So in some ways it's calming to see things like this from people who know...but then, at the same time, if things on the app don't really matter, and in another thread WS said that LORs don't really matter....what does?? I've been stressing about my application and my LORs because I figured those are the only things under my control. Should I be focused elsewhere?
Its not that those things don't matter at all, but if you look at this and all the other threads here, its not those things that people are focusing on but rather, minutiae like placement of activities on the CAF, etc. THAT doesn't matter. So I wouldn't spend a lot of time worrying about placement of these things on the application. I have never once looked at any application and threw it in the trash because the student listed AMSA under Volunteer Activites rather than Honorary/Professional Society Memberships.
In some ways, your fate was sealed after your Step 1/COMLEX 1 scores came in. If programs screen, this and IMG/FMG status are probably the most important.
After that, programs will all have specific things they are looking for. Programs with required or heavy emphasis on research, will look for significant research experience (ie, publications, a PhD). Some may actually be looking at gender (ie, to increase the number of males in Ob-Gyn, females in surgery). Others may weed out applicants needing visas, applicants who have already completed some GME (and therefore might need additional funding), year of graduation, etc. Again, at this point, none of these are under your control.
With regard to LORs, they can be important, as are connections, but mostly in small fields. As aProgDirector himself said, IM is such a big field, that letters are almost always from someone he's never heard of. In a field like PRS or Derm, or even Surg Onc, there are some big names and the faculty may know the letter writer. My point about the letters though, is that, almost without fail, letters are identical. Everyone is superb, the best 4th year student I've seen in years, hard-working, easy to get along with, always willing to stay late and assist the residents, etc.
I'm not sure how you feel you have control over the letters unless you write them yourself. And even then, since you haven't read hundreds of these things, you probably wouldn't realize how they all sound the same after awhile. I found it rather a game with the goal to be to actually find a letter where something negative is written or even more rare, the applicant stands head and shoulders above the fray. I'd venture that a phone call to your top choice from your department Chair or a faculty member, probably holds more weight than the LORs.
I realize that almost all of us in medicine are a bit OCD and Type A and that its natural to worry about these things. But really, if you were interviewing someone for a job, would you really care if they were a member of the AMA, volunteered in a soup kitchen or would it be more important that they had high test scores, were hard working and someone you could stand to be around for 3+ years? You want someone who is bright, reliable and works well with others...sometimes these are best assessed in interview rather than on paper.
There is no way you can predict all the little variables that programs might look for but I'd venture that very few consider ECs as significantly important in residency selection as opposed to medical school selection. Medical students like to think that these things matter; I'll agree that they add some interest to your application, but they will never be more important than your board scores, class rank, citizenship/visa status, etc. nor will they may up for deficiences in those areas. I made the same mistake as a medical student but the fact is that, despite the number of ECs, fantastic LORs or work experience, etc., if a program doesn't like your USMLE score or school you attended or citizenship, then it doesn't matter about the other stuff.
