Sep 14, 2015
I was originally going to send just 3 rad onc letters (home chair, away PD, research) but recently heard that it could be somewhat helpful to send a medicine letter, so I have decided to recycle one of my prelim IM letters for the rad onc application, but I am not sure which. My choices are:
-3rd year clerkship (summary of the whole rotation/department letter)
-sub I director (sort of a summary letter for the rotation)
-sub I attending

I could also ask for a letter that combines the 3rd and 4th year (sub I) rotations and is a summary of all of my IM experiences.

It seems like a lot of people in similar shoes choose the sub I attending but while he told me it was a strong letter, I only worked with the attending for 1 week, whereas the sub I director has comments from all 4 attendings I worked with plus all of the supervising residents, so it might be overall better or have more nice superlatives. However, is it typical to use a rotation director's letter for this position? Thank you in advance.


5+ Year Member
May 20, 2010
Medical Student
Anecdotally, I applied last year and sent only rad onc letters to every rad onc program I applied to, unless there was a requirement for IM letter (penn). I don't think you should worry too too much about this advice to definitely send an IM letter- your goal should just be to send good/strong letters and if your rad onc letters are going to be better, just use those. If you already have a strong IM letter from your sub-I attending I would go ahead and use that if you really want to include something from your medicine experiences- but not necessary in most cases


Total nerd
Staff member
15+ Year Member
Mar 14, 2002
the beach
Attending Physician
There's no right answer here. I think three rad onc letters plus a medicine letter is very reasonable.

I'd use whichever medicine letter is strongest. See if someone in your med school office is willing to read the letters and give you their opinion on which is the strongest letter. Then use that one. If that can't be done or they are equally strong, you can just pick one based on some arbitrary criteria: is it a med onc someone might know? Is it a big name within the medicine community someone might know? Otherwise just pick one. It's not make or break, but it certainly won't hurt to add in a strong medicine letter.
Sep 14, 2015
Ok so I decided I definitely do want this medicine letter included...the only thing I am debating is whether to send a letter from an attending from my sub I or the director of the sub I. I worked with 4 different attendings (1 per week) so I am assuming the director letter will have a range of comments (hopefully the best of each evaluation). The specific attending I have a letter from got along really well with me and I liked working with him, so it might be a more personal letter, although has the downside that it will not convey the sense that multiple attendings liked working with me etc. What are ya'lls thoughts on which of these two to use?


5+ Year Member
Aug 10, 2011
Medical Student
Thanks md228 for the heads up on UPenn requiring an IM letter. To your knowledge, are there any other programs that have odd LOR requirements?