Late switch letter of recommendation question

[brophtho]

MS4 applying anesthesia. I was a late switch (a couple months ago), and the issue is, my application screams ophtho, like dozens of ophtho pubs and leadership. An anesthesia advisor recommended I include a letter from an ophtho mentor to leave no doubt that I am not dual applying. I got to have a glance at the ophtho letter before he submitted, and it is strong but kind of just a regurgitation of my CV and not that personal. I don’t think it serves much purpose other than to reduce the reader’s fears about dual applying. I have 3 planned letters right now, 2 from anesthesiologists who I think should be strong and then a peds letter which I think should be fantastic.

My question, is it absolutely necessary to include this ophtho letter? Is there no other way on my application to tell I am not dual applying (no ophtho rotations, personal statement, etc.)? Thanks.

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[vector2]

MS4 applying anesthesia. I was a late switch (a couple months ago), and the issue is, my application screams ophtho, like dozens of ophtho pubs and leadership. An anesthesia advisor recommended I include a letter from an ophtho mentor to leave no doubt that I am not dual applying. I got to have a glance at the ophtho letter before he submitted, and it is strong but kind of just a regurgitation of my CV and not that personal. I don’t think it serves much purpose other than to reduce the reader’s fears about dual applying. I have 3 planned letters right now, 2 from anesthesiologists who I think should be strong and then a peds letter which I think should be fantastic.

My question, is it absolutely necessary to include this ophtho letter? Is there no other way on my application to tell I am not dual applying (no ophtho rotations, personal statement, etc.)? Thanks.

Why you not applying to ophtho? I mean...username was on track to check out.

 

[deleted875186]

MS4 applying anesthesia. I was a late switch (a couple months ago), and the issue is, my application screams ophtho, like dozens of ophtho pubs and leadership. An anesthesia advisor recommended I include a letter from an ophtho mentor to leave no doubt that I am not dual applying. I got to have a glance at the ophtho letter before he submitted, and it is strong but kind of just a regurgitation of my CV and not that personal. I don’t think it serves much purpose other than to reduce the reader’s fears about dual applying. I have 3 planned letters right now, 2 from anesthesiologists who I think should be strong and then a peds letter which I think should be fantastic.

My question, is it absolutely necessary to include this ophtho letter? Is there no other way on my application to tell I am not dual applying (no ophtho rotations, personal statement, etc.)? Thanks.

I would make sure it’s addressed in your personal statement why your switching. Make sure it’s addressed at interviews. Some places may still assume your applying as a backup.

 

[brophtho]

Why you not applying to ophtho? I mean...username was on track to check out.

After I got in with clinic and the OR, I realized that it was not the field for me. Lost too much medicine. Cataract surgeries weren't that interesting for me. Still enjoyed the short procedures and good lifestyle, and I realized I enjoyed more of the procedures and medical management anesthesia offers. Still has the opportunity for a cushy outpatient life in pain if I so desire, but leaning more towards ICU at the moment.

 

[brophtho]

I would make sure it’s addressed in your personal statement why your switching. Make sure it’s addressed at interviews. Some places may still assume your applying as a backup.

Would you recommend including it as a 4th letter, even if some may take it as a strong "lukewarm" letter? Not that many personal examples within the letter. I would want all of my letters to be as strong as possible

 

[nimbus]

A lot of switchers now with the booming anesthesia job market. Decent jobs in every market. Ophtho can be tough in the beginning and require exploitative buyins in desirable areas. Also PE risk in anesthesia is subsiding as the vultures recognize there will be much less opportunity to make money from anesthesia in the future. Ophtho (and ortho) are still ripe for them.

 

[nimbus]

After I got in with clinic and the OR, I realized that it was not the field for me. Lost too much medicine. Cataract surgeries weren't that interesting for me. Still enjoyed the short procedures and good lifestyle, and I realized I enjoyed more of the procedures and medical management anesthesia offers. Still has the opportunity for a cushy outpatient life in pain if I so desire, but leaning more towards ICU at the moment.

There are lots of long procedures and bad lifestyles in anesthesia. ICU can be even worse. We provide 24/7 in-house coverage with 22 anesthesiologists. The intensivists at our hospital also provide 24/7 in-house coverage but they do it with 8 doctors. Ophtho (and chronic pain) are rarely seen on nights/weekends/holidays. Literally a half dozen times/year.

 

[brophtho]

There are lots of long procedures and bad lifestyles in anesthesia. ICU can be even worse. We provide 24/7 in-house coverage with 22 anesthesiologists. The intensivists at our hospital also provide 24/7 in-house coverage but they do it with 8 doctors. Ophtho (and chronic pain) are rarely seen on nights/weekends/holidays. Literally a half dozen times/year.

