Letter of rec angst

[betterweather]

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I am an allied health provider (think OT/SLP/Dietician/etc) that sees patients both independently and with a physician. In order to do what I do, I attended a professional masters program that is generally considered similarly difficult to get into compared to medical school. I've been working at the same clinic with the same physicians since I graduated 2.5 years ago.

I like what I do, but it's not enough for me. And, without going into too much detail, it's not enough for my community, either: there is a desperate need for more MDs like the two I work with. So I'm going to medical school. I'm getting my ducks in a row to apply 2022-2023.

While this is not a huge surprise for the people who know me well, I think it will seem like quite a reversal to my professional/academic contacts, and I have much apprehension about having to explain why I now suddenly (in their minds) want to be a doctor when I had previously told them or at least strongly implied that I did not. I'm planning to ask for letters of rec from folks in these three categories:

1) My graduate school professors: No getting around this, but these are the people I most dread tell about my med school plans. That's because in order to get into masters programs in my field, you really have to convince the admission committee that you're NOT using it as a SMP-type application booster for med school. Which I wasn't! That wasn't my plan - I just changed! But approaching these people, who so graciously admitted me to the program and taught me so much, and telling them I no longer want to do what they trained me to do feels like a betrayal.

2) The physicians that I work with: I haven't talked to them about my plans to apply to medical school, and so it's really going to come out of the blue here. I'm nervous that they'll think I'm too old (early 30s) and foolish, and that it will necessitate sharing details about my personal life/finances to explain how I'm gonna swing the long hours and not having an income. Also, there's something that feels hubristic about it, like I'm telling a doctor that after seeing them do things for a couple years, I think I could probably do what they do. Not to mention, I'm basically telling them that I hope to quit my job next year, which is a minor hassle for them.

3) My undergraduate research PI: This one just feels rude because she wrote me a letter of rec when I applied for my masters, and now, after not seeing her for like 6 years, I'm asking her to do it again.

Any advice about how to approach this? Stories about your experiences getting letters of recommendation in a similar situation? General pep talk about, uh, coming out as a non-traditional pre-med to my professional network?

 

[deleted367183]

I don’t think you need to/possibly don’t think you should get letters from your grad school profs. If at all possible, your science letters should be from actual basic science people that you encounter during prereqs. Of course I could be proven wrong by a truly exceptional relationship you have with one of them.

Don’t think twice about your undergrad PI. Writing letters whenever someone wants one is part of their job.

I was in nursing school (oops) when I switched to medicine and all the MDs I worked with were happy for me. To the best of my knowledge, you only want one physician letter, anyway, and it’s totally optional unless you’re applying DO.

My letters were one from my humanities undergrad advisor, whom I was close to; postbac lab PI slash 400-level science prof; and 400-level science professor.

 

[betterweather]

I talked to one of the admission directors at my top school, and she agreed that I needed 1 or 2 professors from my graduate program (which is was absolutely a hard science program - I think my comparison allied health things maybe made it seem less so, but I had plenty of classes like metabolism, embryology, teratology, etc, some of which were also attended by residents/fellows) The admissions director felt that a letter from my PI professor was optional, since it was so long ago, and that the grad school profs would be a good choice since it grad school was more recent and the professors know me so much better (my cohort had 7 people, so they got to know each of us pretty well...)

I'm not sure that the letters from the physicians I work with are exactly the same as the typical "physician letters" from physicians that applicants shadowed for a few hours. These are collegues I have worked closely with every day for years. They're the closest thing I have to a direct supervisor at work, meaning as a non-traditional student omitting them would look kind of suspicious. They're also both professors at the medical school, which probably doesn't hurt? The admission director said one would be sufficient but that there's no reason they both couldn't write a letter (I can have up to 5) if they would both say positive things about me.

I think the first step is to talk to them about my plans to apply, like, as if I am still deciding and am seeking advice. It's honestly weird that I haven't done this already - I've talked to half a dozen other physicians, but not the two I spend all day with. I guess I am just scared they'll be discouraging, which is maybe a fear I should unpack...

