Chairman LOR and other options

[jihu]

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I've spoken with several MS4's from my med school who are headed into various gen surg programs, and I've received several warnings to expect very little support from the chairman of our home program. Apparently, the chair strongly wants to keep our med students as residents, and will do very little to support applications elsewhere. Our school isn't anywhere near top 50, so it's not difficult to imagine wanting to net as many US grads as possible. Some have even speculated that, beyond not supporting our application, active sabotage might be possible.

Strong candidates (240+, AOA, etc) received pretty lukewarm LOR's from the chairman, and their requests to make key phone calls to various programs were flat-out refused ("I don't know the PD personally, so I don't see the point." was one excuse given). Our med students haven't been tremendously successful in the gen surg match in recent years, and our predecessors have apparently faced similar difficulties with our chairman.

I understand that the LOR from the chairman is an important piece of the application and The Phone Call can be pretty effective, too. I'm more than a little nervous about the situation with our chairman. I've set up at least one away rotation where I hope to get a VIP letter, but what other options do I have? I've even considered NOT waiving my right to read the letter, just to make sure something shady doesn't end up in my file.

I'm not an all-star, but my record isn't bad (Step 1:225, Honors in Surg, Med, Peds so far). I could use all the help I can get. What should I do?

 

[avgjoe]

I've spoken with several MS4's from my med school who are headed into various gen surg programs, and I've received several warnings to expect very little support from the chairman of our home program. Apparently, the chair strongly wants to keep our med students as residents, and will do very little to support applications elsewhere. Our school isn't anywhere near top 50, so it's not difficult to imagine wanting to net as many US grads as possible. Some have even speculated that, beyond not supporting our application, active sabotage might be possible.

Strong candidates (240+, AOA, etc) received pretty lukewarm LOR's from the chairman, and their requests to make key phone calls to various programs were flat-out refused ("I don't know the PD personally, so I don't see the point." was one excuse given). Our med students haven't been tremendously successful in the gen surg match in recent years, and our predecessors have apparently faced similar difficulties with our chairman.

I understand that the LOR from the chairman is an important piece of the application and The Phone Call can be pretty effective, too. I'm more than a little nervous about the situation with our chairman. I've set up at least one away rotation where I hope to get a VIP letter, but what other options do I have? I've even considered NOT waiving my right to read the letter, just to make sure something shady doesn't end up in my file.

I'm not an all-star, but my record isn't bad (Step 1:225, Honors in Surg, Med, Peds so far). I could use all the help I can get. What should I do?

hey jihu .. good that you wrote. it does sound like a fairly sticky situation, especially since it sounds like most people want to leave.
In terms of your application besides the LORs, your stats seem fine. You may want to take step II early if you think you'll do well in it (and seems like since you have a fair amout of honors you will). Any research possibilities? That will give you a good extra person to write a letter as well.

In terms of the LOR business - first of all, yes, it does help if a chairman writes a letter, but it's not absolutely mandatory. If you're that concerned about it, I would think strongly about getting a fourth letter from someone else. Other high-level attendings at your institution, the high profile guy from your away rotaiton (a great idea), etc. If you have certain places you particularly are considering going for residency, I would also really strongly encourage doing away rotations so they can see how great you are 🙂. You can then get their LORs as well..

About the phone calls, I never had one officially made for me and matched at my number one.. At the same time, I think surgery is a small enough world that you don't actually need an official phone call - people from other institutions often will be collaborating with people from yours, and will contact them if they have any questions. They may even run into them at a random conference and mention that oh we interviewed so-and-so.. how is he? type of thing. So for that be close with a lot of your top faculty, not just the chairman. And also, ask those you are close to to make the phone calls for you if you think it will help - they will often know the right people in the other institution and will be happy to help.

Basically the bottom line is these are all strategies to get around your chairman and not have his strategy affect you too much. Good luck!

