behavior change after letter of recommendation

[randomdoc1]

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I'm not sure if this is the best forum for this, but I'm writing as someone who wrote an LoR for someone applying to a professional school (e.g. medical, PA, etc.). At the time I wrote the letter, I felt comfortable enough to write a decent one. But afterwards, her behavior changed markedly. She works for my clinic and I've caught her packing on extra time she did not work, dragging her feet to get back to patient messages, even telling potential new patients we are not taking new patients when we clearly are. She'd try to find convenient excuses to work remotely from home, and when she does, there's unanswered emails to the clinic. I feel like I'm in an ethical bind. I understand the vulnerable position of applying to professional schools but at the same time, I'm having a hard time supporting someone who's character changed so much for potential involvement in the medical community. It feels like a good act was placed but once this student got what they wanted, everything was out the door. I will be having a discussion with her of reducing her hours, as she does not get much work done here and I don't have utility for that, but it leaves the question of what to do with this letter.

 

[randomdoc1]

This is really a hard situation and I hope you can figure it out with your employee!

Maybe you could try talking to her and directly addressing the issue at hand. As a current applicant, I can tell you that the cycle is not always an easy one (I assume you have been through a similar professional school application cycle). It can often feel overwhelming and underwhelming at the same time. The constant fear of not getting into professional school is also there. Perhaps your employee has not been receiving any interviews or communication from the schools she has applied to. Maybe she is depressed. Before doing something as drastic as cutting down her hours or rescinding your LoR, I would really recommend talking to her, stepping in her shoes, and really understanding why she is acting the way she is acting. I would also ask her why she is working in the clinic if it's not what she wants to do. I would also connect her to a psychiatrist or some other resources if she is not doing well mentally.
I think you both really need to communicate with one another as there seems to be a lack of mutual communication, and this can often lead to feelings of betrayal and animosity between two parties. I would also really advise not to do anything drastic with regards to the LoR as of now (at least until both of you have communicated), mainly because it could potentially mess up your employee's chance at any professional school. A rescinded LoR doesn't look good either way to the professional school or to her. I would suggest if you are going to rescind the LoR, to do so after talking to your employee and letting her now clearly what you intend to do.

I appreciate the input. Actually I've attempted some discussions as well as direct productive feedback about answering the messages in a timely way (or at all). And I constantly have to follow every task she's given due to the pattern of lack of follow through no matter how many times I've tried to discuss with her we all need to take ownership of what tasks we have at hand. I opened the discussion too about some behaviors I've noticed and she's saying everything's fine but it's still the same old behavior patterns no matter how much feedback or discussion is given. So I'm truly at a loss. She already is connected with mental health providers.

 

[allseasons]

I'm not sure if this is the best forum for this, but I'm writing as someone who wrote an LoR for someone applying to a professional school (e.g. medical, PA, etc.). At the time I wrote the letter, I felt comfortable enough to write a decent one. But afterwards, her behavior changed markedly. She works for my clinic and I've caught her packing on extra time she did not work, dragging her feet to get back to patient messages, even telling potential new patients we are not taking new patients when we clearly are. She'd try to find convenient excuses to work remotely from home, and when she does, there's unanswered emails to the clinic. I feel like I'm in an ethical bind. I understand the vulnerable position of applying to professional schools but at the same time, I'm having a hard time supporting someone who's character changed so much for potential involvement in the medical community. It feels like a good act was placed but once this student got what they wanted, everything was out the door. I will be having a discussion with her of reducing her hours, as she does not get much work done here and I don't have utility for that, but it leaves the question of what to do with this letter.

have you already submitted the LoR and the application has been sent?

 

[jhmmd]

I'm not sure if this is the best forum for this, but I'm writing as someone who wrote an LoR for someone applying to a professional school (e.g. medical, PA, etc.). At the time I wrote the letter, I felt comfortable enough to write a decent one. But afterwards, her behavior changed markedly. She works for my clinic and I've caught her packing on extra time she did not work, dragging her feet to get back to patient messages, even telling potential new patients we are not taking new patients when we clearly are. She'd try to find convenient excuses to work remotely from home, and when she does, there's unanswered emails to the clinic. I feel like I'm in an ethical bind. I understand the vulnerable position of applying to professional schools but at the same time, I'm having a hard time supporting someone who's character changed so much for potential involvement in the medical community. It feels like a good act was placed but once this student got what they wanted, everything was out the door. I will be having a discussion with her of reducing her hours, as she does not get much work done here and I don't have utility for that, but it leaves the question of what to do with this letter.