 

[Bonne Nuit]

I talked to one of the admission directors at my top school, and she agreed that I needed 1 or 2 professors from my graduate program (which is was absolutely a hard science program - I think my comparison allied health things maybe made it seem less so, but I had plenty of classes like metabolism, embryology, teratology, etc, some of which were also attended by residents/fellows) The admissions director felt that a letter from my PI professor was optional, since it was so long ago, and that the grad school profs would be a good choice since it grad school was more recent and the professors know me so much better (my cohort had 7 people, so they got to know each of us pretty well...)

I'm not sure that the letters from the physicians I work with are exactly the same as the typical "physician letters" from physicians that applicants shadowed for a few hours. These are collegues I have worked closely with every day for years. They're the closest thing I have to a direct supervisor at work, meaning as a non-traditional student omitting them would look kind of suspicious. They're also both professors at the medical school, which probably doesn't hurt? The admission director said one would be sufficient but that there's no reason they both couldn't write a letter (I can have up to 5) if they would both say positive things about me.

I think the first step is to talk to them about my plans to apply, like, as if I am still deciding and am seeking advice. It's honestly weird that I haven't done this already - I've talked to half a dozen other physicians, but not the two I spend all day with. I guess I am just scared they'll be discouraging, which is maybe a fear I should unpack...

So you’re aware, many medical schools require several academic letters. One school I applied to required 4. Only one or two programs asked me for a supervisor/mentor letter.

Do you have all your medical school prerequisites completed?

 

[betterweather]

I'm missing physics, working on it now, but its online because of covid so I have pretty much no interaction with the professor.

The school I'm applying to (probably only this one, early decision - I know everyone basically recommends against this. I know.) requires 3 academic letters, but students who have been out of school for more than 2 years can substitute up to 2 of them with "employer letters from a direct supervisor, a letter from a research PI/supervisor or letters from a substantive volunteer environment."

But my grad school program director (who taught some health science courses), grad school thesis committee chair (who taught some health science courses), and my molecular biology lab PI (from whom I took microbio) would all count as academic anyway, right?

 

[Bonne Nuit]

I'm missing physics, working on it now, but its online because of covid so I have pretty much no interaction with the professor.

The school I'm applying to (probably only this one, early decision - I know everyone basically recommends against this. I know.) requires 3 academic letters, but students who have been out of school for more than 2 years can substitute up to 2 of them with "employer letters from a direct supervisor, a letter from a research PI/supervisor or letters from a substantive volunteer environment."

But my grad school program director (who taught some health science courses), grad school thesis committee chair (who taught some health science courses), and my molecular biology lab PI (from whom I took microbio) would all count as academic anyway, right?

Science/academic letters should be written by professors with whom you have taken coursework. I can't tell from the way this is worded whether you took classes with the committee chair and program director, or if these are just administrators you know who also teach classes. If it's the former (i.e., these were your professors at one point), then yes, these will be considered academic/science letters.

Yes, ED in general is highly inadvisable if your goal is to become a doctor. It is also inadvisable to target your application to a single school. Are you interested in applying to other schools, or is it this the only program you're willing to consider?

 

[betterweather]

Oh, I took multiple classes from both of them, and one of them was a clinical supervisor as well. Sorry, yeah, that was unclear.

I want to be a doctor, but I am not at a place in my life where I can put my desires and goals 100% first. My partner and children can't move right now, and I really don't want to move away from my family. That may change, but I don't see it changing this admission cycle. So this year, at least, I can't move. I can apply to the school in my city for which I am a well qualified candidate, numbers-wise. I am a good writer, a good interviewer, have a very strong relationship with the med school (I work at an affiliated clinic, I have good working relationships with many of the professors in pediatric specialties, I am a guest lecturer in an M1 class, etc), and I have a compelling story. There are no guarantees in life and that is doubly true for medical school admission, but I think I have a very good chance of getting in.

