Which LORs should I submit to this particular program?

[njdevil5]

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I am applying to one particular neuro program that I have received two LORs from. These are the only neuro letters that I have. It seems kind of strange to submit the letters they wrote back to them.

I have two IM letters, a Peds and a FM letter. Which ones do you think i should submit?

 

[Law2Doc]

I am applying to one particular neuro program that I have received two LORs from. These are the only neuro letters that I have. It seems kind of strange to submit the letters they wrote back to them.

I have two IM letters, a Peds and a FM letter. Which ones do you think i should submit?

For any neuro program, I would give both neuro letters. Then pick the best two of the remaining 4. Use 1 neuro and both the IM letters for the prelim year, IMHO, and maybe squeeze in the peds for any transitional years. Probably wouldn't use the FM letter unless you think it's better than some of the others.

Honestly you probably shouldn't be asking for so many letters unless you are actually going to apply to multiple specialties. It is considered bad form to have a letter writer write a letter if you are reasonably sure you won't use it.

 

[Winged Scapula]

Yeah, what's the deal with all the letters from different specialties?

If you are applying for Neuro, submit your Neuro letters and the IM ones.

 

[njdevil5]

I'll be using the letters for Neuro, FM and IM. I'm a USIMG and am applying to multiple specialties because of low board scores with neuro being my preference.

My question is, which letters should I use in applying to the program that originally provided my two neuro letters. Wouldn't it be strange for the program director to get his own letter back?

 

[Winged Scapula]

I am applying to multiple specialties because of low board scores with neuro being my preference.

My question is, which letters should I use in applying to the program that originally provided my two neuro letters. Wouldn't it be strange for the program director to get his own letter back?

No. It would be stranger to submit a Peds or FM letter to a Neuro program.

 

[DarthNeurology]

I'll be using the letters for Neuro, FM and IM. I'm a USIMG and am applying to multiple specialties because of low board scores with neuro being my preference.

My question is, which letters should I use in applying to the program that originally provided my two neuro letters. Wouldn't it be strange for the program director to get his own letter back?

I am assuming that the program director knows you, i.e. in worked with you and would of course remember you during the rotation. Assuming that you also got an LOR from another neurologist at this place (not the PD!) I would use it.

I don't think it would help to submit an LOR to a neurology PD who knows you already. He/she will NOT read their own LOR of course as they most like have a firm impression of you. If I was you I would send the one LOR from the other neurology attending at this institution NOT the PD own letter back to him/her.

Then I would add the two IM letters. If you can add four letters then I would also send the Peds letter assuming they are all fantastic. One route to peds neurology is via an adult neurology residency and then a pedi neuro fellowship. If you are sure you don't want to do pedi neurology, then I would add on the family practice letter. I think FP and neurology are similar enough, i.e. in FP you may have been an ace with common neurology problems such as headache, etc . . .

Sending 4 family practice letters in a pathology application would be strange, I think family practice letters can be sent to fields outside of family practice such as ob/gyn, IM, Peds, Neurology and even psychiatry. Fields such as FP, IM, ob/gyn, Peds, Neurology and medicine subspecialties overlap much, other fields such as surgery you need field specific letters. Obviously for your other neurology programs where you didn't rotate you should send the two neurology letters and could even send 50% 2 Neuro letters, 2 IM letters or 50% 2 Neuro letters and 1 Peds and 1 IM letter. Personally this is what I would do as I wouldn't want to put all my eggs in one basket if I also was interested in pedi neurology. For straight old neurology I might do 75% 2 Neuro LORs, 2 IM LORs and then maybe 25% 2 Neuro LORS and 1 IM and 1 Family Practice LOR.

Bottom-line, if I as a PD required three LORs (which mostly would be from people outside of my institution) I would have much less information if I myself already wrote one of those letters (but good at this program as they already know you), I would feel safer about an applicant who also proved they could do excellent not at just my instituion so if I knew you AND saw 3-4 excellent LORs from other atttendings then this would help. If you tried to count my own LOR as part of my programs requirement I would feel "cheated" by you and wonder why you as an applicant sent me my own LOR? Just my own point of view though.

 

[DarthNeurology]

No. It would be stranger to submit a Peds or FM letter to a Neuro program.

While normally I would defer to Winged (and I love the new cat picture) I would feel cheated as a PD to get my own letter and would ask the applicant "So you sent me my own letter back!" with a grin. Not that LORs are super important for residency, but I would use the extra letter to show how other attendings like me work as well. I would say that a Family practice letter if stellar would help more than simply telling the PD what he/she already knows.

Obviously for other neurology residency programs you should send both neurology letters. But I think you need to show that you actually think before sending out LORs.