My $.02: As @little_smiley_octopus said, your employee may be under a lot of stress and there may be more factors at play here. The common denominator may not be your LoR.

 

[randomdoc1]

have you already submitted the LoR and the application has been sent?

Yes, it has. The timing of it almost felt too convenient and exploitative. But, I think what I'm more alarmed by is the little to no effect of multiple attempts to communicate with her. It appears that regardless of what she may be going through, she's made the decision to not make very good decisions. Especially the cheating on the time sheet to get a bigger paycheck for hours not worked. That was quite alarming.

 

[thumbz]

My $.02: As @little_smiley_octopus said, your employee may be under a lot of stress and there may be more factors at play here. The common denominator may not be your LoR.

Agreed. Sounds like something else drastically changed in their life, as I can't imagine anyone doing that much of a shift just because they got a letter. I could see a resignation coming after that but not this epic shift to apathy.

I've seen it a handful of times in my residents, and once in my own personal life very recently.

Edit - the cheating on the time sheet part however is more damning. Personally I would talk to her, ask if she needs some time off or if she's struggling and see where it goes. If you get unsatisfactory answers I would cut her hours/terminate.

 

[LizzyM]

Many LoR writers do include a "please call me if you would like to discuss the candidate" and sometimes this is a signal that there were things I didn't put in the letter that I'd love to tell you over the phone. Having that text in the letter is also an opportunity to share what's happened since the leter was written. Of course, too late with regard to this applicant but you might want to consider that going forward. It is not likely that you will get many calls but it can happen.

 

[Princeton Medical Student]

This is really a hard situation and I hope you can figure it out with your employee!

Maybe you could try talking to her and directly addressing the issue at hand. As a current applicant, I can tell you that the cycle is not always an easy one (I assume you have been through a similar professional school application cycle). It can often feel overwhelming and underwhelming at the same time. The constant fear of not getting into professional school is also there. Perhaps your employee has not been receiving any interviews or communication from the schools she has applied to. Maybe she is depressed. Before doing something as drastic as cutting down her hours or rescinding your LoR, I would really recommend talking to her, stepping in her shoes, and really understanding why she is acting the way she is acting. I would also ask her why she is working in the clinic if it's not what she wants to do. I would also connect her to a psychiatrist or some other resources if she is not doing well mentally.
I think you both really need to communicate with one another as there seems to be a lack of mutual communication, and this can often lead to feelings of betrayal and animosity between two parties. I would also really advise not to do anything drastic with regards to the LoR as of now (at least until both of you have communicated), mainly because it could potentially mess up your employee's chance at any professional school. A rescinded LoR doesn't look good either way to the professional school or to her. I would suggest if you are going to rescind the LoR, to do so after talking to your employee and letting her now clearly what you intend to do.

Found the 4th quartile CASPER scorer

 

[allseasons]

Yes, it has. The timing of it almost felt too convenient and exploitative. I think what I'm more alarmed by is the little to no effect of multiple attempts to communicate with her. It appears that regardless of what she may be going through, she's made the decision to not make very good decisions. Especially the cheating on the time sheet to get a bigger paycheck for hours not worked. That was quite alarming.

Honestly, I disagree a bit with the others here. You made an effort to talk to her, and didn't get any reasonable response. Regardless of stress, I see no valid reason to cheat on the time sheet (unless we're talking like 10 minutes or something, in which case she might have thought it reasonable to round up while you might not agree, but I doubt that's the case here). Apathy and stress might make you work less but it doesn't make you cheat hours. And even if it does, for some reason, that indicates she has an absolutely terrible reaction to stress that would still cast a negative light over her imo.

Personally, I think once rec letters are submitted they are pretty final. However, this case seems extreme enough that if I were you I think I would make an exception to that general rule. The thing is, how would you go about doing it? There are 180 ish med schools in the country, I think, and you have no idea where she applied. You probably can guess at a few of them, but there's not really that much I think you can do at this point, as there's no formal place for you to submit a "rescind request".

 

[allseasons]

Found the 4th percentile CASPER scorer

holy **** you're right this is literally the perfect CASPer response

 

[randomdoc1]

Many LoR writers do include a "please call me if you would like to discuss the candidate" and sometimes this is a signal that there were things I didn't put in the letter that I'd love to tell you over the phone. Having that text in the letter is also an opportunity to share what's happened since the leter was written. Of course, too late with regard to this applicant but you might want to consider that going forward. It is not likely that you will get many calls but it can happen.

