LOR question

[E.A. Poe]

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I've got pretty good letters of recommendation from two locally known pathologists. I was told that you need to also get a letter from a nationally known pathologist, such as a program director. Any thoughts as to whether or not I should need to pursue this, or am I good.

Answers from someone in residency/practice and NOT on the interview trail would really be appreciated.

 

[Alteran]

Academic pathology is a small field and the 20 + year veterans of that world pretty much know everyone and the state of every program worth going to. So it definitely would not hurt to have a LOR from one of them. That said, I don't think you're at a disadvantage by not having a letter from a program director. Pretty much, and I could be wrong, programs are interested in seeing that you have a desire to do path and that you are recognized as such by a fellow pathologist and any additional comments on how good your diagnostic capabilities are just icing on the cake. What programs don't want to see are people who are going into path because they couldn't match into something else and are just there taking up a slot for the time being until they can transfer to their original residency pick. Any letter that says to the contrary, albeit implicitly, will also be a big boost.

 

[E.A. Poe]

Bumping for feedback from non-medical student.

Though, thanks for the advice Alteran.

 

[yaah]

It is always best if you can have a GOOD letter from a well known pathologist (a program director, department chair, pathologist with a national reputation). The reason being is that PDs can evaluate praise from these people better (perhaps they have seen letters from them before, perhaps they know them personally) and they also know that those people generally know what makes a good resident and pathologist.

However, having a weak letter from one of these people isn't really going to do you much of anything, particularly if it comes at the expense of a good letter from someone less well known. The fact that they are coming from practicing pathologists or research supervisors is a good thing - these people also know what it takes to be a good pathologist.

That being said, many dept chairs or program directors (like the ones at your med school, for example) are used to writing letters for people they haven't worked with a great deal. They take your CV, they talk to people who do know you. So these can be good letters even if you aren't buddy-buddy with them.

As for your specific situation only you know what is best. If you are concerned, you can probably talk to the PD at your med school, if they have a path program, or alternatively talk to the dean of your med school. They will likely have access to the letters, and they have a lot of experience with them, so they can let you know if they are weak or strong or whatever. You have two letters which you think are good, I wouldn't discount those.

 

[BU Pathology]

The question of the best letters is frequently asked. The applicant is applying for training, not for an actual position. If you have been hard working, intelligent, and careful while rotating through pediatrics, then these characteristics will probably continue during your pathology residency. Letters from academic physicians carry more credibility because academics have typically worked with several students over the years and can place their credentials in perspective.

In my opinion the letters for pathology residency with the most influence would be in this order:
1) Well known pathologist with whom you have worked closely for at least 1 month. This letter will show you interest in pathology and other pathologists will likely respect the opinion. Many applicants do NOT have these types of letters, although as the field is becoming more competitive this is changing.

2) Academic physician with whom you have worked closely for at least one month. Most programs respect the abilities of our colleagues to evaluate students a strong letter from a clinician about your work ethic and dedication will carry substantial weight.

3) Community pathologists. The issue here is the amount of experience that the pathologist has working with students. If you were hiring a pathologist, their opinion would be important. It is narrow minded to believe that only a pathologist has the ability to evaluate academic potential to function as a pathology resident.

These are my personal observations after writing hundreds of letters, and reading literally thousands of letters. Some programs will put substantial weight in a letter from any pathologist, but I do not. It shold also be noted that in the surgical subspecialty fields it is considered nearly mandatory to have most of your letters from specialists in the field.

In my opinion, the best letters come from those who know you well and have the experience to evaluate your characteristics. These letter writers may not be pathologists.

Dan Remick, M.D.
Professor and Chair of Pathology and laboratory Medicine, Boston University