the file format of the original submission, at revision you must provide us with an editable file of the entire article. Keep the layout of the text as simple as possible. Most formatting codes will be removed and replaced on processing the article. The electronic text should be prepared in a way very similar to that of conventional manuscripts (see also the Guide to Publishing with Elsevier). See also the section on Electronic artwork.
To avoid unnecessary errors you are strongly advised to use the 'spell-check' and 'grammar-check' functions of your word processor.
• Title. Concise and informative. Titles are often used in information-retrieval systems. Avoid abbreviations and formulae where possible. Trial names can be used in the titles as appropriate.
• Author names and affiliations. Where the family name may be ambiguous (e.g., a double name), please indicate correct presentation clearly. Present the authors' affiliation addresses (where the actual work was done) below the names. Indicate all affiliations with a lower-case superscript letter immediately after the author's name and in front of the appropriate address. Provide the full postal address of each affiliation, including the country name and, if available, the email address of each author.
• Corresponding author. Clearly indicate who will handle correspondence at all stages of review and publication as well as post-publication. Ensure that phone numbers (with country and area code) are provided in addition to the email address and the complete postal address. Contact details must be kept up to date by the corresponding author.
• Present/permanent address. If an author has moved since the work described in the article was done, or was visiting at the time, a "Present address" (or "Permanent address") may be indicated as a footnote to that author's name. The address at which the author actually did the work must be retained as the main, affiliation address. Superscript Arabic numerals are used for such footnotes.
A graphical abstract may also be provided at the author’s discretion. A graphical abstract summarizes the contents of the article in a concise, pictorial form designed to capture the attention of a wide readership online. The image should clearly represent the work described in the article and should be submitted as a separate file in the online submission system. Image size: Please provide an image with a minimum of 531 × 1328 pixels (h × w) or proportionally more. The image should be readable at a size of 5 × 13 cm using a regular screen resolution of 96 dpi. Preferred file types: TIFF, EPS, PDF or MS Office files. See http://www.elsevier.com/graphicalabstracts for examples. Authors can make use of Elsevier's Illustration and Enhancement service to ensure the best presentation of their images also in accordance with all technical requirements: http://webshop.elsevier.com/illustrationservices/ImagePolishing/gap/requestForm.cfm.
Authors of all AJM articles are asked to provide research highlights -- 3 to 5 bullet points that convey the core findings of the article, which will be published in addition to the article abstract. Please use 'Highlights' in the file name. The maximum number of characters per bullet point is 85 characters, including spaces. See http://www.elsevier.com/highlights for examples.
Footnotes should be used sparingly. Number them consecutively throughout the article. Many word processors build footnotes into the text, and this feature may be used. Should this not be the case, indicate the position of footnotes in the text and present the footnotes themselves separately at the end of the article.
• Make sure you use uniform lettering and sizing of your original artwork.
• Preferred fonts: Arial (or Helvetica), Times New Roman (or Times), Symbol, Courier.
• Number the illustrations according to their sequence in the text.
• Use a logical naming convention for your artwork files.
• Indicate per figure if it is a single, 1.5 or 2-column fitting image.
• For Word submissions only, you may still provide figures and their captions, and tables within a single file at the revision stage.
• Please note that individual figure files larger than 10 MB must be provided in separate source files.
A detailed guide on electronic artwork is available.
You are urged to visit this site; some excerpts from the detailed information are given here.
Regardless of the application used, when your electronic artwork is finalized, please 'save as' or convert the images to one of the following formats (note the resolution requirements for line drawings, halftones, and line/halftone combinations given below):
EPS (or PDF): Vector drawings. Embed the font or save the text as 'graphics'.
TIFF (or JPG): Color or grayscale photographs (halftones): always use a minimum of 300 dpi.
TIFF (or JPG): Bitmapped line drawings: use a minimum of 1000 dpi.
TIFF (or JPG): Combinations bitmapped line/half-tone (color or grayscale): a minimum of 500 dpi is required.
Please do not:
• Supply files that are optimized for screen use (e.g., GIF, BMP, PICT, WPG); the resolution is too low.
• Supply files that are too low in resolution.
• Submit graphics that are disproportionately large for the content.
Please make sure that artwork files are in an acceptable format (TIFF (or JPEG), EPS (or PDF) or MS Office files) and with the correct resolution. If, together with your accepted article, you submit usable color figures then Elsevier will ensure, at no additional charge, that these figures will appear in color online (e.g., ScienceDirect and other sites) in addition to color reproduction in print. Further information on the preparation of electronic artwork.
