LORs - open or closed

[bowlofmushypeas]

This is probably a silly question, but is it pretty customary to send closed LORs? That's how I've always done it for college, med school, etc., but I feel like a resident at some point told me that it doesn't matter if letters are open are closed (i.e., I can read it beforehand to decide which to send into ERAS). I'm having a hard time deciding between two letters..but I'm guessing it's probably poor form to look at them

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[bowlofmushypeas]

To piggyback on this, does reputation of the attending if they are NOT in the field you're applying for matter? For instance, if I'm applying to peds and am deciding between letters from the chair of adult rheumatology vs. a surgeon, is the former's letter going to hold more weight?

 

[Winged Scapula]

This is probably a silly question, but is it pretty customary to send closed LORs? That's how I've always done it for college, med school, etc., but I feel like a resident at some point told me that it doesn't matter if letters are open are closed (i.e., I can read it beforehand to decide which to send into ERAS). I'm having a hard time deciding between two letters..but I'm guessing it's probably poor form to look at them

You are expected to waive the right to see your LORs for residency; this is no different than for college, med school, etc.

To piggyback on this, does reputation of the attending if they are NOT in the field you're applying for matter? For instance, if I'm applying to peds and am deciding between letters from the chair of adult rheumatology vs. a surgeon, is the former's letter going to hold more weight?

Not necessarily, as it would be expected that physicians in other specialties would not be aware of the reputation. For example, I have no idea who the "famous" pediatricians or adult rheumatologists in the US are and expect they have no idea who is a well known surgeon.

I might ask you however, why aren't your letters from pediatricians? Perhaps it doesn't matter in Peds, but in general, pediatricians are best suited to discuss your suitability for a pediatric residency and practice. What does a surgeon or rheumatologist know about that?

 

[bowlofmushypeas]

You are expected to waive the right to see your LORs for residency; this is no different than for college, med school, etc.



Not necessarily, as it would be expected that physicians in other specialties would not be aware of the reputation. For example, I have no idea who the "famous" pediatricians or adult rheumatologists in the US are and expect they have no idea who is a well known surgeon.

I might ask you however, why aren't your letters from pediatricians? Perhaps it doesn't matter in Peds, but in general, pediatricians are best suited to discuss your suitability for a pediatric residency and practice. What does a surgeon or rheumatologist know about that?

I do have peds letters. However, I'm reserving one of my letter spots for a non-peds letter

 

[gutonc]

I do have peds letters. However, I'm reserving one of my letter spots for a non-peds letter

Why? Is it phenomenal? Otherwise that makes little sense.

 

[Winged Scapula]

Why? Is it phenomenal? Otherwise that makes little sense.

Agreed.

Unless there is something specific about this letter or the experience (ie, a significant Research project), I'm not sure why you would need to reserve a spot for a non-peds letter.

 

[Mass Effect]

I'm not the OP, but I was always told (by numerous people) that at least one letter should be from someone outside of the specialty for which you're applying. You're saying that's not the case?

 

[bowlofmushypeas]

I'm not the OP, but I was always told (by numerous people) that at least one letter should be from someone outside of the specialty for which you're applying. You're saying that's not the case?

This is what I've always heard too. In my case, I think either of these non-peds letter writers would write more strongly than a 3rd peds person anyways.

 

[Winged Scapula]

I'm not the OP, but I was always told (by numerous people) that at least one letter should be from someone outside of the specialty for which you're applying. You're saying that's not the case?

Its certainly not the case in surgery where you want your letters to be from surgeons; YMMV with other specialties, but I don't think you need to go out of your way to find letters from remotely related specialties unless they are (as noted above) better than one you can get from the specialty you're applying to.

 

[gutonc]

I'm not the OP, but I was always told (by numerous people) that at least one letter should be from someone outside of the specialty for which you're applying. You're saying that's not the case?

Yes, I'm saying that's not the case.

Think of it like this. You're applying for a job making widgets. So you get 3 letters of reference saying they've never seen anybody who can craft widgets like you can and that you'll make an excellent widget maker, and a 4th saying you're awesome at petting cats. Well...good for you I guess, but no widget making supervisor gives a s*** about your cat petting skills.

By this logic, a LOR from your boss at the Piggly Wiggly when you were in high school and made employee of the month 3 times in one year should be included.

Moral of the story? Don't ditch a specialty-specific letter for one from somebody in a different specialty. If you're going to top off 3 specialty LORs with a 4th one from a different specialty, or a research letter, that's fine. But don't drop a relevant LOR for an outside one just to mix it up. That's dumb.

 

[Mass Effect]

Moral of the story? Don't ditch a specialty-specific letter for one from somebody in a different specialty. If you're going to top off 3 specialty LORs with a 4th one from a different specialty, or a research letter, that's fine. But don't drop a relevant LOR for an outside one just to mix it up. That's dumb.