I could also apply one other school that is more than an hour away, which would be a brutal commute on top of already long hours, further cutting into time with my family. I'd be away from my collegues and my patients, whereas if I stay at my home institution I can stay involved in my clinics and my clinical research. I don't know that it's worth it to maybe, possibly, give myself a better chance of getting in as soon as possible. For many reasons, I think I'd rather wait and apply next cycle if I don't get in ED this cycle.

 

[Bonne Nuit]

Oh, I took multiple classes from both of them, and one of them was a clinical supervisor as well. Sorry, yeah, that was unclear.

I want to be a doctor, but I am not at a place in my life where I can put my desires and goals 100% first. My partner and children can't move right now, and I really don't want to move away from my family. That may change, but I don't see it changing this admission cycle. So this year, at least, I can't move. I can apply to the school in my city for which I am a well qualified candidate, numbers-wise. I am a good writer, a good interviewer, have a very strong relationship with the med school (I work at an affiliated clinic, I have good working relationships with many of the professors in pediatric specialties, I am a guest lecturer in an M1 class, etc), and I have a compelling story. There are no guarantees in life and that is doubly true for medical school admission, but I think I have a very good chance of getting in.

I could also apply one other school that is more than an hour away, which would be a brutal commute on top of already long hours, further cutting into time with my family. I'd be away from my collegues and my patients, whereas if I say at my home institute I can stay involved in my clinics and my clinical research. I don't know that it's worth it to maybe, possibly, give myself a better chance of getting in as soon as possible. For many reasons, I think I'd rather wait and apply next cycle if I don't get in ED this cycle.

It sounds like you've given this some thought, and if you're tied to an area, sometimes the only decision is between ED or no application at all. It's not an unreasonable choice in your case, and it's clear you understand the risks.

To address your original question: I actually am a little concerned about the politics of your decision to leave your field in pursuit of medicine, though I hope my concerns are unfounded. I don't know anything your grad school specifically, but I do know that some graduate programs can be insular and petty. You also indicated that your program tries to weed out individuals who seek a stepping stone to medical school. I hope that the professors you worked with are chill and reasonable, but all it takes is one of them to think "Betterweather wasted a spot in our program and lied to us about their medical school intentions" and your application is toast.

So if you are absolutely 100% convinced that you want to pursue medicine, I think you need to tell your professors sooner rather than later and see where the chips fall. Pay very close attention to their reactions. If you sense that anyone's giving you pushback, creating drama, expressing disappointment beyond "we will be sad to see you move on!", or anything "off" about how they react, you should find someone else to write your LOR.

You might consider first discussing your situation with a trusted mentor within/familiar with your program - maybe one of the physicians you work with, who you can trust to maintain your confidentiality?- and see what advice they have about navigating the politics of your decision.

Alternatively, you could wait until after you receive your MCAT score to decide whether to go public with your decision. I am assuming you haven't taken this yet since you didn't post your score. I don't know how much time that will leave you to request letters, but if your MCAT score isn't where it needs to be, then you'll at least avoid stirring the pot over nothing.

 

[betterweather]

Man, you are a thoughtful and thorough responder! I'm gonna try to chunk up your post so I can address each piece individually

"...all it takes is one of them to think "Betterweather wasted a spot in our program and lied to us about their medical school intentions" and your application is toast."

This is the worst case scenario, absolutely, and I'm going to heed your advice about listening carefully before I actually ask for a letter.

Director, MS, might be legitimately hurt that I am not going to stay in the profession, because we're a lot alike as people, but hopefully being on the same wavelength in general will help me convince her that I was never dishonest about my intentions. Plus, my graduate research led to a (relatively minor) change in our professional guidelines, so its not like I haven't had any impact in the field - I was here! It was very meaningful to me, so much so that I want to do 9 years of further education to contribute to the field in a new way.

Thesis Chair, MD, is actually an MD in the specialty I wish to go into, and she's a phenomenal, empathetic, brilliant physician and a great clinical instructor and someone I very much aspire to be like, so I can explain that she is herself a reason I wish to pursue medicine. Also, she is very aware that there is a shortage of her specialty, and that there is a demographic problem that will worsen it (she and both of the physicians at my clinic are all in their 70s), so hopefully she'll understand my motivations.