 

[Winged Scapula]

While normally I would defer to Winged

Since when? 😉

(and I love the new cat picture) I would feel cheated as a PD to get my own letter and would ask the applicant "So you sent me my own letter back!" with a grin. Not that LORs are super important for residency, but I would use the extra letter to show how other attendings like me work as well. I would say that a Family practice letter if stellar would help more than simply telling the PD what he/she already knows.

I understand but IMHO, the PD is not the only one reviewing the application. The OP will likely be interviewed by other faculty members and having a letter from "one of their own" would be useful, more so than a letter from a Pediatrician they don't know and who presumably knows nothing about being a neurologist. As a matter of fact, the PD may not even review this particular application since these decisions are usually group processes.

That said, as you note, LORs are generally not super important, and it probably doesn't make a huge difference either way.

 

[njdevil5]

I see your point and I see what the others are saying. One more question to you. You mention sending 4 letters. All of the program websites say that they require 3. Is 4 overdoing it? Or do people typically send 1 extra?

 

[Winged Scapula]

I see your point and I see what the others are saying. One more question to you. You mention sending 4 letters. All of the program websites say that they require 3. Is 4 overdoing it? Or do people typically send 1 extra?

As I and aProgDirector have often said, if a program requires 3, sending more looks like you cannot follow directions. Do not send more than a program requires.

 

[Law2Doc]

As I and aProgDirector have often said, if a program requires 3, sending more looks like you cannot follow directions. Do not send more than a program requires.

Actually aProgDirector disagreed with this on another thread the other week, and from what I've read, has been saying folks might want to save the 4th slot for good LORs they might get from Sub-Is later in the year. ERAS allows you to send 4, and the required 3 is the minimum. There is nothing wrong with adding a 4th if it's strong. What aProgDirector said and I agree with is you shouldn't play games trying to delete one and add a new one after the initial 4 are downloaded, in hopes of sneaking in a 5th LOR. (aProgDirector's exact quote from another thread was "Do not send more than 4 letters. It's silly, and only demonstrates that you can't follow directions.").

 

[Winged Scapula]

Actually aProgDirector disagreed with this on another thread the other week, and from what I've read, has been saying folks might want to save the 4th slot for good LORs they might get from Sub-Is later in the year. ERAS allows you to send 4, and the required 3 is the minimum. There is nothing wrong with adding a 4th if it's strong. What aProgDirector said and I agree with is you shouldn't play games trying to delete one and add a new one after the initial 4 are downloaded, in hopes of sneaking in a 5th LOR. (aProgDirector's exact quote from another thread was "Do not send more than 4 letters. It's silly, and only demonstrates that you can't follow directions.").

He has said this on multiple occasions. Its fine if a program allows you to send more than 3. But if their directions say "3 letters only" (which some programs do), then I would not send a 4th, even if it were good.

The OP was asking if people typically send more. The answer is "no" and you have to ask yourself what you are attempting to accomplish by sending an additional letter. In his case, it doesn't sound like its from a Sub-I or that it would add anything special to his application.

 

[Law2Doc]

The OP was asking if people typically send more. The answer is "no" and you have to ask yourself what you are attempting to accomplish by sending an additional letter. In his case, it doesn't sound like its from a Sub-I or that it would add anything special to his application.

I have not seen the "only" language in any of the places I have looked at. If programs do say this, then sure, absolutely, do what they ask. But ERAS allows for inclusion of a 4th letter for a reason, I would think, and that reason isn't to trip up folks who don't follow directions.

As for adding a 4th letter, I can think of numerous reasons why it might not be a bad thing (for either the student or the program director reading them) if it provides additional insight into the person in other venues. Meaning if you did an away rotation, significant research, a sub-I, plus had good LORs from clinical rotations, it might not be so bad to use the maximum. I've also heard that sending a mix of folks who know you really well and folks who are big names is not a bad idea, and for this you might need the whole 4.
All these strategies are hamstrung if you have only 3 LORs to use, and already have to devote one to your specialty, and want to use 1-2 from other (core) rotations.

So sure, if it's a question of following explicit instructions, then follow them, but if it's not, and you feel it will make a favorable impression to include a 4th, then yeah, go for it. Again, I agree this is probably not really the OP's situation, since he seems to just be collecting (too many) letters without a particular "strategy" in terms of how it helps. But I sure wouldn't be advising people that 4 letters is, per se, a bad idea. In a number of situations (at least per advice I have been given) it isn't. And I'd say I know enough people who plan to send 4 letters that I'm not sure saying it's not "typical" is accurate, at least for some specialties.

 

[Winged Scapula]

I didn't mean to imply that 4 letters was necessarily a bad thing.