Ensure that each illustration has a caption. A caption should comprise a brief title (not on the figure itself) and a description of the illustration. Keep text in the illustrations themselves to a minimum but explain all symbols and abbreviations used.
Please submit tables as editable text and not as images. Tables can be placed either next to the relevant text in the article, or on separate page(s) at the end. Number tables consecutively in accordance with their appearance in the text and place any table notes below the table body. Be sparing in the use of tables and ensure that the data presented in them do not duplicate results described elsewhere in the article. Please avoid using vertical rules and shading in table cells.
- Start each table at the top of a new page.
- Give each table a title. Number tables using Arabic numerals (Table 1, Table 2, etc.) in the order in which they are mentioned in the text.
- Provide a footnote to each table, identifying all abbreviations used.
- Number in order of mention. Ensure that all references listed in end-notes are cited within the text.
- Provide complete concluding page numbers for all journal references and specific page numbers for all book references. Indicate all abstracts and letters.
- Follow general arrangement, abbreviations, and punctuation as given in Uniform Requirements for Manuscripts Submitted to Biomedical Journals. For periodicals, follow Index Medicus, listing all authors when four or fewer; when five or more, list only first three and add et al.
- Personal communications are discouraged. If included, they must be noted parenthetically in the text, dated by month and year, and accompanied by a written acknowledgment.
- No periods are used after authors' initials.
Increased discoverability of research and high-quality peer review are ensured by online links to the sources cited. In order to allow us to create links to abstracting and indexing services, such as Scopus, CrossRef and PubMed, please ensure that data provided in the references are correct. Please note that incorrect surnames, journal/book titles, publication year and pagination may prevent link creation. When copying references, please be careful as they may already contain errors. Use of the DOI is encouraged.
As a minimum, provide the full URL and the date when the reference was last accessed. Provide any further information, such as DOI, author names, dates, reference to a source publication, etc., if known. Web references should be listed in order of their appearance in the text, similar to other references.
This journal encourages you to cite underlying or relevant datasets in your manuscript by citing them in your text and including a data reference in your Reference List. Data references should include the following elements: author name(s), dataset title, data repository, version (where available), year, and global persistent identifier. Add [dataset] immediately before the reference so we can properly identify it as a data reference. The [dataset] identifier will not appear in your published article.
References in a special issue
Please ensure that the words "this issue" are added to any references in the list (and any citations in the text) to other articles in the same Special Issue.
Reference management software
Most Elsevier journals have their reference template available in many of the most popular reference management software products. These include all products that support Citation Style Language styles, such as Mendeley and Zotero, as well as EndNote. Using the word processor plug-ins from these products, authors only need to select the appropriate journal template when preparing their article, after which citations and bibliographies will be automatically formatted in the journal's style. If no template is yet available for this journal, please follow the format of the sample references and citations as shown in this Guide.
Users of Mendeley Desktop can easily install the reference style for this journal by clicking the following link:
When preparing your manuscript, you will then be able to select this style using the Mendeley plug-ins for Microsoft Word or LibreOffice.
There are no strict requirements on reference formatting at submission. References can be in any style or format as long as the style is consistent. Where applicable, author(s) name(s), journal title/book title, chapter title/article title, year of publication, volume number/book chapter and the pagination must be present. Use of DOI is highly encouraged. The reference style used by the journal will be applied to the accepted article by Elsevier at the proof stage. Note that missing data will be highlighted at proof stage for the author to correct. If you do wish to format the references yourself they should be arranged according to the following examples:
1. Oguro, M, Imahiro, S, Saito, S, Nakashizuka, T. Mortality data for Japanese oak wilt disease and surrounding forest compositions, Mendeley Data, v1; 2015. http://dx.doi.org/10.17632/xwj98nb39r.1.
The journal encourages authors to create an AudioSlides presentation with their published article. AudioSlides are brief, webinar-style presentations that are shown next to the online article on ScienceDirect. This gives authors the opportunity to summarize their research in their own words and to help readers understand what the paper is about. More information and examples are available. Authors of this journal will automatically receive an invitation e-mail to create an AudioSlides presentation after acceptance of their paper.
Include interactive data visualizations in your publication and let your readers interact and engage more closely with your research. Follow the instructions here to find out about available data visualization options and how to include them with your article.
