LORs MD vs MD/PhD

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At my school, the premedical committee put together a packet with their own letter as well as all of my letters from classroom professors to research mentors. It was one packet and was considered "one letter." This went to both the MD and PhD committees for the MD-PhD programs that I applied. I imagine your case will not be too different. Send all your LORs.
 
I don't think you need to ask any one person to prepare two letters. If you do encounter an MD program that wants fewer letters than the same school's MD/PhD program, sure, you could leave out some of the more research-oriented ones; but those are likely to be your stronger letters anyway, I would reckon.

Ultimately the letters will be read pretty quickly and "holistically" so for there to be an extra will be no big deal.
 
I called AAMC with respect to a similar issue and my impression is that you can not chose what letters go to MD vs. MD/PhD programs at a given school, you designate the letters to go to that school, and they go, with no differentiation as to MD vs MD/PhD program to receive.

My understanding is that for schools that participate in the letter service, AAMC sends a packet to the school with all your letters in it. That's it. Maybe for Duke and the Louisiana schools (not participating in the letter service) you can differentiate programs....but for the letter service schools, most all of them, the school just gets a packet from AAMC (hopefully just once, if all your letters are in before you designate them to schools/get secondaries out).

If I am wrong please correct me! Thanks.