Honestly, I disagree a bit with the others here. You made an effort to talk to her, and didn't get any reasonable response. Regardless of stress, I see no valid reason to cheat on the time sheet (unless we're talking like 10 minutes or something, in which case she might have thought it reasonable to round up while you might not agree, but I doubt that's the case here). Apathy and stress might make you work less but it doesn't make you cheat hours. And even if it does, for some reason, that indicates she has an absolutely terrible reaction to stress that would still cast a negative light over her imo.

Thank you for these excellent points. Going forward, I will indeed start putting "please call me" note on my LoRs. If it continues to go well, it will just strengthen their application more. If areas of concern come up, well, then they do and we cross that bridge when we get there. But yes, as a psychiatrist myself...I understand things come up. But there's a line, where we also hold responsibility for how we react to stress. In the medical field, there is going to be a TON of things going on. And if this is how she reacts to stress, it does raise concerns. But at the end of the day, she decides the final course and it can go anywhere from very well to very poorly. The medical school admission process was frustrating and confusing to me too. But i can see why now. Not just all the studying, but the physical and emotional stress. I've fallen asleep standing before. And this field needs us to be resilient or ready to start practicing it and have the right attitude about it.

 

[randomdoc1]

Is there a way to submit the "rescind request" through the pre-profession health committee of the employee's undergraduate university? Or potentially through AMCAS or AACOMAS?

The application was through yes, a centralized application process. I'm still torn about this. I likely won't do anything with the LoR. But will admit, feel somewhat haunted at the thought of her working at such a professional level if progress is not made in how she reacts to stress first for her own sake and second for good patient care.

 

[allseasons]

Thank you for these excellent points. Going forward, I will indeed start putting "please call me" note on my LoRs. If it continues to go well, it will just strengthen their application more. If areas of concern come up, well, then they do and we cross that bridge when we get there. But yes, as a psychiatrist myself...I understanding things come up. But there's a line, where we also hold responsibility for how we react to stress. In the medical field, there is going to be a TON of things going on. And if this is how she reacts to stress, it does raise concerns. But at the end of the day, she decides the final course and it can go anywhere from very well to very poorly. The medical school admission process was frustrating and confusing to me too. But i can see why now. Not just all the studying, but the physical and emotional stress. I've fallen asleep standing before. And this field needs us to be resilient or ready to start practicing it and have the right attitude about it.

As far as I am aware, almost never do they call LoR writers except when there is a mismatch between activity description and letter description. It's unlikely the please call message will do anything unless they have other reasons to suspect. Perhaps the best move here is to just fire her? I don't really see any way to rescind the letter at this point, barring blindly emailing 100+ schools.

The application was through yes, a centralized application process. I'm still torn about this. I likely won't do anything with the LoR. But will admit, feel somewhat haunted at the thought of her working at such a professional level if progress is not made in how she reacts to stress first for her own sake and second for good patient care.

Yea, the service is either AMCAS or AACOMAS, but I don't think either of them will actually rescind the letter even if you ask for them to. At this point it's already been sent to schools, and AMCAS no longer interacts unless there's a falsification proved. In your case, the letter was true at the time it was submit (and dated), so I don't think it would qualify.

 

[wysdoc]

Thank you for these excellent points. Going forward, I will indeed start putting "please call me" note on my LoRs. If it continues to go well, it will just strengthen their application more. If areas of concern come up, well, then they do and we cross that bridge when we get there. But yes, as a psychiatrist myself...I understand things come up. But there's a line, where we also hold responsibility for how we react to stress. In the medical field, there is going to be a TON of things going on. And if this is how she reacts to stress, it does raise concerns. But at the end of the day, she decides the final course and it can go anywhere from very well to very poorly. The medical school admission process was frustrating and confusing to me too. But i can see why now. Not just all the studying, but the physical and emotional stress. I've fallen asleep standing before. And this field needs us to be resilient or ready to start practicing it and have the right attitude about it.

@randomdoc1 sent you a pm

 

[SlitLampExam]

This kind of behavior, like lying that the practice is not taking new patients, will come up again. This applicant may have trouble again in life.

I wouldn't do anything about the recommendation letter. It was accurate at the time of writing.

 

[Angus Avagadro]

Time card violations are a reason for dismissal from any position. HR considers this a serious violation. I might consider a follow up letter.

 

[Kmani6]

I would not "consider a follow-up letter." That seems like an inappropriate course of action given the circumstances and frankly seems excessive.

The appropriate course of action for time card violations is simply permanent termination or if being lenient a warning + reducing hours.

 

[allseasons]

I would not "consider a follow-up letter." That seems like an inappropriate course of action given the circumstances and frankly seems excessive.

