New "4 letters max" and a new away letter

[jungleland]

Sorry to add another inane q to the stack.

What's up with the 4 letters max thing?

So, I have 4 letters ready to go from my home program, and I'm ready to submit in the morning. I'm currently on an away at my dream program in internal medicine. My attending agreed to write me a letter on Friday, but it won't be ready for "a few weeks".

When I submit tomorrow morning, including to this program, do I include my four (I think, great) letters from my home program? Or do I have to cut one out and leave a spot for him to fill when he finishes? I'm hesitant to cut because I've already had to cut my medicine sub I letter from the letters I am sending (since I feel that my current 4 letters all know me better [3 3rd year medicine attendings + chair]).

IE- how strict is this "four letters per program max" that ERAS is implementing now? Can I get away with one more?

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[Raryn]

Sorry to add another inane q to the stack.

What's up with the 4 letters max thing?

So, I have 4 letters ready to go from my home program, and I'm ready to submit in the morning. I'm currently on an away at my dream program in internal medicine. My attending agreed to write me a letter on Friday, but it won't be ready for "a few weeks".

When I submit tomorrow morning, including to this program, do I include my four (I think, great) letters from my home program? Or do I have to cut one out and leave a spot for him to fill when he finishes? I'm hesitant to cut because I've already had to cut my medicine sub I letter from the letters I am sending (since I feel that my current 4 letters all know me better [3 3rd year medicine attendings + chair]).

IE- how strict is this "four letters per program max" that ERAS is implementing now? Can I get away with one more?

Absolutely strict. There's literally no way to add a fifth letter or remove one of your four.

Only way to add one after submission would be to leave a slot open.

Or just have your letter writer email it to your programs individually. This is generally frowned upon.

 

[jungleland]

Got it. And having him send the letter directly to the program is also a no-no now, correct? Or do you think programs will still be amenable to this if it comes from the same program?

 

[gutonc]

And just so we're clear. ERAS has been implementing the 4 LOR rule for as long as I've been paying attention (which is coming up on 10 years now). The only difference is that for the past 3 years or so they got rid of the work around that allowed sending a 5th letter.

Not using your Sub I letter is a mistake.

Finally, you are dramatically overestimating the relevance of LORs.

 

[jungleland]

Thanks gutonc.

I've wrestled with this subI letter issue for a while, and while I performed well on the SubI, I got to know each of my other 3 letter writers much better and all volunteered independently to write the letters before I had the chance to ask; I've also worked with them in other capacities (research, etc) separately. The advice I got was to go with people who know you best (in a clinical setting) and to worry less about the specific rotation title. The subI letter may or may not be a "form" letter and is far less a sure thing.

 

[mvenus929]

Internal Medicine (and surgery) seem to be more picky about their letters than other fields. If any of your third year letters are NOT from internal medicine, you should cut them in favor of the letters from your AI rotations.

 

[jungleland]

Unfortunately, they're all from IM (although one is a subspecialist and another is Med-Peds). I guess the weight of an "AI Letter" is stronger than I thought. It's frustrating since I haven't even seen comments from the clerkship yet so I have no idea what the AI letter's language is like. Obviously, they agreed to write it, but it's tough to part with these known entities...