Do I need a Int\. Med. LOR when I apply?

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Hi, I'll be applying for Psych residencies and I was wondering how important it is to have an LOR from a IM attending..... Had some bad luck with attendings....Of the two floor attendings I had for my clerkship, one was not really interested in interacting w/ MS and also moved to a new institution recently, the other one was kind of a jerk and it seems he didn't like me very much. Not really sure if my small group teaching attending would be an option, as these are not traditionally the attendings asked for LORs at my school. I'm pretty sure I can do well enough on my neuro clerkship in the near future to get a good LOR from an attending there. Would this be a suitable option or would it be considered a red flag on apps? Shooting for top programs here (everything else is in good order, high Step 1, H in psych clerkship, excellent LOR from psych attending, HP in other clerkships).

Not having a medicine attending letter could happen for many reasons, and will be just fine. Just find 4 good letters and don't worry.

Originally Posted by lambda242

Hi, I'll be applying for Psych residencies and I was wondering how important it is to have an LOR from a IM attending.....

Will depend on the programs to which you apply. Certainly having an IM letter is not a requirement at MGH, Columbia, UCSF, etc but you should check the web sites of the programs where you are applying. (Some programs will specify what kinds of letters they want, e.g., "at least one letter should be from a psychiatrist", "one letter from a non-psychiatrist".)

Some of the more call-heavy programs may be expecting a letter from a 'hard' clerkship (e.g., surgery, medicine) just to demonstrate that you will be able to handle the rigors of internship. Can't remember any cases in our admissions committee meetings where lack of an IM letter was a red flag, though.

When I was applying, I think I ran across one or two programs that asked for a medicine letter specifically, but the majority of programs won't care if you have a Neuro letter vs. IM letter.

Originally Posted by peppy

When I was applying, I think I ran across one or two programs that asked for a medicine letter specifically, but the majority of programs won't care if you have a Neuro letter vs. IM letter.

Yeah, I think there are a few programs out there that specifically want a medicine letter, but I think it's rare. Personally, I'd try to get a non-psych letter in there, but fm/peds/whatever are probably good as well.

And even the ones that say that on their website might not really *mean* it. A quick email to the program coordinator (in mid-july, most of them are REALLY overwhelmed with their incoming/outgoing residents right now) would clarify. Websites get written and not updated and one person thought it was important to say something and nobody else cares and the person that cared already took the money and ran, etc.

2 Psych letters, 1 Peds and 1 Surgical specialty letter got me into a UCLA program and I couldn't be happier. So you don't need an IM letter per se. I interviewed at top places.

Having said that, my letters were all extremely strong, from leaders in the field who knew me first-hand. I think that's much more important than having an IM letter that says flattering yet generic non-personal things.

Double check the requirements of each program you apply to just in case.

Originally Posted by atsai3

Some of the more call-heavy programs may be expecting a letter from a 'hard' clerkship (e.g., surgery, medicine) just to demonstrate that you will be able to handle the rigors of internship. Can't remember any cases in our admissions committee meetings where lack of an IM letter was a red flag, though.

Would OB/GYN count as "hard" clerkship? B/c of my compressed clinical schedule (MD/PhD) I actually won't have finished Peds or Surg when I apply. One of my letters will also be from my PI.

Originally Posted by lambda242

Would OB/GYN count as "hard" clerkship? B/c of my compressed clinical schedule (MD/PhD) I actually won't have finished Peds or Surg when I apply. One of my letters will also be from my PI.

Yes. Even despite that, I'd have to assume the MD/PhD would cover a multitude of sins.

I think some places prefer at least one non-psychiatry letter but I do not know of any top programs that require IM specifically, just a non-psych one. However, the most important thing is the letters are strong, and from people who have something substantive to say about you clinically. Letters in other specialties or from well known figures are icing on the cake.

3 strong clinical letters is likely what programs mainly want/require. It typically looks better that you show some breadth in your abilities so having a letter from a non-psych specialty is a plus but not having one is not necessarily a deal breaker. If you are in a MD/PhD program, then you will likely already have a leg up on things compared to most applicants.

Thank you for the feedback! Much appreciated!