 

[drrouz]

It is a tricky situation indeed. I feel bad for you, I mean wtf? I agree with what avgjoe recommends. The only thing I would add is that a good number of programs I applied to specifically required a letter from the chairman to complete the application (you can find this information out by visiting the programs website, it will not be posted on FRIEDA). So I'm afraid you will need one from this chairman for these programs. Remember that ERAS allows you to select where each letter is released to. So you don't have to release the chairman letter to programs that don't require it.
I'm going to go out on a limb here and say that if you are that concerned about what will be in the letter, do not waive your right to see the letter. I doubt anyone will call you on it, but if they do maybe you can find a tactful way to explain the situation without badmouthing your chairman. A bad/lukewarm letter from your chairman can in my opinion ruin your application, why take the chance? Having an open letter may also make the chairman more careful in what he/she wirtes. I would make sure the other letters are from well placed people though, and definately waive your right to see those. Good luck.

 

[Kopa]

Does the Chairman's letter have to come from your home program, or can it be a letter from a chairman at a different program?

 

[jihu]

Thanks for the input. I'll think about not waiving my right to read the chairman letter, but I might want to avoid annoying him if I can (in the past few years, I've learned never to be shocked at the level of pettiness that comes out of grown men and women).

And avgjoe, you're definitely correct about most people wanting to avoid getting snared in our program--many of the residents are sincerely miserable, and the reviews posted on scutwork are scathing.

As for taking Step 2 early, I have it scheduled in October (I wanted to do my surgery Sub-I's early in order to make sure my letters and application would be complete when they needed to be). This is a little off-topic, but:
Some programs seem to prefer or require a Step 2 score for consideration for admission--does this mean I need to have it in time to be invited for an interview, or just done by the end of November to have it help me get ranked higher?

Anyway, thanks for all your help guys.

 

[drpectin]

Thanks for the input. I'll think about not waiving my right to read the chairman letter, but I might want to avoid annoying him if I can (in the past few years, I've learned never to be shocked at the level of pettiness that comes out of grown men and women).



Anyway, thanks for all your help guys.

You are absolutely correct about the pettiness out of grown men and women. One thing you can never change, there will always be someone who dislikes you for no particular reason.

As for the Step 2, I for one and putting off taking it. I think that it will preclude an interview with some places, like University of Chicago, while others mainly state that Step 2 is required for entrance into the program (I have to take both step 2 exams to graduate anyway).

In the end I don't know, all of our clerkships had NBME shelf exams and I did okay on those so I'm not worried. If you are taking step 2 early make sure to note the score on your application as soon as possible. All MSPE's aren't released until Nov 1, so they have to download at least once so if your score is up they will see it. However if you get your score later, you will have to notify every program (that offered an interview) of your score.

 

[Dr. V]

As for taking Step 2 early, I have it scheduled in October (I wanted to do my surgery Sub-I's early in order to make sure my letters and application would be complete when they needed to be). This is a little off-topic, but:
Some programs seem to prefer or require a Step 2 score for consideration for admission--does this mean I need to have it in time to be invited for an interview, or just done by the end of November to have it help me get ranked higher?

Anyway, thanks for all your help guys.

Yes, there are MANY programs that require you to have taken Step II and have at least made their individual minimum score before they will schedule an interview. One of my classmates missed out on some interviews because her step II score was late getting in and they had filled up all their days before she got her scores. She did well, and one of them squeezed her in anyway, but it still happened. (She still got her #1 choice but it COULD have been a disaster).

 

[drpectin]

duplicate

 

[drpectin]

Yes, there are MANY programs that require you to have taken Step II and have at least made their individual minimum score before they will schedule an interview. One of my classmates missed out on some interviews because her step II score was late getting in and they had filled up all their days before she got her scores. She did well, and one of them squeezed her in anyway, but it still happened. (She still got her #1 choice but it COULD have been a disaster).

Could you name some of these many programs that REQUIRE step II?

I've looked through the ACS and Freida and University of chicago is the only one with such strict language. Or least of the programs that I'm interested in.

 

[Ergo]

duplicate

 

[Ergo]

Dont trust this guy (chairman) to write anything stellar. Sounds like he isnt supporting his grads, which hurts. So, do two away rotations at places you might want to go. First one should be an awesome place, an ivory tower like Pitt, Michigan, Vanderbilt or some other well known surgery powerhouse then get letters from people there. Do a second away at a very good program in a place you'd like to be. A great rotation will nearly guarantee an interview and will likely get you LOR. Use those letters. 225 isnt bad, by the way.
PM me for more info if you want...


