letters of recommendation

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mdphd2010

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i know they say you need three letters, but i got different messages from different advisors. the associate dean said my phd advisor's letter substitutes for a clinical letter, but the residency advisor implied it doesn't. i'm applying for pathology, and so far my letters look like:
1. research advisor, who is a pathologist but i did not do clinical work with him
2. internal medicine clerkship director
3. pathology clerkship director
4. director of the md/phd program
do i need another clinical letter? if so, it kind of sucks because it would be from someone who doesn't know me well and it would bump a stronger recommendation ...

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