I don't mind the "bad lifestyle" as much. To be honest, that was one of the things which turned me off from ophtho was how everyone was so obsessed with getting off work ASAP. I like to stay and make sure my work is complete before going home. I enjoy the fast-acting OR medicine, being able to push a drug and immediately see the effects on blood pressure, etc. Feels very fun to me, almost like a videogame. I enjoy the cardiopulmonary physiology and how everything is intertwined in anesthesia. I am leaning more towards ICU/cardiac at the moment, but pain is always an option if I change my mind.

 

[nimbus]

I don't mind the "bad lifestyle" as much. To be honest, that was one of the things which turned me off from ophtho was how everyone was so obsessed with getting off work ASAP. I like to stay and make sure my work is complete before going home. I enjoy the fast-acting OR medicine, being able to push a drug and immediately see the effects on blood pressure, etc. Feels very fun to me, almost like a videogame. I enjoy the cardiopulmonary physiology and how everything is intertwined in anesthesia. I am leaning more towards ICU/cardiac at the moment, but pain is always an option if I change my mind.

It is fun which is what makes the bad lifestyle bearable.

 

[vector2]

. To be honest, that was one of the things which turned me off from ophtho was how everyone was so obsessed with getting off work ASAP. I like to stay and make sure my work is complete before going home.

99.999% chance your attitude toward work hours will be different 10 yrs from now.

 

[deleted875186]

Would you recommend including it as a 4th letter, even if some may take it as a strong "lukewarm" letter? Not that many personal examples within the letter. I would want all of my letters to be as strong as possible

I reviewed apps and interviewed for my residency during training. Most of the time the PD knows when people are applying as a backup, usually ortho/ortho/ENT applicants. I think a lukewarm letter is neither good nor bad, if it helps explain why your switching to anesthesia than I think it is helpful.

Honestly though, most applicants like yourself have good boards and overall good app, and if you’ve published some stuff, the anesthesia program looks at is as someone who will produce some academic stuff for them and make them look good, so I think you’ll be fine.

 

[Drwine]

IMHO there shouldn't be stigma in having a backup plan for applying to a specialty that has intense competition. If an applicant doesn't get into medical in the US there is a chance to study medicine abroad. There is no option to go abroad to do a residency and return to the US to practice. My first choice was ophthalmology and anesthesiology was my backup. Forty years later I have no regrets that ended up with my second choice. Everything is a trade off. If I was an ophthalmologist in private practice, 3 week ski trips would not have been a reality.

 

[GassYous]

I don't mind the "bad lifestyle" as much. To be honest, that was one of the things which turned me off from ophtho was how everyone was so obsessed with getting off work ASAP. I like to stay and make sure my work is complete before going home. I enjoy the fast-acting OR medicine, being able to push a drug and immediately see the effects on blood pressure, etc. Feels very fun to me, almost like a videogame. I enjoy the cardiopulmonary physiology and how everything is intertwined in anesthesia. I am leaning more towards ICU/cardiac at the moment, but pain is always an option if I change my mind.

Why wouldn't you want to get off work asap?

 

[deleted875186]

IMHO there shouldn't be stigma in having a backup plan for applying to a specialty that has intense competition. If an applicant doesn't get into medical in the US there is a chance to study medicine abroad. There is no option to go abroad to do a residency and return to the US to practice. My first choice was ophthalmology and anesthesiology was my backup. Forty years later I have no regrets that ended up with my second choice. Everything is a trade off. If I was an ophthalmologist in private practice, 3 week ski trips would not have been a reality.

It’s not stigma, it’s how the match works.

Programs want to interview applicants that will rank them highly, so they don’t go too far down their list to fill. If your applying backup, it’s very low likelihood you’ll end up with the program, they don’t want to waste an interview spot.

 

[nimbus]

IMHO there shouldn't be stigma in having a backup plan for applying to a specialty that has intense competition. If an applicant doesn't get into medical in the US there is a chance to study medicine abroad. There is no option to go abroad to do a residency and return to the US to practice. My first choice was ophthalmology and anesthesiology was my backup. Forty years later I have no regrets that ended up with my second choice. Everything is a trade off. If I was an ophthalmologist in private practice, 3 week ski trips would not have been a reality.

I work with a retina guy who has a house in Telluride and goes to Alaska every year to heliski. It helps to maintain a stable of young associates who stay with you for 2 years before moving on.

 

[AnonymousPD]

OP,

Just some free advice from someone on the other end of the recruitment equation. You are right to assume that focus on optho-related activities in your application will spur all sorts of assumptions on the program end of things. This is something that happens fairly commonly, and I can confirm that the initial reaction will be that you are either dual applying, or things are going poorly for you in the early optho match.

But this is an easy problem to solve. All you need to do is authentically describe your change of heart either in your personal statement or during your interview. Unless you have a more compelling thing to write about in your personal statement, my advice would be to put it there. Otherwise there will be some who read your application without taking it seriously for the reasons above. If you wait until interviews...then my advice is to proactively talk about it as soon as you can. Don't wait until someone asks you about it.

In-demand programs have a lot of applicants to choose from. They will rarely spend time or offer a valuable interview position on someone who they feel might not be serious about the specialty.