This journal encourages and enables you to share data that supports your research publication where appropriate, and enables you to interlink the data with your published articles. Research data refers to the results of observations or experimentation that validate research findings. To facilitate reproducibility and data reuse, this journal also encourages you to share your software, code, models, algorithms, protocols, methods and other useful materials related to the project.
Below are a number of ways in which you can associate data with your article or make a statement about the availability of your data when submitting your manuscript. If you are sharing data in one of these ways, you are encouraged to cite the data in your manuscript and reference list. Please refer to the "References" section for more information about data citation. For more information on depositing, sharing and using research data and other relevant research materials, visit the research data page.Data linking
If you have made your research data available in a data repository, you can link your article directly to the dataset. Elsevier collaborates with a number of repositories to link articles on ScienceDirect with relevant repositories, giving readers access to underlying data that gives them a better understanding of the research described.
There are different ways to link your datasets to your article. When available, you can directly link your dataset to your article by providing the relevant information in the submission system. For more information, visit the database linking page.For supported data repositories a repository banner will automatically appear next to your published article on ScienceDirect.
In addition, you can link to relevant data or entities through identifiers within the text of your manuscript, using the following format: Database: xxxx (e.g., TAIR: AT1G01020; CCDC: 734053; PDB: 1XFN).Mendeley Data
This journal supports Mendeley Data, enabling you to deposit any research data (including raw and processed data, video, code, software, algorithms, protocols, and methods) associated with your manuscript in a free-to-use, open access repository. Before submitting your article, you can deposit the relevant datasets to Mendeley Data. Please include the DOI of the deposited dataset(s) in your main manuscript file. The datasets will be listed and directly accessible to readers next to your published article online.
For more information, visit the Mendeley Data for journals page.Data statement
To foster transparency, we encourage you to state the availability of your data in your submission. This may be a requirement of your funding body or institution. If your data is unavailable to access or unsuitable to post, you will have the opportunity to indicate why during the submission process, for example by stating that the research data is confidential. The statement will appear with your published article on ScienceDirect. For more information, visit the Data Statement page.
Use of the Digital Object Identifier
The Digital Object Identifier (DOI) may be used to cite and link to electronic documents. The DOI is a unique alpha-numeric character string assigned to a document by the publisher upon the initial electronic publication. The assigned DOI never changes and is therefore an ideal medium for citing documents, particularly articles in press because they have not yet received their full bibliographic information. Here is an example of a correctly given DOI:
Online proof correction
Corresponding authors will receive an e-mail with a link to our online proofing system, allowing annotation and correction of proofs online. The environment is similar to MS Word: in addition to editing text, you can also comment on figures/tables and answer questions from the Copy Editor. Web-based proofing provides a faster and less error-prone process by allowing you to directly type your corrections, eliminating the potential introduction of errors.
If preferred, you can still choose to annotate and upload your edits on the PDF version. All instructions for proofing will be given in the e-mail we send to authors, including alternative methods to the online version and PDF.
We will do everything possible to get your article published quickly and accurately. Please use this proof only for checking the typesetting, editing, completeness and correctness of the text, tables and figures. Significant changes to the article as accepted for publication will only be considered at this stage with permission from the Editor. It is important to ensure that all corrections are sent back to us in one communication. Please check carefully before replying, as inclusion of any subsequent corrections cannot be guaranteed. Proofreading is solely your responsibility.
The editors will try to make a preliminary decision concerning the potential suitability of a manuscript for the Journal within a few days, and to obtain peer review expeditiously. Electronic submission of manuscripts facilitate this process.
Visit the Elsevier Support Center to find the answers you need. Here you will find everything from Frequently Asked Questions to ways to get in touch.
You can also check the status of your submitted article or find out when your accepted article will be published.
Career Resources articles posted on NEJM CareerCenter are produced by freelance health care writers as an advertising service of the publishing division of the Massachusetts Medical Society and should not be construed as coming from the New England Journal of Medicine, nor do they represent the views of the New England Journal of Medicine or the Massachusetts Medical Society.
Physicians seeking a practice opportunity might think of the cover letter as an old-fashioned, generally unimportant component of their application for or expression of interest in a position, but that is not the case. In this digital age of clipped, often rapid-fire communications, the cover letter has become more important than ever because it offers a way to differentiate the physician from other candidates. It provides a vehicle for sharing personal and professional information that might be important to prospective employers but doesn’t quite fit in the CV. The cover letter should be brief, well written, professional and positive in tone, and absolutely error-free. It should also give the recipient the sense that the physician has researched the opportunity or organization before writing the letter.