With all due respect, I don't think anyone was suggesting such a thing. What I've been told is that once you have 2-3 letters from your specialty, you should supplement with attendings from related specialties. For example, if you're applying to internal medicine, getting a letter from someone in neurology advocating your clinical skills and why you'd be a good IM physician can help. And vice versa.

If you're applying to peds, a letter from an EM attending who can speak about your clinical skills with kids (if you're in an ER that sees peds patients) is still related. If you're applying to family medicine, a letter from OB-Gyn would still be relevant (as would a letter from IM and peds).

That's just what I (and apparently the OP) have been told. Obviously, surgery is different since you'll need letters that address your skills in the OR, but for a lot of other specialties, there's overlap, especially when talking about overall clinical skills, interaction with patients, medical knowledge, etc.

 

[gutonc]

With all due respect, I don't think anyone was suggesting such a thing. What I've been told is that once you have 2-3 letters from your specialty, you should supplement with attendings from related specialties. For example, if you're applying to internal medicine, getting a letter from someone in neurology advocating your clinical skills and why you'd be a good IM physician can help. And vice versa.

If you're applying to peds, a letter from an EM attending who can speak about your clinical skills with kids (if you're in an ER that sees peds patients) is still related. If you're applying to family medicine, a letter from OB-Gyn would still be relevant (as would a letter from IM and peds).

That's just what I (and apparently the OP) have been told. Obviously, surgery is different since you'll need letters that address your skills in the OR, but for a lot of other specialties, there's overlap, especially when talking about overall clinical skills, interaction with patients, medical knowledge, etc.

If you don't have 3 LORs from your specialty, I will assume that you don't know anyone well enough in that specialty to write them for you and, if that is the case, clearly you're not actually interested in the specialty.

If you feel that you need a 4th LOR (Protip...you don't. Seriously. Do you have any idea how long it takes to read 500 LORs?) then I suppose a 4th one from a different specialty is fine. But the OP is talking about Peds. S/he should have done a minimum of 4 Peds rotations (Clerkship, SubI, PICU/NICU, Peds subspecialty) and should have LORs from all of those.

A LOR from a surgeon or from an adult rheumatologist will have absolutely no bearing on a Peds app. None.

 

[Mass Effect]

If you don't have 3 LORs from your specialty, I will assume that you don't know anyone well enough in that specialty to write them for you and, if that is the case, clearly you're not actually interested in the specialty

I think that's a leap, but okay. There's no point in me debating it since I haven't been through the process. I'm sure there are some program directors who feel exactly as you do. I do know that not everyone feels the same. Maybe it's (a) specialty dependent and (b) program director dependent.

 

[Winged Scapula]

If you're applying to peds, a letter from an EM attending who can speak about your clinical skills with kids (if you're in an ER that sees peds patients) is still related. If you're applying to family medicine, a letter from OB-Gyn would still be relevant (as would a letter from IM and peds).

Fair enough, but the OP mentioned letters from a surgeon and Adult Rheum - unrelated specialties that presumably have no idea what it takes to be a Pediatrician.

As gutonc noted, you don't need 4 LORs and there is no reason why someone should be specifically gunning for a non-specialty letter as the 4th one.

That's just what I (and apparently the OP) have been told. Obviously, surgery is different since you'll need letters that address your skills in the OR, but for a lot of other specialties, there's overlap, especially when talking about overall clinical skills, interaction with patients, medical knowledge, etc.

Surgeons don't want letters from other surgeons because of the issue of technical skills (because that can be taught) but rather because only a surgeon knows what it takes to succeed in a surgical residency and practice. Presumably the same would be true for other specialties which is the POV that gutonc and I have. LORs from related specialties make some small sense but a) the OP is not looking at LORs from related specialties and b) a 4th LOR is not necessary.

 

[bowlofmushypeas]

I do feel pretty comfortable about applying with 2 peds and 1 non-peds letter. Another question that's come up for me also is the chairman/program director's letter--anyone know how this typically is done or have advice on how to make the most of it if we haven't had extensive contact with our PDs? This seems to be a common problem particularly at big schools like mine.

In addition, how many peds residencies accept 4 lettesr? And, for that 4th letter, how appropriate would it be for a non-clinician, non-researcher to write? For instance, I'm thinking about an individual I've worked with recently to develop a pediatric public health intervention so in a way, it's certainly related to kiddos and health. Obviously, the meat of LORs will come from clinicians, but for that 4th optional letter, this could be a different perspective. Would this be valued?

 

[BeardedRunner]

I've always heard that a letter from your Medicine or Medicine Sub-I Attending is a gold standard due to the depth of skills this rotation requires. You carry numerous patients, present to the attending on a daily basis, and are likely to get pimped the most - so that's definitely something to consider.