The appropriate course of action for time card violations is simply permanent termination or if being lenient a warning + reducing hours.

yea, I second this. The letter of rec reflects what the applicant did up until the time it was dated. Nothing in the letter was false (at the time it was written), and a behavior change afterward doesn't falsify anything prior to the letter submission. I think at this point it is an employment issue and she should be terminated (or however you want to deal with it).

 

[KnightDoc]

yea, I second this. The letter of rec reflects what the applicant did up until the time it was dated. Nothing in the letter was false (at the time it was written), and a behavior change afterward doesn't falsify anything prior to the letter submission. I think at this point it is an employment issue and she should be terminated (or however you want to deal with it).

That's one way to look at it. Another way is that, just like applicants like to submit updates when they think it will help, if the writer is particularly peeved, there is no reason they shouldn't explore an update to bring new information before the adcoms.

By the way, falsifying time cards is stealing, whether it's 15 minutes, 15 hours, or 15 days. Is that something adcoms might care about? If so, is OP wrong for feeling some obligation to disclose after recommending the candidate?

No matter what OP ends up doing, to me this sounds like a cautionary tale about screwing around with letter writers before, during and after the letter is written.

 

[allseasons]

That's one way to look at it. Another way is that, just like applicants like to submit updates when they think it will help, if the writer is particularly peeved, there is no reason they shouldn't explore an update to bring new information before the adcoms.

By the way, falsifying time cards is stealing, whether it's 15 minutes, 15 hours, or 15 days. Is that something adcoms might care about? If so, is OP wrong for feeling some obligation to disclose after recommending the candidate?

No matter what OP ends up doing, to me this sounds like a cautionary tale about screwing around with letter writers before, during and after the letter is written.

yea, I was just providing my perspective and what I would do. If op chooses another path, I think that's totally justified. The time card thing sucks, and I honestly don't think there's an excuse for it.

 

[allseasons]

Yeah, I agree- there is no excuse for dishonesty and lack of integrity especially when documenting hours in the workplace. How are we supposed to know if she will lack integrity during medical documentation, patient evaluations, and when prescribing? Like OP suggested, I would be uncomfortable if his/her student worked in the medical field as a professional to whom many look up. I would suggest termination/reduction of hours as the best course of action in the clinic. Although, @allseasons I would say that med school recommendation is an "accurate assessment of the applicant’s suitability for medical school rather than advocate for the applicant" until the present. One thing @randomdoc1 could do is "upload a new version of a letter to AMCAS they've already submitted, so long as they use the same Letter ID number that was assigned to the original letter" even if the AMCAS application is already submitted. I would suggest against this---but if drastic actions must be taken, you have an alternative at least.

Not 100% sure how this works, but I'm fairly certain that the applicant has to designate the letter ID, not the recommender.

 

[randomdoc1]

Yeah, I agree- there is no excuse for dishonesty and lack of integrity especially when documenting hours in the workplace. How are we supposed to know if she will lack integrity during medical documentation, patient evaluations, and when prescribing? Like OP suggested, I would be uncomfortable if his/her student worked in the medical field as a professional to whom many look up.

Those are my thoughts exactly. I'm more concerned about the long haul. The HR/employment decisions can be pretty cut and dry. But as a psychiatrist, I always encourage people to look within themselves to examine the origins when stronger emotions come up and this is likely what's creating the most distress for me.

Wow, I thoroughly enjoy this discussion with everyone here. It's interesting also with the different viewpoints between premed, resident, attending as well as attendings who own clinics themselves (they have a unique HR viewpoint because at the end of the day patient care needs to be attended to and a clinic needs to function). I feel much better about decisions I'm contemplating. At this time, no intention to do anything with the LoR. In the career path, this employee will interact with different individuals/settings and there will continue to be many opportunities to grow and it will be up to her if she will use it as such. This helped me process some of my own guilt/conflicted feelings about actions to take. Some of this stems from the fact that speaking as an attending now (we were all premeds once upon a time), we do desperately want to see people succeed so there's a level of grief/empathy as well.

 

[Proudfather94]

Honestly I think cutting their hours or firing them should be enough. You could sit them down and explain how they're hurting patients with that type of behavior which is unacceptable for someone who wants to become a physician. Stealing time is not great either and you could tell them they're literally trying to steal from you. Hopefully that would give them the kick in the pants they need to modify their behavior.

 

[LizzyM]

If the applicant listed this job on the application and if the school that admits the applicant verifies the ECs with phone calls, it would be interesting to give the stop date of employment and say "would not rehire" (that's HR code for "was fired"). Fire her before the new year and save yourself the trouble of issuing a W2 for2022.