If a program allows 4 letters and you have letters which each offer a different aspect of you as a candidate, then by all means use them. ERAS doesn't offer a 4th spot to try and trip people up, but it has been the case that programs WILL specify that applicants are not to submit more than the required number of letters. But since there are programs which allow 4 letters, ERAS needs to have the slot available.

With regard to the OP, I agree...he/she seems to be simply collecting letters from each rotation without regard to what they offer to his application. Having read hundreds of these letters, I can tell you that for the vast majority of applicants, that extra, 4th letter, doesn't add a whit to their application, as its simply "more of the same".

 

[DarthNeurology]

As I and aProgDirector have often said, if a program requires 3, sending more looks like you cannot follow directions. Do not send more than a program requires.

Off their websites most programs just list the number of letters required under application requirements I haven't seen any that say only a minimum of three, but I guess it is good to double check as theoretically a couple programs may require this.

I am interested in how a Program Director would not be involved with the application of an applicant. I guess this coule potentially happen, especially if a program get thousands of applicants and a good buddy of the PD get weeded out without the PD's knowledge. I guess someone could go and call the PD directly and ask why they were not invited for an interview.

Once an applicant is interviewed (and quite likely ranked) I would assume that the PD would have a look at all the applications and interview everybody. Or no?

 

[njdevil5]

My "strategy" in collecting these letters is this: I'm a USIMG with low board scores applying to multiple disciplines.

Neuro - 2 Neuro LORs, 1 IM
FM - 1 FM, 1 IM, 1 Peds
IM - 2 IM, 1 FM
Prelim - 2 IM, 1 Neuro

I really do not see this as just collecting them from each rotation. Exactly what is wrong with this?

Neuro is my first choice, followed by FM and IM.

 

[Law2Doc]

My "strategy" in collecting these letters is this: I'm a USIMG with low board scores applying to multiple disciplines.

Neuro - 2 Neuro LORs, 1 IM
FM - 1 FM, 1 IM, 1 Peds
IM - 2 IM, 1 FM

I really do not see this as just collecting them from each rotation. Exactly what is wrong with this?

Neuro is my first choice, followed by FM and IM.

Nothing is per se wrong, it's just that you have a lot more letters than most people get (you described 6, most people get at most 4), and multiple letters in multiple specialties from the same department is definitely not the norm.

 

[Winged Scapula]

I am interested in how a Program Director would not be involved with the application of an applicant. I guess this coule potentially happen, especially if a program get thousands of applicants and a good buddy of the PD get weeded out without the PD's knowledge. I guess someone could go and call the PD directly and ask why they were not invited for an interview.

Once an applicant is interviewed (and quite likely ranked) I would assume that the PD would have a look at all the applications and interview everybody. Or no?

It is not possible for the PD to interview every applicant or even every interviewee for his/her program unless they interview very few applicants. This is the reason why it requires a huge coordination effort of faculty, administrative personnel and residents.

My residency program interviewed around 30-35 applicants per categorical position; this means between 120 and 150 interviewees; each interview day consisted of around 35 applicants, each having 4 interviews (3 faculty, 1 resident). It would be impossible for the PD to interview each and every one of these students. It would also be an impossible task to have the PD review the hundreds of applications, or even the hundreds of applications for those being interviewed. Imagine what it would be like if you have 40 residents per year, like some of the big IM programs. 😱

If a candidate was particularly special and we knew that they were *not* being interviewed by the PD, it was the job of the faculty or the resident meeting with this person to bring them to the PD or to make other arrangements for the PD to meet them and have a discussion.

I know this, not only from experience during the process, but from personal experience when the PD asked me if I could "hang around" a bit after the interview day and go for some coffee. I assume many programs work the same way, as it has been repeated at other programs and reported here.

The ranking session involves all the faculty and residents involved talking about each and every interviewee. If there were disagreements, it was rumored that the PD and the Chair settled them "behind closed doors". If there was no disagreement, it would not necessarily be the case that the PD felt the need to further review the application when the student had already been selected for interview, interviewed by several faculty members, met the residents and gotten the thumbs up for ranking.

This is why I say it isn't necessarily the case that the PD would be closely reviewing applications or interviewing all those invited. The scenario I imagine is that the OP applies to the program, with the letter from the PD, and faculty member interviewing him makes note that the student rotated there and has a good rec from the PD, and mentions this when ranking time comes up.

 

[Winged Scapula]

My "strategy" in collecting these letters is this: I'm a USIMG with low board scores applying to multiple disciplines.

Neuro - 2 Neuro LORs, 1 IM
FM - 1 FM, 1 IM, 1 Peds
IM - 2 IM, 1 FM
Prelim - 2 IM, 1 Neuro

I really do not see this as just collecting them from each rotation. Exactly what is wrong with this?

Neuro is my first choice, followed by FM and IM.

As L2D notes, there is nothing wrong per se, its just unusual.