By the way, they were REALLY nice at Vanderbilt. Seem like they are approachable for a letter.

I've spoken with several MS4's from my med school who are headed into various gen surg programs, and I've received several warnings to expect very little support from the chairman of our home program. Apparently, the chair strongly wants to keep our med students as residents, and will do very little to support applications elsewhere. Our school isn't anywhere near top 50, so it's not difficult to imagine wanting to net as many US grads as possible. Some have even speculated that, beyond not supporting our application, active sabotage might be possible.

Strong candidates (240+, AOA, etc) received pretty lukewarm LOR's from the chairman, and their requests to make key phone calls to various programs were flat-out refused ("I don't know the PD personally, so I don't see the point." was one excuse given). Our med students haven't been tremendously successful in the gen surg match in recent years, and our predecessors have apparently faced similar difficulties with our chairman.

I understand that the LOR from the chairman is an important piece of the application and The Phone Call can be pretty effective, too. I'm more than a little nervous about the situation with our chairman. I've set up at least one away rotation where I hope to get a VIP letter, but what other options do I have? I've even considered NOT waiving my right to read the letter, just to make sure something shady doesn't end up in my file.

I'm not an all-star, but my record isn't bad (Step 1:225, Honors in Surg, Med, Peds so far). I could use all the help I can get. What should I do?

 

[Ergo]

Does the Chairman's letter have to come from your home program, or can it be a letter from a chairman at a different program?

Letters from other chairmen work great if people know them. At least one letter needs to come from your home school. If the chairman is going to sabotauge (sp?) you then use a surg faculty youve worked with alot.

I took step 2 late, just read secrets a few times, and did fine. Its just easier than step 1 after taking all hose NBME exams during 3rd year. Noone cared about the fact that I hadn't taken it.

Most important thing is LOR and who you know. Rotations WORK if you WORK.

 

[Dr. V]

Could you name some of these many programs that REQUIRE step II?

I've looked through the ACS and Freida and University of chicago is the only one with such strict language. Or least of the programs that I'm interested in.

Well if you are in NJ you likely won't be interested in them because they are in the south, but most of the time this was conveyed in the letters for interviews and not on their websites etc.

I remember that Mercer and Savannah both off the top of my head, I THINK Charlotte, Greenville, Spartanburg, and Chattanooga as well. I would have to look back through my emails and go to their individual web sites to be sure.

That's the best way to know, go to their specific sites or call them.

Of course if you blow the top off step I they likely won't hold you back, but otherwise many of the ones in the South want to see both steps. I interviewed at several places with a guy from Louisville who said that even those that didn't require sometimes acted as if they would be more comfortable if he had his scores. Don't know how much truth there is to that because I wasn't in his shoes but he didn't seem like the type to make stuff up.

Here is the exerpt from the e-mail Savannah sent me.

"Thank you for applying to our General Surgery Residency program at Memorial
Health University Medical Center in Savannah, Georgia. Our program requires
that you score a minimum of 200 or more on USMLE Step 1 and Step 2. Your Step 1 score is above our minimum requirement, however, your Step 2 score is not yet in ERAS. I will need these scores before you can be invited to interview with us."

This was the first response I got. I had it and one other and didn't hear anything for a while and honestly got worried. Then after my Step II was posted to ERAS the interviews started rolling in. Did it have anything to do with it or was it a coincidence? Well for at least a few of those schools I know it was policy, the others maybe it was coincidence. Savannah and Mercer both have it as policy on their web pages.

PS: For the origional poster, don't worry your numbers are better than mine were, I only had a 215 on step 1. I applied to 21 programs, got interviews to 17, 1 rejection letter (Vanderbilt) and I guess 3 didn't care enough to send one LOL. Oh yeah, I got my #1 choice too. You should be fine if you keep the chair from gettin ya.

 

[Dr. V]

Well I just researched it a little more by going to each individual programs website that I applied to.