 

[allseasons]

If the applicant listed this job on the application and if the school that admits the applicant verifies the ECs with phone calls, it would be interesting to give the stop date of employment and say "would not rehire" (that's HR code for "was fired"). Fire her before the new year and save yourself the trouble of issuing a W2 for2022.

don't they usually verify around 3rd year (I think that's what @gonnif said).

 

[randomdoc1]

I agree with a lot of what has been said. Looking at this situation, the bigger picture of things is that there are far bigger lessons for this applicant to learn. Bring that attitude to medical school, residency, an employer---good luck. This will be much more for her to deal with than myself at the end of the day.

 

[proudofmykids]

To me, it sounds like this candidate is under new financial stress, and or a mental health issue flare-up considering the change of behavior. If your clinic is part of her student institution, can you pursue and IA for the time card issue? This could provide the right balance of fairness. Given their defiance to ignore your feedback, hopefully it is well documented and your can pursue terminating them from their position.
Based on your comment, I would place my bet on a mental health issue that almost sounds like their behavior coincides with a medication compliance change.

 

[nimbus]

Dr. Death probably had early signals like this too and he was passed along.

 

[Darrow O'Lykos]

As far as I am aware, almost never do they call LoR writers except when there is a mismatch between activity description and letter description. It's unlikely the please call message will do anything unless they have other reasons to suspect. Perhaps the best move here is to just fire her? I don't really see any way to rescind the letter at this point, barring blindly emailing 100+ schools.

Prior to my acceptance, my med school called all of my LoR authors (this was told to me directly by my LoR authors, and I was told the conversations were done with every matriculant).

Yea, the service is either AMCAS or AACOMAS, but I don't think either of them will actually rescind the letter even if you ask for them to. At this point it's already been sent to schools, and AMCAS no longer interacts unless there's a falsification proved. In your case, the letter was true at the time it was submit (and dated), so I don't think it would qualify.

Speaking from experience (long story), I know that AMCAS will send updates to all schools to which you submitted an app that are subjective in nature (not talking about transcripts, etc.) if they feel it is warranted (good or bad).

I agree that there are valid points on both sides of this discussion and that the decision on the correct course of action is ultimately OP's to make, however I think it's worth noting that this employee may end up with an acceptance that deprives another worthy applicant of an acceptance that doesn't lie to patients, steal time from their employer, or just overall give up on their commitment to someone they respected enough to request a LoR from in the first place. OP doesn't know theoretical applicant-B, but we all know there are countless worthy applicants each year that don't get a seat.

Sending an update in to AMCAS is doable and pretty straightforward, but it would certainly make a drastic impact. OP, it sounds like you've made earnest attempts to connect with them and that you want to see them succeed, but at a certain point the ethical shortcuts your employee is willing to take may be indicative of how they'll act in the future profession. I don't see much difference between that and termination of employment, because if they don't get an acceptance this cycle (which, silence from adcoms may explain the change of behavior depending on timing), then if you were to fire her prior to the next application cycle, then not only will she lose that clinical opportunity, but your reference for next year as well. I don't know how others feel, but I bet adcoms next year would see that as somewhat of a red flag anyway.

 

[DD214]

Dr. Death probably had early signals like this too and he was passed along.

and somehow graduated from a neurosurgery residency

I still can't get my head around that.

Not to derail the thread, but has there been any new information from the program who graduated him or did they lawyer up?

 

[ahnonemoose]

Yea, the service is either AMCAS or AACOMAS,

Only if not applying to Texas schools which use TMDSAS. There are 13 medical schools in Texas using TMDSAS with another one on the way.

 

[jamaica jan sun princess]

This behavior honestly doesn't surprise me after doing a post-bac and meeting some premeds.

 

[deleted1100659]

If shes that lazy I would wager shell end up failing out anyways, for what its worth.

 

[THEBACKANDFORTH]

OP, I'd just fire her and move on.

I wonder if it's less about becoming lazy after LOR and more about just feeling burned out tbh. It might be less manipulative than you think. Maybe she just feels severely underpaid, for example, as the job market is hot AF and even mcdonalds is paying 18/hr. Lots of reasons an employee may be unmotivated. Who knows if she even used your letter, also. I got multiple backup letters because letter writers can be unreliable. Did the same for residency and one of my favorite attendings failed to upload on time.

I can also tell you that med school and time make you more mature. I was serially late to jobs at the age of 22 and often ducked work (which was hard and payed 9.50/hr), but i can tell you as a 27 year old MS4 about to start residency i work diligently, read on my own time, and show up punctually.