"If you sense that anyone's giving you pushback, creating drama, expressing disappointment beyond "we will be sad to see you move on!", or anything "off" about how they react, you should find someone else to write your LOR."

This is wise advice.
Once, I was asked for a letter of recommendation by a shadow whom I did not have an entirely positive experience with, and I told her, "I can't write a strong letter of recommendation, perhaps there is someone else you can ask?" So, I plan to ask them not if they can write *a* letter, but if they feel they could wrote a *strong* letter, which will give them an out if they wish to not do it, or would write a less-than-stellar letter.

"You might consider first discussing your situation with a trusted mentor within/familiar with your program - maybe one of the physicians you work with, who you can trust to maintain your confidentiality?- and see what advice they have about navigating the politics of your decision."

As far as I can tell, there are 3 people who went from what I am -> MD, all of whom specialized where I want to specialize. I reached out to one of them, who was incredibly gracious and spoke with me for over an hour. She said she realized she want to be in medicine while she was still in grad school and applied before she even graduate, meaning she practiced less than a year before starting med school. Even so, she said that her professors were supportive and understood, and that her nervousness was unfounded... so, fingers crossed!

"Alternatively, you could wait until after you receive your MCAT score to decide whether to go public with your decision. I am assuming you haven't taken this yet since you didn't post your score. I don't know how much time that will leave you to request letters, but if your MCAT score isn't where it needs to be, then you'll at least avoid stirring the pot over nothing."

I don't want to come off as cocky, but while I have not taken the MCAT, I am not concerned about my MCAT score. I am just, very very good at these sorts of dumb tests and I anticipate this will be one of the strongest areas of my application. I took one of the 4 AMCAS practice tests as a baseline before doing any serious studying and got a 515, (132 CARS, less everywhere else) and currently I'm anki-ing the heck out of the other sections, so I'm hoping to bump my final score up a couple points from there into the high teens at least. I promise I will come back and tell you what I score, though, so that if I am way off we can all laugh scornfully at my hubris.

You're a non-trad, too, right? Can I ask what you did first and why you changed your mind? And what specialty you hope to practice in?

 

[Bonne Nuit]

You're a non-trad, too, right? Can I ask what you did first and why you changed your mind? And what specialty you hope to practice in?

Yes, very nontrad. I was 30 when I left my job and started my postbac (starting with zero prerequisites), and 35 when I matriculated. I had worked with patients in college as part of an internship and I loved it, but I never considered medical school or even thought something like that could be an option for me. I ended up going straight into a corporate/management-track career after graduation, and it was a bad fit from the start. I was actually pretty good at the job itself, but I hated the corporate environment, the politics/culture of the organization, the obscene way our workers were exploited, and the enormous waste. To shake off the ickiness of what I was doing from 9-5, I started volunteering and found myself again working with patients, including a lot of children with chronic illnesses and disabilities. I was good at it and I loved it. I met several doctors through volunteering, they knew I wanted out of my job and encouraged me to explore healthcare as a second career. I started Googling my options, found SDN and realized that maybe medicine could be a match for my goals/skills/interests, took a week off work to shadow a doctor, and the rest is history.

I'm very undecided on a specialty as of right now. I thought I wanted to do endocrinology or heme/onc when I started, but I've found myself gravitating more and more towards procedure-heavy specialties as of late. I start clinical rotations this year, so ask me again next January and I'll probably have a better answer for you.

 

[betterweather]

I don't want to come off as cocky, but while I have not taken the MCAT, I am not concerned about my MCAT score. I am just, very very good at these sorts of dumb tests and I anticipate this will be one of the strongest areas of my application. I took one of the 4 AMCAS practice tests as a baseline before doing any serious studying and got a 515, (132 CARS, less everywhere else) and currently I'm anki-ing the heck out of the other sections, so I'm hoping to bump my final score up a couple points from there into the high teens at least. I promise I will come back and tell you what I score, though, so that if I am way off we can all laugh scornfully at my hubris.

I got a 521! Alas, we do not get to laugh scornfully.