Here's the list that require you to have step II to interview according to their web sites that I applied to.

Mercer in Macon and Savannah, University of Alabama Birmingham, University of Kentucky, University of Louisville (I was almost positive they didn't after interviewing with that guy, go figgure), University of South Carolina, and Erlanger in Chattanooga. These all said no interviews without completed appications, and step II must be included for an application to be complete.

Unclear Vanderbilt said that only completed applications with the exception of the deans letters would be reviewed for interviews, but stopped short of defining completion as having step II in. Virginia Commonwealth specifically stated that Step II was required for the application to be complete, but did not say they needed a complete application to schedule an interview. Both said the application had to be completed by their deadline though.

I THINK that Greenville and Spartanburg SC both required it, but take that with a grain of salt because I thought Medical College of Georgia did too and they specifically say they do not. 😱 😀

I also see another thread that has been started that listed three or four that I didn't apply to and didn't research.

So, it would be in anyones best interest to at least find out about the ones they are interested in before assuming they don't need step II to get an interview.

 

[jayman]

That sucks dude.

You know, chairpersons (new P.C. term) should be supportive at a time like this. The chairperson of surgery at my medical school when I applied this past year definitely had the opposite POV - he wanted to have a mix in his incoming intern class. Just goes to show. But to screw you over just so he/she can keep you sounds pretty pathetic. The job of the chairperson is to make the program better so that crap like this doesn't have to happen in order to draw good applicants.

Sorry for your dilemma. I guess try not to piss him off - if he's a really big guy in the surgery world, definitely don't. And if you suspect that he'd burn you if he realized that you don't want to stay at your home institution, then definitely don't be candid with him about your plans and don't have him write a letter for you. Get only surgeons to write your LORs, though!

Good luck.

 

[jayman]

I had posted this on another thread, but just wanted to say that it was my experience that having Step 2 CK by interview time in order to get an invite was not strictly adhered to at all.

Just study hard and do well.

 

[jihu]

And if you suspect that he'd burn you if he realized that you don't want to stay at your home institution, then definitely don't be candid with him about your plans and don't have him write a letter for you. Get only surgeons to write your LORs, though!

Good luck.

Thanks for everyone's advice, and for your sympathies 🙂 Jayman, it sounds like I'll have to get a letter from the chair in order to apply to certain programs. It guess the goal now is to not piss him off, and consider not waiving my right to read the letter.

What's especially annoying is the fact that the LOR could be a considerable boost to our med students' apps--the chair is a recognizable entity in the surgical arena. I've also thought about bringing up the issue with the Dean of Students, but ended up concluding that it would be largely ineffective and sound accusatory without any evidence. Still, maybe consistent complaints from several people over the years might do something for future applicants. I don't know.

All this talk about Step 2 scores makes me think about shuffling my 4th year schedule. It's a little confusing--some people say that it's important to have a Step 2 score locked in early, whereas other people say that having at least 3 LOR's in the bag should take precedence. I didn't get any LOR's from my MS3 year, so I have to start collecting them starting July. From July-October, I wanted to squeeze in 3 months of AI's (1 home, 2 away) and a month of something light while studying for Step 2. If I start with Step 2, and then jump into my rotations in August, I might not have my letters done in time.

Anyone have thoughts on Step 2 vs. LOR's?

 

[Dr. V]

All this talk about Step 2 scores makes me think about shuffling my 4th year schedule. It's a little confusing--some people say that it's important to have a Step 2 score locked in early, whereas other people say that having at least 3 LOR's in the bag should take precedence. I didn't get any LOR's from my MS3 year, so I have to start collecting them starting July. From July-October, I wanted to squeeze in 3 months of AI's (1 home, 2 away) and a month of something light while studying for Step 2. If I start with Step 2, and then jump into my rotations in August, I might not have my letters done in time.

Anyone have thoughts on Step 2 vs. LOR's?