Edit: You could even directly ask, why aren't you motivated to work hard. If you can't provide her what she needs for motivation, fire her. Maybe the correct answer is, 'oh you feel underpaid in the market right now, I'll raise your 11 dollars to 14 but if you don't work like you did this summer I'm going to have to let you go'

 

[F34Rit53lf]

I'm not sure if this is the best forum for this, but I'm writing as someone who wrote an LoR for someone applying to a professional school (e.g. medical, PA, etc.). At the time I wrote the letter, I felt comfortable enough to write a decent one. But afterwards, her behavior changed markedly. She works for my clinic and I've caught her packing on extra time she did not work, dragging her feet to get back to patient messages, even telling potential new patients we are not taking new patients when we clearly are. She'd try to find convenient excuses to work remotely from home, and when she does, there's unanswered emails to the clinic. I feel like I'm in an ethical bind. I understand the vulnerable position of applying to professional schools but at the same time, I'm having a hard time supporting someone who's character changed so much for potential involvement in the medical community. It feels like a good act was placed but once this student got what they wanted, everything was out the door. I will be having a discussion with her of reducing her hours, as she does not get much work done here and I don't have utility for that, but it leaves the question of what to do with this letter.

When I was in graduate school I was the student in this situation. I had an aunt take her own life and an uncle go to prison. I didn’t really understand the effect it was having on me (I.e missing deadlines, lack of reliability). My PI took my behavior as disrespect, when really it was grief, and refused to let me finish. My career never rebounded.

I’m not saying this is what’s going on with this individual necessarily, but there are other possible explanations. I would suggest having a discussion about the sudden flagging performance, as failure to fully understand the situation can make a bad situation worse for the individual. Assumptions can be dangerous.

 

[LadyDustyBlue]

Those are my thoughts exactly. I'm more concerned about the long haul. The HR/employment decisions can be pretty cut and dry. But as a psychiatrist, I always encourage people to look within themselves to examine the origins when stronger emotions come up and this is likely what's creating the most distress for me.

Wow, I thoroughly enjoy this discussion with everyone here. It's interesting also with the different viewpoints between premed, resident, attending as well as attendings who own clinics themselves (they have a unique HR viewpoint because at the end of the day patient care needs to be attended to and a clinic needs to function). I feel much better about decisions I'm contemplating. At this time, no intention to do anything with the LoR. In the career path, this employee will interact with different individuals/settings and there will continue to be many opportunities to grow and it will be up to her if she will use it as such. This helped me process some of my own guilt/conflicted feelings about actions to take. Some of this stems from the fact that speaking as an attending now (we were all premeds once upon a time), we do desperately want to see people succeed so there's a level of grief/empathy as well.

Truly, it’s out of your hands and I can see that this has caused you a lot of worry & anguish. Let this be a lesson learned and remember that whatever this employee is going through, they’ll likely learn the hard way for actions of dishonesty if the real effort that’s needed cannot possibly be sustained by them in the long-run. It isn’t for you at this point to mediate, as things will get more difficult if they can’t meet their challenges well/better.

However - I’ll say that there’s a difference between, say: stealing sauce packets from the back room or something trivial, and like changing the amount of hours you’ve worked to get more money.

But again, not everything is black-and-white. Whatever is going on in this person’s life, one way or another, there will be consequences with or without you having a discussion with them. Hopefully things get better, whatever it may be.

 

[SCallergydoc]

I had a front desk employee tell new patients we didn't have opening for months when we had some that week and every week after....she did not want to work very hard and open slots were easier for her. She was fired on the spot. If I had just written her a LOR, I would write to the board and tell them I was rescinding the letter. I would not explain why and let them decide on a course of action.

 

[Amed]

I'm not sure if this is the best forum for this, but I'm writing as someone who wrote an LoR for someone applying to a professional school (e.g. medical, PA, etc.). At the time I wrote the letter, I felt comfortable enough to write a decent one. But afterwards, her behavior changed markedly. She works for my clinic and I've caught her packing on extra time she did not work, dragging her feet to get back to patient messages, even telling potential new patients we are not taking new patients when we clearly are. She'd try to find convenient excuses to work remotely from home, and when she does, there's unanswered emails to the clinic. I feel like I'm in an ethical bind. I understand the vulnerable position of applying to professional schools but at the same time, I'm having a hard time supporting someone who's character changed so much for potential involvement in the medical community. It feels like a good act was placed but once this student got what they wanted, everything was out the door. I will be having a discussion with her of reducing her hours, as she does not get much work done here and I don't have utility for that, but it leaves the question of what to do with this letter.

