LOR question

[sloop]

I was wondering how important it is considered to have one of your letters be IM or related when applying to psych residencies. The reason I'm asking is that I had asked someone I worked closely with last year for an IM letter, and they agreed. It would have been a good letter, but due to an unforeseen situation, it became essentially impossible to follow up with this person and get the letter. I do not have a medicine sub-I until late in the year so I will effectively be unable to get one.

I do anticipate having three letters, however. Two of the writers are psychiatrists: both really like me and one of them I have worked with in both third and fourth year, so he knows me well. The other is an anesthesiologist who happens to know me both clinically and through a course that is kind of hard to explain but basically involved seeing many reflective essays I wrote throughout my rotations about my experiences and perspective on patients and events that I saw in the hospital. I understand that this might be a bit atypical but at least content-wise, I actually think this may be one of my best letters. This person actually approached me and asked if I would like a letter and in the subsequent correspondence volunteered how they were glad to write me a letter as I really impressed them with how intelligent, thoughtful, compassionate and supportive I was. I'm just not sure how poorly it comes across to be missing an IM/Peds/FM letter.

Otherwise, my application is competitive as a US allopathic senior with step 1 and 2 in the low 250s and high 250s respectively, honors in psych and another rotation, high pass in the rest, universally positive comments from clerkships with all specifically commenting on my compassion and ability to build rapport, virtually all honors in the first two years, a smattering of preclinical awards, a long history of tutoring in college and med school, some med school research experience in psych but no pubs, some biology bench research in college which yielded me as a non-presenting author on a poster but not much else, etc.

I know I'm probably being a bit neurotic and ridiculous worrying about this, especially at this point when there's little to be done about it, but I'm just hoping I haven't screwed things up by not somehow getting an IM, Peds or FM letter.

Thanks for any insight anyone can provide on this. I really appreciate it.

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[FlowRate]

There are a select minority of programs that say they require a medicine/non-psych letter on their websites. There are a few programs that have entirely unique requirements e.g. UNC says they require the letter from the chariman of psych at your institution. Some say they prefer 3 letters, other say they prefer 4.

What I came to find out is that most people sent what they thought were the best 4 letters they had to all programs, with no regard for these arcane requirements. Many people have had interviews to UNC without a chair's letter and people who sent 4 letters to 3 letter places do just fine.

That's a long winded way of saying that you'll be fine as long as:
1. your letters are good (or at least not bad)
2. at least two are by physicians
3. at least one is by a psychiatrist
4. there are three or four letters in total

 

[splik]

I think there are very few programs that require an IM/Peds letter (and even programs that "require" things will suddenly not have requirements if the applicant is otherwise impressive), the anesthesiology one will suffice. The best letters should be from someone who knows you well and can write a strong letter. I have seen letters from anesthesiology, rad onc, neurosurgery, radiology, plastic surgery and so on. LoRs are important, but only after board scores, clerkship grades, and medical school

 

[wolfvgang22]

Yeah, I didn't have an IM letter either. You will be fine if you can get along with interviewers, you are very competitive.

 

[Bifteck]

Similar question. I have 3 psychiatry LORs, 1 IM, and 1 research. Deciding whether to submit the 3 psychiatry or do 2 psych, 1 IM. Any thoughts? Assuming all else is equal (strength of letters, position of faculty).

 

[OldPsychDoc]

Similar question. I have 3 psychiatry LORs, 1 IM, and 1 research. Deciding whether to submit the 3 psychiatry or do 2 psych, 1 IM. Any thoughts? Assuming all else is equal (strength of letters, position of faculty).

In this case, I'd recommend the 2 psych, 1 IM. As I've said before, the best non-psych letters say something like "Student Bifteck performed at the level of an intern on this rotation. We wish that Bifteck would apply to our program because we'd absolutely love to have them as a______ resident in our program, but they're just SO committed to psychiatry that all of our bribes, free lunches, and dates with hot drug reps couldn't sway them..."

 

[psychhopefull2016]

Right now I have a clinical psych, a FM, and a research psych uploaded. My other letter writers (psych) are a being a little slow/ aren't responding to emails well. Is research psych ok for one of the letters? Hopefully I will have a 4th letter from my psych sub-I but I am worried it won't be up by the 15th

 

[OldPsychDoc]

Right now I have a clinical psych, a FM, and a research psych uploaded. My other letter writers (psych) are a being a little slow/ aren't responding to emails well. Is research psych ok for one of the letters? Hopefully I will have a 4th letter from my psych sub-I but I am worried it won't be up by the 15th

All good.

 

[clausewitz2]

Had a psych, FM and neurology letter for most places I applied to. The FM letter was from someone I worked with closely for a month. The neurology letter was from my home program director who approached me in November to tell me in person that it was not too late to submit a neurology application and that he would be sure I got an interview. Only two of the places I applied did not invite me, and only one of them was a place actually geared towards AMGs.

You're fine.

 

[splik]

Hopefully I will have a 4th letter from my psych sub-I but I am worried it won't be up by the 15th

is this a joke? why would you be worried about this? you do realize september 15 is when applications open it is not the deadline. some people don't even put their applications in until a few weeks later (and in some cases even later, which though not advisable happens and is not the end of the world), and letter writers commonly don't get round to writing the letters until later on. some programs will only interview when the application is complete but many off interviews to people with incomplete applications. also many programs won't review applications until october when the dean's letter comes in.

