Please Help! Letter of rec from Academic or Community Physician

[Perforin]

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So I am getting ready to send in my third year schedule, and I was wondering if it mattered if you got a letter of rec from a community or academic physician? I'm sure an academic physician would be better if they were in the particular field that you were applying to (Anesthesia, for example) because they may be more well known. But, if you are applying to Anesthesia, and want to get a letter of recommendation from an internal medicine doctor as 1 of my 3 letters, would it matter if that internal medicine doctor was an academic physician or a community physician?

Reason I ask, is that at our school we can do rotations at our school with academic physicians, or at a certain community hospital with physicians that aren't academic. I really want to do my rotation at the community hospital, where I know some of the physicians already from my personal life, but I would go to the academic place if it makes more sense for my career.

Anybody have any insight into this? I am really racking my brain trying to figure out what to do. I know what I want to do (community hospital), but I don't know what I should do in terms of what would be the most beneficial to me come time to apply for residencies.

 

[typhoonegator]

Well, it sounds like you know what you want to do, and honestly, it probably won't make too much difference if the person is outside of the field of your interest. If you are applying anesthesia outside your own institution, then no one is likely to know the letter-writer, be they academic or community. However, it may carry a little more weight if they can look at the signature line and say, "well, I don't know who this is, but they are an associate professor at school X, so they must have seen a lot of med-students and have a well-formed opinion on what the population averages are." At the community hospital, you might not get this slight advantage.

Still, you'd be better off going to the site you prefer and rocking the rotation rather than being miserable at an academic site and getting a lukewarm letter.

 

[SouthernSurgeon]

If you are applying anesthesia outside your own institution, then no one is likely to know the letter-writer, be they academic or community.

I don't know about that...admittedly I'm not going into anesthesia, but all of my letter writers (academic surgeons) are well known - I think at every interview I went on the interviewers knew who all of them were and had met/personally knew some of them. The academic medicine community is pretty tightly knit - people know each other.

Still, you'd be better off going to the site you prefer and rocking the rotation rather than being miserable at an academic site and getting a lukewarm letter.

Strongly agree with this. Really, most students get their LORs from their fourth year rotations more than their third year. Your number one goal third year is to have a good learning experience and figure out what you want to do with your life.

 

[lowbudget]

I don't know anything about anesthesia; but I would say, generally, that you should get the letter of rec from a writer who is most likely going to place you in the most positive light (within realistic boundaries, of course... well, duh). It depends on you and your style. If you shine in groups/crowds where there's hierarchy and/or can deliver high quality work when called upon (or, only when called upon), you may be seen in a better light in the eyes of an academic attending who only sees a student sporadically/rarely. If you shine better one-on-one and/or may need some time to "warm-up" and familiarize yourself to an attending, maybe the community attending is a better one to go with, whom you likely would be working with everyday all the time on a one-on-one, hands-on basis.

Everybody's different based on their style. For those who deliver consistently (well or badly) it doesn't matter, really. For those who have a tendency to perform poorly and be unlucky enough to have people *only* notice you when you perform poorly, you need to stick with an attending who can follow you over time and and average out the many impression data points, instead of being recalled the 1-2 times that you screwed up as a representation of the "entire you".

That being said, many students become residents based on positive snapshots, and when they become residents, it's clear that those positive snapshots are only when the resident "turns it on" and that this resident unfortunately cannot consistently deliver high quality. A false positive superior resident due to sampling error... very disappointing. If you are a student who is very consistent, you want an attending who can vouch for that consistency and deliver it in a letter.

 

[SukaNeNauka]

Based on my experience, academic physicians tend to be better letter writers because they have more experience in working with students, residents, fellows. Academia is a very small world, and people know each other very well.

 

[Perforin]

All sound advice. I appreciate the input!

 

[sunset823]

I don't know about that...admittedly I'm not going into anesthesia, but all of my letter writers (academic surgeons) are well known - I think at every interview I went on the interviewers knew who all of them were and had met/personally knew some of them. The academic medicine community is pretty tightly knit - people know each other.

I think this may be true for both anesthesia and surgery because both are distinctly non-academic fields, and not too many people choose to stay in academia, so the academic world is small for both. (This is actually something I'm concerned about with anesthesia, since I definitely want to be in academics)

However, I'm guessing in IM and peds, where there are both a lot of doctors and a lot of people in academia, not everyone would know everybody else in the country. To the OP, since you seem to be talking about an IM doctor, I don't think it'll make a difference - go where you're happy, which sounds like it will be a community hospital.

 

[WhoisJohnGalt]

I just wanted to throw out there that while it's awesome that you're thinking ahead to letters of rec (I know that I and many others in my class wished we'd have thought of them before August of fourth year!), you really don't know where your letters are coming from at this point. Pick the preceptors you want to work with, and the letters will naturally come from there. I'm doing psych and one of my letters came from OB/GYN. I never would have guessed that at your stage of the game, but I just really clicked with that attending and it was natural to ask him. My point is, you're really overthinking this. Regardless of who you pick, you might end up hating them and asking someone else for a letter. You will have plenty of rotations and plenty of attendings during your third year to get letters, and if you're not happy with all those choices you have a few months in fourth year too! Do what makes you happy and worry about letters as the rotations happen.

 

[waterhammer]

I matched to gas this year with letters all from community physicians, so it can be done. Pick physicians that you think will write a solid and thoughtful recommendation. One from a known name is probably better, but not if it's generic and bland.

Do try to have at least one from an anesthesiologist, however. I had one from each of these: anes, im, gen surg, and plastics. Warning: the surgeons took their sweet time with the letters.