Omg please don’t do that to her! I’ve never met the girl but that is a horrifying realization. She is probably under unbearable stress. I think you should let her work out her issues with mental health. Please, just give her the benefit of the doubt.

 

[Mr.Smile12]

I'm not sure if this is the best forum for this, but I'm writing as someone who wrote an LoR for someone applying to a professional school (e.g. medical, PA, etc.). At the time I wrote the letter, I felt comfortable enough to write a decent one. But afterwards, her behavior changed markedly. She works for my clinic and I've caught her packing on extra time she did not work, dragging her feet to get back to patient messages, even telling potential new patients we are not taking new patients when we clearly are. She'd try to find convenient excuses to work remotely from home, and when she does, there's unanswered emails to the clinic. I feel like I'm in an ethical bind. I understand the vulnerable position of applying to professional schools but at the same time, I'm having a hard time supporting someone who's character changed so much for potential involvement in the medical community. It feels like a good act was placed but once this student got what they wanted, everything was out the door. I will be having a discussion with her of reducing her hours, as she does not get much work done here and I don't have utility for that, but it leaves the question of what to do with this letter.

Does this person currently attend or recently graduated from a University with a prehealth advisor/office?

 

[THEBACKANDFORTH]

Does this person currently attend or recently graduated from a University with a prehealth advisor/office?

If you're suggesting OP influence a committee letter, that basically borders on malice. Also, I wonder if maybe FERPA protects OP from having a committee letter altered in such a fashion not consistent with established norms for the school and would certainly protect from the school having any sort of discussion with OP about student.

 

[Mr.Smile12]

If you're suggesting OP influence a committee letter, that basically borders on malice. Also, I wonder if maybe FERPA protects OP from having a committee letter altered in such a fashion not consistent with established norms for the school and would certainly protect from the school having any sort of discussion with OP about student.

It isn't clear whether a committee letter or letter packet is involved, but that isn't where I was going to suggest action at first. Also FERPA rights are waived in any letter of recommendation involving academic records. The advisor would be in a position to receive the information only.

I've received a few calls from similar writers in the past and basically said there was nothing that can be done once I submit the packet unless it were something truly extraordinary. But as an advisor I would want to know in case this is something I have also observed about the applicant from other references or professors. If the student is really experiencing something negative, we should try to help. Many on this thread have suggested some trouble or stress is a possible issue.

Likewise, no one in admissions is just going to accept a disgruntled call or email. We don't have the time.

 

[Lynx zwo drei vier]

I appreciate the input. Actually I've attempted some discussions as well as direct productive feedback about answering the messages in a timely way (or at all). And I constantly have to follow every task she's given due to the pattern of lack of follow through no matter how many times I've tried to discuss with her we all need to take ownership of what tasks we have at hand. I opened the discussion too about some behaviors I've noticed and she's saying everything's fine but it's still the same old behavior patterns no matter how much feedback or discussion is given. So I'm truly at a loss. She already is connected with mental health providers.

I'd recommend being gentle but transparent. Let her know that her earlier performance was excellent, and that you were happy to write the LoR, but be clear that her performance has subsequently declined. Don't sound threatening, but say that you're concerned that your LoR might not have represented her true enthusiasm for healthcare. You want her to know that these concerns are serious, but you also don't want her to panic, which would probably make her performance worsen.

Also, if you think that she trusts you enough for this kind of conversation, say that you're concerned about her mental health. Ask her if she thinks that she needs time off to work on it. Let her know that if this is the case, you won't hold it against her and that it will be confidential between the two of you.

 

[Matthew9Thirtyfive]

Dr. Death probably had early signals like this too and he was passed along.

And not even to his extreme. There are physicians out there who just cut little corners or don’t exactly do things the way they should be done, and I’d bet almost all of them had early signals that just got brushed under the rug due to our culture of not wanting to hurt someone’s career or make waves.

 

[Angus Avagadro]

Omg please don’t do that to her! I’ve never met the girl but that is a horrifying realization. She is probably under unbearable stress. I think you should let her work out her issues with mental health. Please, just give her the benefit of the doubt.

OP has counseled her as per their comments. Time card violations are in essence stealing. She should at the least be dismissed and f/u with her mental health providers. Remember as @Goro often says, med school is a crucible.....any underlying mental issues can be exacerbated even if under good control. I don't believe condoning inappropriate behavior by ignoring it or giving the benefit of the doubt is helping the student in the long run. I have had students drop out or take a year off to deal with mental health issues.

