Seriously? a red-flag for not getting a LOR. I am not sure about that, but I never sat on the admissions committee. However I would NOT think that this would be so heavily weighted. Yes it is important to get a LOR from programs:
- most improtantly is that the person you are asking will write you a good letter, they liked your work, you spent most your month with them gives them a better chance to get to know you & write you a letter
- particularly if that person is highly recognized by other in the specialty.
- an esteemed faculty member at the program you are rotating (i.e. dir of neurorehab/ program dir./ dept chair/ fellowship dir.)
- if you already have letters that are great or from very highly respected faculty I don't see why not getting a letter would be a red flag. How LORs does one really need??