Well it's confusing because both opinions are correct 😕 😕

I would venture to guess the ones that it didn't matter for had very, very good scores on Step I, and the ones like myself where it did matter (you saw my letter from Savannah) had average to below average Step I scores. I didn't realize so many of the programs I applied to had that "policy", and it explains why my interviews started rolling in after I had Step II in (keep in mind I didn't perform nearly as well as most people on this board did, I only got a 215 on step I). I would say the higher your score on Step I the more likely a program is to be lenient with having Step II in before getting an interview.

Those programs that say they require Step II before interviews also "officially" require all the LOR's for interviews as well. I would bet that would be the same though, the better you look on paper the more liberal they will be with their interpretation of a "complete application".

Your step I is much better than mine so it may never be an issue for you. On the other hand it might and you only get one shot at this. It wouldn't hurt to check on the programs you really want to go to and feel them out.

 

[jayman]

Agreed with the above poster...for the most part.

It's a little tricky. You just have to decide what needs to be attacked first. If you like your Step 1 score and really want to rack up several LORs in your first few months, I think that's fine. The flip side of that coin is also okay if you're going to worry about whether your Step 1 score or not will close any doors for you.

With regards to contacting programs: if it's their "policy" that you have to have Step 2 in before they'll grant you an interview, they will not tell you over the phone that it only applies to applicants who have a "questionable" Step 1 score. You just have to decide if you feel comfortable with your score and kind of wing it from there...that being said, if you wait until October to take Step 2, I think your scores will be in with enough time for you to get interviews based on that...assuming that what was holding them up.

Good luck.

 

[Roux-en-Y]

"In terms of the LOR business - first of all, yes, it does help if a chairman writes a letter, but it's not absolutely mandatory. If you're that concerned about it, I would think strongly about getting a fourth letter from someone else. Other high-level attendings at your institution, the high profile guy from your away rotaiton (a great idea), etc. If you have certain places you particularly are considering going for residency, I would also really strongly encourage doing away rotations so they can see [/COLOR] how great you are 🙂. You can then get their LORs as well.."[/COLOR][/PHP]
I disagree with your first sentence. You MUST have a LOR from your dept chair. Not having one is a BIG RED FLAG. I would do AT LEAST 2 away rotations and try to do them on the PROGRAM DIRECTOR'S service. At the end of your rotation, make an appt w/ each away program director and sit down and voice your concern re LOR from home chair. Your home chair may be "notorious" for doing this within the academic community; that is it may be well known by other PD's that this is how he operates (no pun intended). Also, talk to/ make conact with previous grads who matched at different locations and consider doing an away there.
Best of luck.

 

[debvz]

Well I just researched it a little more by going to each individual programs website that I applied to.

Here's the list that require you to have step II to interview according to their web sites that I applied to.

Mercer in Macon and Savannah, University of Alabama Birmingham, University of Kentucky, University of Louisville (I was almost positive they didn't after interviewing with that guy, go figgure), University of South Carolina, and Erlanger in Chattanooga. These all said no interviews without completed appications, and step II must be included for an application to be complete.

So, it would be in anyones best interest to at least find out about the ones they are interested in before assuming they don't need step II to get an interview.

From my interviewing experience (upcoming PGY-2), I took step 2 late Oct, and didnt receive my scores til late Nov. I, too, was concerned about interviewing b/c of what the many sites said about requiring step 2 prior to granting interviews, but...

Contrary to what their websites said, I received interviews at UAB, U of Ky, U of Louisville, and Chattanooga prior to my step 2 score becoming available.

My full list of applications did not require step 2, except for Savannah. I had already completed interviews at Scott and White, U Miss, U Ky, and I received my scores the evening prior to my U of Louisville interview.

In summary, the following did NOT require step 2 scores prior to offering interview:

Baylor-Dallas
Baylor-Houston
Christus-St.Joseph (Tx)
Emory
EVMS
LSU-New Orleans
LSU-Shreveport
MCG
Scott and White-Temple,TX
UAB
U Arkansas
U Florida - Gainesville
U Florida - Jacksonville
U Kentucky
U Louisville
U Mississippi
U Oklahoma
UT-Chattanooga
UT-Knoxville
UT-Memphis
UTx-Houston
UTx-MB- Galveston
UTx-San Antonio
West Va Univ

Hope this helps, and good luck!