By Bonnie Darves
When a physician encounters the seemingly perfect practice opportunity — with a mid-sized group in their hometown that is affiliated with a health system that has an excellent reputation — it’s tempting to quickly compose the requested cover letter to accompany her CV and send it off.
Yes, it is smart to express interest in a desirable position as soon as possible, but it’s not prudent to view the cover letter as a mere formality. Today, when so much communication between physicians and recruiters or prospective employers is electronic — in either brief email responses or via online forms — the cover letter has become increasingly important. Here’s why: The carefully crafted letter offers an opportunity to differentiate the resident or fellow from other physicians who respond, and a chance to demonstrate highly personalized interest in the position.
“The cover letter’s value is certainly not decreasing in the digital age. Because it is usually the second contact physicians have with an organization, it is very important,” said James Tysinger, PhD, vice chair for professional development in the University of Texas Health Science Center department of family and community medicine in San Antonio. “It is your opportunity to include something about who you are, and to provide information that won’t be in your CV about why the position and the geographic location interest you.” For the resident seeking a fellowship, the letter is the ideal vehicle to convey to the program director that the physician has researched the program’s focus and reputation, he added.
Longtime recruiter Regina Levison, president of the national firm Levison Search Associates, agrees that the geographic preference statement is a vital piece of information that should appear early in the letter. “The geographic ‘connection’ to the opportunity’s location is the most important message you can include — whether it’s because you grew up there, have relatives in the region, or simply have always dreamed of living or working there,” Ms. Levison said. “Health care organizations today are not just recruiting to fill a specific opportunity; they are recruiting for retention.” As the health care delivery system changes to incorporate accountable care organizations and quality focused reimbursement, organizations are seeking physicians who will “stay around” to help meet long-term organizational objectives.
Craig Fowler, president of the National Association of Physician Recruiters (NAPR), and vice president of recruiting and training for Pinnacle Health Group in Atlanta, urges residents to include at least an introductory cover letter or note with their CV, even when it’s not requested. In his experience, 8 out of 10 physicians who express initial interest in a position don’t take the effort to write a letter unless asked.
“The cover letter really is a differentiator, and even though a recruiter will always look at your CV first, the letter is nice to have. I often feel that it gives me a sense of the physician — a good letter can make the physician come to life,” Mr. Fowler said. He enjoys, for example, learning about the physician’s personal interests and family, in addition to what he seeks in a practice opportunity.
Peter Cebulka, director of recruiting development for the national firm Merritt Hawkins, agrees that the cover letter can provide information that isn’t appropriate in a CV but could be important to a hiring organization. “The letter gives you a chance to talk about your professional goals, or why you’re committed to a particular area or practice setting,” Mr. Cebulka said. It can also highlight something compelling about the physician’s residency program that the recipient might not know.
If there are gaps in the CV that are not sensitive in nature, and therefore don’t require a phone conversation, that information should be included in the letter. “It’s important to briefly explain gaps because your application might be passed over if you don’t,” Mr. Fowler said.
Jim Stone, co-founder and president of The Medicus Firm, a national physician search company, offers helpful guidance on incorporating a career objective in the cover letter. “You may want to include a career objective or job search goals, but be careful not to be too specific or you may rule yourself out of consideration,” he advised. “Therefore, if there is one goal that really sums up your search, or some objective that is a must-have for you under any circumstances, it would be okay to include that.”
On another note, Mr. Stone urges physicians to include brief examples of any soft skills, such as communication, teamwork, technological aptitude, leadership, or problem solving.
Format and structure: short and targeted works
While there are no rules per se about a cover letter’s length or content, there are general guidelines for what works best and is likely to be well received. (See “Cover letters: What to do, what to avoid” section at the end of this article.) Dr. Tysinger, who counsels residents and practicing physicians on preparing CVs and cover letters, and frequently presents on the topic, recommends a single-page, three-paragraph format delivered in a professional, business letter layout, in simple language. Following is his basic guidance on the letter’s structure:
- First paragraph: Introduce yourself and state why you are writing — whether that is to be considered for a specific position, to express general interest in joining the organization, or the recommendation of a colleague.
- Second paragraph: Provide brief details about yourself and why you are interested in the opportunity and the location. Note any professional connections to the opportunity or organization, and any special skills or interests, such as management or teaching.
- Third paragraph: Thank the recipient for the opportunity to apply and for reviewing your CV, and end the letter with a statement indicating that you look forward to hearing from the recipient soon.