But if you are applying to multiple specialties, then it makes sense to have letters from multiple specialists. Most students however apply for 1 specialty, have most of their letters from that field and top out at 4.

Now that you've explained your strategy, it makes more sense.

 

[DarthNeurology]

My residency program interviewed around 30-35 applicants per categorical position; this means between 120 and 150 interviewees; each interview day consisted of around 35 applicants, each having 4 interviews (3 faculty, 1 resident). It would be impossible for the PD to interview each and every one of these students. It would also be an impossible task to have the PD review the hundreds of applications, or even the hundreds of applications for those being interviewed. Imagine what it would be like if you have 40 residents per year, like some of the big IM programs. 😱

If a candidate was particularly special and we knew that they were *not* being interviewed by the PD, it was the job of the faculty or the resident meeting with this person to bring them to the PD or to make other arrangements for the PD to meet them and have a discussion.

The scenario I imagine is that the OP applies to the program, with the letter from the PD, and faculty member interviewing him makes note that the student rotated there and has a good rec from the PD, and mentions this when ranking time comes up.

From my interviews I would say at most there were 20-30 being interviewed per day, and interview days usually were only a couple of days a week spread out over about three months if not more. I would say interviews are about 15-20 minutes or on average about 3 applicants per hour and the PD was usually serially interviewing people so he/she would see maybe half or more of the interviewees.

However, some programs invite something like 12 interviewees a day and the PD interviews everybody with morning and early afternoon interviews. Most neurology programs are small, i.e. 4 or so spots so they can afford the luxury of having the PD interview everybody over the same timetable that mega large IM programs have to work with. So maybe you would have a group of six applicants a day and the PD comes out and introduces himself/herself and recognize Bob or Jane the medical student.

I would think given the size of Neurology residency programs it would be very hard to miss a student who rotated at the hospital, knew the PD and some not have this brought to the PD's attention that their star applicant was there. I would guess that the PD would recognize the applicant first thing off when the PD usually greats everybody, with Neurology I doubt this would be over 8-10 people.

Now, say I am wrong and a faculty interviewer sees the letter from the PD. We all know that LORs have glowing almost meaningless comments as nobody wants to have a lawsuit over a LOR unfairly bashing a student.

If you were the faculty member you would ask the PD if the applicant really was a good fit with the residency program (i.e. what the PD really thought) so you could get it straight from the PDs mouth and discuss it with the PD presumably. Would you really even read the PD's letter when you could just go down the hall during lunch and talk with the PD?

 

[Winged Scapula]

From my interviews I would say at most there were 20-30 being interviewed per day, and interview days usually were only a couple of days a week spread out over about three months if not more. I would say interviews are about 15-20 minutes or on average about 3 applicants per hour and the PD was usually serially interviewing people so he/she would see maybe half or more of the interviewees.

However, some programs invite something like 12 interviewees a day and the PD interviews everybody with morning and early afternoon interviews. Most neurology programs are small, i.e. 4 or so spots so they can afford the luxury of having the PD interview everybody over the same timetable that mega large IM programs have to work with. So maybe you would have a group of six applicants a day and the PD comes out and introduces himself/herself and recognize Bob or Jane the medical student.

Sure...makes sense that the PD interviews everyone if you have that few of applicants and the interviews are that short (ours were 20-30 mins).

I would think given the size of Neurology residency programs it would be very hard to miss a student who rotated at the hospital, knew the PD and some not have this brought to the PD's attention that their star applicant was there. I would guess that the PD would recognize the applicant first thing off when the PD usually greats everybody, with Neurology I doubt this would be over 8-10 people.

Depends on how memorable the OP is, but yes, it is much more likely given the small number of applicants/interviewees that the PD would be remembered.

Now, say I am wrong and a faculty interviewer sees the letter from the PD. We all know that LORs have glowing almost meaningless comments as nobody wants to have a lawsuit over a LOR unfairly bashing a student.

Exactly, which is why I tend to think everyone is "overthinking" this.

If you were the faculty member you would ask the PD if the applicant really was a good fit with the residency program (i.e. what the PD really thought) so you could get it straight from the PDs mouth and discuss it with the PD presumably. Would you really even read the PD's letter when you could just go down the hall during lunch and talk with the PD?

Eh, depends on which was more work or if I felt that perhaps the PD would have something more to say. But you're right, I'm sure I'd say something to the PD about interviewing someone who had rotated there before.

 

[njdevil5]

You all have given me a bit of an education on the process and I appreciate that. I wish my board scores were higher and I would have a reasonable shot at matching in neuro and only be looking at one discipline. I figure my best shot is the program I rotated at.

In all probability, I will end up with a FM residency (which I wouldn't mind, by the way) but I figured I would give it my best shot.