 

[Lynx zwo drei vier]

Dr. Death probably had early signals like this too and he was passed along.

I enjoyed that show, but I hate the way that this guy has suddenly become the go-to cautionary tale when it comes to underperforming students. He was a sociopathic fringe case. There are lots of people with work ethic issues, and >99% of them won't go on to become serial killers. Most of them will probably mature out of it, or be shaken out of it by a firm warning that they're screwing things up.

Obviously, it's best that one mature out of it before medical school, but this doesn't sound like a budding psychopath.

 

[Lynx zwo drei vier]

and somehow graduated from a neurosurgery residency

I still can't get my head around that.

Not to derail the thread, but has there been any new information from the program who graduated him or did they lawyer up?

This was in the days before EMRs were as widespread as they are now, so the paper trail is probably made out of literal paper.

And yeah, the University of Tennessee definitely has sought legal counsel over this.

 

[allseasons]

Prior to my acceptance, my med school called all of my LoR authors (this was told to me directly by my LoR authors, and I was told the conversations were done with every matriculant).



Speaking from experience (long story), I know that AMCAS will send updates to all schools to which you submitted an app that are subjective in nature (not talking about transcripts, etc.) if they feel it is warranted (good or bad).

I agree that there are valid points on both sides of this discussion and that the decision on the correct course of action is ultimately OP's to make, however I think it's worth noting that this employee may end up with an acceptance that deprives another worthy applicant of an acceptance that doesn't lie to patients, steal time from their employer, or just overall give up on their commitment to someone they respected enough to request a LoR from in the first place. OP doesn't know theoretical applicant-B, but we all know there are countless worthy applicants each year that don't get a seat.

Sending an update in to AMCAS is doable and pretty straightforward, but it would certainly make a drastic impact. OP, it sounds like you've made earnest attempts to connect with them and that you want to see them succeed, but at a certain point the ethical shortcuts your employee is willing to take may be indicative of how they'll act in the future profession. I don't see much difference between that and termination of employment, because if they don't get an acceptance this cycle (which, silence from adcoms may explain the change of behavior depending on timing), then if you were to fire her prior to the next application cycle, then not only will she lose that clinical opportunity, but your reference for next year as well. I don't know how others feel, but I bet adcoms next year would see that as somewhat of a red flag anyway.

What school was this, just curious? Between my friends and I, we have over 20 acceptances across 2 cycles and not once did this happen (calling recommenders). The only school I've seen that calls is cclcm, and even then only the research recommenders.

 

[randomdoc1]

Does this person currently attend or recently graduated from a University with a prehealth advisor/office?

She very well may. This employee is resourceful, is well established with a mental health provider at a clinic I know that has a good reputation. And I agree with what's been said in terms of, the ball is in her court. She has the resources so now it's up to her to make good use of them.

If shes that lazy I would wager shell end up failing out anyways, for what its worth.

I'd agree.

This discussion is great. As an update, to my knowledge, she had not gotten any acceptances currently and it sounds very slim on the interviews. I get it, it took me longer to get accepted but as most suggested, it's not an excuse for this behavior. She did on her own, quit. Which takes a huge emotional load off. It was interesting how it went down. There was a power outage at the clinic, usually the power comes right back in a couple of hours and her and another coworker were scheduled for that day. Together, they were really pushing for work from home with this attitude of "well I don't want to come in if there is nothing to do", full knowing if they get to work from home all day, their work is cut in half since they can't do in office procedures remotely. I'm like bruh, you still getting paid. Even if we still only have two hours with power left in the day, we can salvage the in office procedures that need to get done (and generate income---to pay YOU). The two of them together (and I suspect she was the leader on this) gave such an attitude that I called them back and said, if you want to work from home, wish granted (in reality, I did not feel like having them come in disgruntled with such a rotten attitude that would just make the atmosphere reek). But with the caveat that, unfortunately without the in office procedures, there's not enough work for both people for a full day, so how about you two decide who takes a half day (other half UNPAID of course). I was fed up with the attitude. If they wanted work from home so bad, they got it. I have a replacement now and the remaining employee seems to have gotten the message.

Sure enough, the power did come back in exactly two hours. That drama was started all for nothing.

Another point of this that really hit home is: this really isn't even the tip of the iceberg. The medical field is very trying and your limits won't just be pushed/tested...more like assaulted? lol. Even that at times can be an understatement. It's so hard to describe, I remember hearing this so much as a premed (and remember too well scouring this very forum in the early 2000's...wow, that sounds old), but there was no way I would have appreciated the true extent until already being in the midst of it. It does indeed call for certain characteristics.