 

[psychhopefull2016]

is this a joke? why would you be worried about this? you do realize september 15 is when applications open it is not the deadline. some people don't even put their applications in until a few weeks later (and in some cases even later, which though not advisable happens and is not the end of the world), and letter writers commonly don't get round to writing the letters until later on. some programs will only interview when the application is complete but many off interviews to people with incomplete applications. also many programs won't review applications until october when the dean's letter comes in.

My home school basically has been telling us that September 15 is a hard deadline and people won't look at us if we submit after that date and making us all very anxious. We had 6 people not match last year including 1 in psychiatry despite being a top 20 school and they are putting the fear of God in us, basically flat out told us our applications wouldn't be looked at if they weren't in completely on the first day.

 

[OldPsychDoc]

My home school basically has been telling us that September 15 is a hard deadline and people won't look at us if we submit after that date and making us all very anxious. We had 6 people not match last year including 1 in psychiatry despite being a top 20 school and they are putting the fear of God in us, basically flat out told us our applications wouldn't be looked at if they weren't in completely on the first day.

Your home school is whipping up fear like a Trump campaign rally.
All they are doing is ensuring that ERAS runs too slowly on the 15th for anyone to do anything.
Anytime from 9/15 - 10/1 is still "on time" for psychiatry.

 

[psychhopefull2016]

Your home school is whipping up fear like a Trump campaign rally.
All they are doing is ensuring that ERAS runs too slowly on the 15th for anyone to do anything.
Anytime from 9/15 - 10/1 is still "on time" for psychiatry.

Thanks for the reassurance! Hopefully with the soft open on the 6th ERAS doesn't flip out this year too much

 

[Amygdarya]

We had 6 people not match last year including 1 in psychiatry despite being a top 20 school.

Not to make any of the current applicants any more anxious than they already are, but how could that happen? Did that person only apply to MGH, Columbia, UCSF and UCLA-NPI? Or was he/she such an awful person that even your home program (though that may be one of the mentioned programs) wouldn't take him/her?

For what it's worth, it's the dean's job to make the school look good and make sure everyone matches. Our dean of whatever is responsible for the match (I'm really bad with academic titles) is notorious for freaking seniors out every year (and we may have only one graduate a year not match - and not even every year - and that would be someone applying to a very small ridiculously competitive specialty)

 

[psychhopefull2016]

Not to make any of the current applicants any more anxious than they already are, but how could that happen? Did that person only apply to MGH, Columbia, UCSF and UCLA-NPI? Or was he/she such an awful person that even your home program (though that may be one of the mentioned programs) wouldn't take him/her?

For what it's worth, it's the dean's job to make the school look good and make sure everyone matches. Our dean of whatever is responsible for the match (I'm really bad with academic titles) is notorious for freaking seniors out every year (and we may have only one graduate a year not match - and not even every year - and that would be someone applying to a very small ridiculously competitive specialty)

Person was a bit of a mess. Was my psych sub-I while I was on my psych 3rd year rotation. Wasn't mean or anything but once started sobbing and told the whole team she was crying because the pharmacy didn't fill her antidepressants on time but she had screamed at a nurse prior to that on the same day and was always late and missed like 4 days due to being "sick." All this on the sub-I in her desired specialty. Apparently was equally bad on other stuff. But still makes me nervous that she didn't match at all...

 

[Amygdarya]

Person was a bit of a mess. Was my psych sub-I while I was on my psych 3rd year rotation. Wasn't mean or anything but once started sobbing and told the whole team she was crying because the pharmacy didn't fill her antidepressants on time but she had screamed at a nurse prior to that on the same day and was always late and missed like 4 days due to being "sick." All this on the sub-I in her desired specialty. Apparently was equally bad on other stuff. But still makes me nervous that she didn't match at all...

To be fair, she may have actually been sick (as in depressed eg., and yelling at the nurse doesn't contradict it since people can be very irritable when depressed; or there may have been other psych issues) but yeah she sure didn't make a good impression. I see what you mean.
As far as I can tell, you shouldn't have a problem matching (and it seems like you want to stay at your home program?)

 

[psychhopefull2016]

To be fair, she may have actually been sick (as in depressed eg., and yelling at the nurse doesn't contradict it since people can be very irritable when depressed; or there may have been other psych issues) but yeah she sure didn't make a good impression. I see what you mean.
As far as I can tell, you shouldn't have a problem matching (and it seems like you want to stay at your home program?)

She was absolutely not doing well mentally and was in treatment but she was not in a good place to be doing an audition rotation essentially, the illness she stated she had at the time was gastro.

And yes I want to stay at my home program but it's a very prestigious program and I am anxious about getting a spot as you can all probably tell.

 

[Amygdarya]

And yes I want to stay at my home program but it's a very prestigious program and I am anxious about getting a spot as you can all probably tell.

I hear ya. I'm a year behind you and also want to stay at my home program, which is also very prestigious, and I'm already anxious

You have a very competitive application and you sound like a reasonable person, so you should do really well in the match. I'll be rooting for you. Goid luck!

 

[OrangeOrange]

Sorry for the bump - another LOR related question for you guys.

I'm thinking about asking for a research letter (basic science). The work was in neuroscience but not psych. PI is a bigwig, but I didn't interact with her directly all that much. Should I ask for a letter from her or from the fellow (now faculty) I worked with daily? They are both MD/PhDs, if it matters.