Other sources agreed that cover letters should not exceed one page, unless special circumstances dictate an extra paragraph or two. In that case, a two-page letter is acceptable. Ms. Levison advised briefly summarizing education and training in the second paragraph, and if it’s the physician’s first opportunity search, stating briefly why he became a physician.
It’s best to avoid going into extensive detail about personal interests or extracurricular pursuits. That could give the recipient the impression that the physician is more concerned about lifestyle than medical practice.
Professional tone, error-free content are musts
It should go without saying that the cover letter must be professionally written and free of spelling or grammatical errors, but unfortunately, that’s not always the case. All of the recruiters interviewed for this article have received cover letters that are poorly written or, in some cases, replete with misspellings; all agreed that an error-riddled letter could prevent its writer from being considered for an opportunity regardless of her or his qualifications.
Of course, word processing programs include spell-checkers and, usually, some grammar-checking functionality. That’s helpful, but it isn’t sufficient vetting to ensure the letter is in excellent shape. Because of the letter’s potential importance, physicians should have several trusted individuals — on the professional and personal side — review the document, including a professional editor, if warranted. “If writing isn’t your strong suit, or English isn’t your first language, do get professional advice before you finalize the letter,” Mr. Cebulka recommends.
Ms. Levinson offers pointed advice regarding double-checking for errors. “Are there any typos or mistakes that would make the new organization question your ability to keep accurate records?” she said. It’s worth noting that some recruiting firms offer assistance with cover letter writing, but it’s best not to count on that service.
Striking the right tone in the cover letter can be somewhat challenging when the resident doesn’t have a good sense of the organization offering the opportunity. Some hospitals or groups are very formal, and therefore expect to receive formal communication. Others might be somewhat casual, from the standpoint of their culture, and therefore less inclined to bring in a physician who comes across as stiff, even if she isn’t. For these reasons, it’s smart to research the hiring entity to the extent possible before finishing the letter. The group’s website or the health system’s physician portal are good starting places to gauge the culture, but a discussion with a physician who practices there, happily, also can be helpful.
Ideally, the letter’s tone should be professional but friendly, and should sound like its writer, and not like a cookie-cutter form letter. “The letter should be professional and warm, and the tone should also reflect how you would communicate with patients and staff,” Ms. Levison said.
“A little colloquialism is OK, if it shows your personality,” Mr. Fowler maintains, provided the overall tone remains professional.
The sources concurred that the cover letter is not the forum for including a laundry list of the physician’s position parameters, or for negotiating compensation or other potential contract terms. Physicians in a highly recruited specialty might mention required equipment or infrastructure, if the lack of those items would preclude further discussion. But for the most part, those specifics should be left for an on-site interview.
“If the parameter is a potential deal-breaker, you can mention it, but avoid sounding inflexible,” Mr. Cebulka advised. That means not setting limits on the amount of call, or number of night shifts or weekends, for example. Those details can be discussed and possibly negotiated later.
Very important parameters should, however, be provided to the recruiter outside the context of the cover letter if such detail is requested. That’s especially important if the recruiter will introduce the physician to multiple opportunities.
“If you’re in a highly recruited specialty, there will be plenty of opportunities. But it’s helpful for recruiters to know what you’re absolutely looking for, so that you don’t waste your time or theirs,” Mr. Cebulka said.
Cover letters: What to do, what to avoid
The sources who contributed to this article offered these additional tips on what physicians should do, or not do, when they craft their cover letters.
- Address the cover letter to an individual physician, practice administrator, recruiter, or other individual as the situation warrants, and not “to whom it may concern.”
- Be upbeat and positive. Ensure that the letter’s tone reflects your excitement about medicine, and that it reflects the way you would speak in an in-person interview.
- Include letters of reference with the cover letter if you’re looking for a fellowship or are formally applying for a specific position.
- Close the letter with a call to action if it’s an ideal opportunity (and likely a popular one). Let the recipient know that you will call in a few days to follow up, and indicate when you would be available to meet in person. It doesn’t hurt to state the best ways to reach you.
- Don’t sound desperate or beg for the job, even if it’s the perfect opportunity or you are worried about securing a position.
- Steer clear of “selling” yourself or making claims about why you would be the absolute best candidate. Instead, let your credentials and references make the case for you.
- Avoid sarcasm in any context, and generally steer clear of humor, unless you know the person to whom the letter is addressed very well.
- Don’t disparage individuals, programs, or institutions if you have had a negative experience somewhere — regardless of the reason.
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