Prelim Medicine LORs

[Green Chimneys]

I admit this was poor planning on my part. I am applying to anesthesiology and I am hoping for a categorical position. However, of the 13 interviews I currently have 7 of them are at institutions which do not have a categorical program. Stupidly, until right now, I have not applied to any preliminary programs.

My step 1 score isn't off the charts and I'm late in the game, so I'm not even going to bother with TY...I'll apply just to prelim med. My dilemma is this: all my LORs are geared towards anesthesia. I have 2 from anesthesiologists, 1 from the anesthesia department chair, and 1 from a neurosurgeon. Despite waiving my right to see the letter, the neurosurgeon emailed me his LOR which specifically stated to "dear program director" that i was "applying to [their] anesthesiology residency for july 2010." Unfortunately, it's way too late in the game to get new letters at this point. At least 2 of the letters presumably speak strongly to my experience and interest in critical care, which should be a positive applying for IM prelims.

I'm not trying to go anywhere special with this. I will apply to my home institution, maybe one or two mid level academic institutions, and the rest community hospitals in the region. I just want to make sure I have a job next year.

Will these heavily slanted LORs be a problem when applying? I am hoping that the programs I will apply to will need warm bodies, but this late in the game I don't know. Should I bag the whole thing and just try to scramble in to a prelim year in the event that I might need it? How doable is that process?

---

Members don't see this ad.

 

[smq123]

Should I bag the whole thing and just try to scramble in to a prelim year in the event that I might need it? How doable is that process?

<sigh>....I wouldn't bank on getting anything in the scramble. Granted, as an AMG, you'll probably end up with something - it may have to be a surgical prelim year in the boondocks, though.

Furthermore, if you can do ANYTHING to avoid the scramble, do it. The scramble, even for prelim positions, is hardly a benign process. Keep in mind that you'll be competing with tons of AMGs who were unable to match, and are looking for something to keep them employed for a year. You'll also be competing with IMGs who are perfectly happy to take a prelim year in the attempt to finally end up in a US residency somewhere down the road. That hardly sounds less nerve-wracking than trying to apply for a prelim at the last minute.

Finally, I thought that medicine prelim years require a letter from an internist? I'm not 100% sure on this one, though.

Since one of your letters is from a neurosurgeon, would you be willing to apply to some surgical prelim years? That may be easier than trying to get a medicine letter, if you need one.

 

[error404]

<sigh>....I wouldn't bank on getting anything in the scramble. Granted, as an AMG, you'll probably end up with something - it may have to be a surgical prelim year in the boondocks, though.

Furthermore, if you can do ANYTHING to avoid the scramble, do it. ...

Finally, I thought that medicine prelim years require a letter from an internist? I'm not 100% sure on this one, though.

1. I agree... don't scramble unless you have to. Ask your writers nicely and respectfully for letters that are geared.
2. Apply to prelims regardless of the direction of your letters. If you can't get quick fixes on your LORs, send the anesthesia ones. A surgical prelim may be better than no prelim at all, so don't rule it out entirely.
3. Rank your categorical programs higher.
4. If your scores are decent, you can likely scramble somewhere-- but don't get all elitist because you might be disappointed.

I'm more optimistic than the above poster regarding your chances in the scramble, provided that this was a one-time screw up that otherwise isn't reflected in your grades/scores/letters.

A lot of prelim med programs request a letter from an internist... but I don't know that they all *require* it. That said... it will look odd to be an applicant to a specialty without a letter from that specialty.

 

[Green Chimneys]

Thanks for the advice so far, guys. I am going to bargain, beg, and plead with attendings I have had in the past for an internal medicine letter and outside of my home institution, I will probably only apply in my home region to community programs to shift the odds in my favor.

2 of the letters are specifically geared towards my interest and experience in critical care, so I'm hoping that will also translate well for me. I agree that it will look odd to have an application so blatantly geared towards anesthesiology but don't prelim programs kind of expect this? I mean, people that are actually applying to do a residency in internal medicine don't DO a preliminary year, so most of these apps must be for people applying to other specialties, or for people who never figured out what they wanted to do and need another year to decide, right?

Good call on the surgical prelims as well. I'll throw a couple apps in that direction too and see if anything sticks. I was hoping to do IM because even though all internships suck, a surgical internship for someone with no desire to be a surgeon seems like suicide. The surgical interns I have seen who are applying to anesthesia or other specialties had to deal with not only the torment of the vicious work load but also received nothing but contempt from their fellow residents and attendings. I'll avoid it if I can.

I'll put the apps out this weekend, hopefully I won't have to use them. If I can catch at least 10 categorical anesthesia interviews, I'll cancel the prelim bid and hedge my bets. Wish me luck!