 

[BeardedRunner]

I do feel pretty comfortable about applying with 2 peds and 1 non-peds letter. Another question that's come up for me also is the chairman/program director's letter--anyone know how this typically is done or have advice on how to make the most of it if we haven't had extensive contact with our PDs? This seems to be a common problem particularly at big schools like mine

If your school guarantees a chairman/PD letter, like mine did for medicine (with >90 ppl applying including 55 categoricals and 35 prelims), then you then you will likely have a meeting with an attending from the department who will ask questions in an attempt to get to know you - academic interests, research interest, personal background, hobbies, etc. After that there was a separate, short, 5-10 minute meeting with the actual PD to "ask questions". The PD usually doesn't have much to ask you besides the generic, "What are your future goals?" questions (i.e. academic vs private practice; sub-specialty vs general). Then he or she will give you an opportunity to ask them questions - it is very important to have a couple questions prepared because the PD is looking to gauge your interest and enthusiasm about the specialty with this question (regarding your questions). In the end, the letter is usually pretty generic, with a few distinguishing factors, in a 2-3 sentences about you squeezed in at the end by the PD. If you have the luxury of the other attending writing the bulk of the letter, then it will be more personalized.

 

[mvenus929]

I might ask you however, why aren't your letters from pediatricians? Perhaps it doesn't matter in Peds, but in general, pediatricians are best suited to discuss your suitability for a pediatric residency and practice. What does a surgeon or rheumatologist know about that?

With all due respect, I've had our PD tell us that she enjoys seeing letters from outside of peds, because it shows that you can work with non-pediatricians (and there are non-peds people who rotate through general peds, at least in our hospital (including FM, EM, and anesthesia), and we have to work with non-peds residents both on 'off service' rotations (our residents rotate through peds surgery, but I'm not sure how common that is), as well as if there are, say, surgical consults on our patients.

A LOR from a surgeon or from an adult rheumatologist will have absolutely no bearing on a Peds app. None.

One of the peds surgery attendings here regularly writes letters for people going into peds. And supposedly they're very good letters. Far as I know, no one from my school going into peds hasn't matched. At least not in the past several years.

Another question that's come up for me also is the chairman/program director's letter--anyone know how this typically is done or have advice on how to make the most of it if we haven't had extensive contact with our PDs? This seems to be a common problem particularly at big schools like mine.

First, you should realize that there are only a handful of peds programs that require chair/pd/clerkship director letters. I think I counted somewhere around 10. If you don't plan to apply to any of those programs, you don't need to get a departmental letter.

Second, you should look to see what letters are accepted for these letters. I had our clerkship director write my departmental letter, because he could pull information from my third year evaluations to write the letter. I set up an appointment with him, we chatted, and he figured out what about my application he should highlight in the letter. If you have to get it from the PD or chair, then just make an appointment with them, and show up with your CV and personal statement in hand.

 

[Winged Scapula]

With all due respect, I've had our PD tell us that she enjoys seeing letters from outside of peds, because it shows that you can work with non-pediatricians (and there are non-peds people who rotate through general peds, at least in our hospital (including FM, EM, and anesthesia), and we have to work with non-peds residents both on 'off service' rotations (our residents rotate through peds surgery, but I'm not sure how common that is), as well as if there are, say, surgical consults on our patients.

With all due respect, I *did* note that perhaps it was different in pads or other specialties.

YMMV.

 

[mvenus929]

With all due respect, I *did* note that perhaps it was different in pads or other specialties.

YMMV.

Yet, between you and glutonc, you keep arguing against using non-peds letters when going into peds. I recognize that that's the norm in surgery and other specialties, but it's not necessarily the norm in peds, which was the point of my post.

 

[Winged Scapula]

Yet, between you and glutonc, you keep arguing against using non-peds letters when going into peds. I recognize that that's the norm in surgery and other specialties, but it's not necessarily the norm in peds, which was the point of my post.

Fair enough.

My POV was that I didn't think the OP needed to go out of her way to find a 4th LOR from a non-pediatrician. If pediatric programs prefer such letters, then that's what she should do and I have learned something.

As gutonc and I have noted, that is unusual in IM and Surgery. I'm not sure if your program is different or if that is common in pediatrics but I appreciate your input.

 

[oldbearprofessor]

I have no idea who the "famous" pediatricians .........in the US are

I am SO hurt.....

As far as the theme of this warm and fuzzy thread, it is true that pedi folks are used to and some may actually like seeing one non-pedi letter, especially from a medicine or surgery attending. Skills in time management and interpersonal interactions may cross-over nicely into pedi residency. I'm not sure it's that big a deal in most cases, but it wouldn't surprise me that more than a few pedi PDs (I am not a PD!) indicate such a preference.

As far as the OP's original question, as noted by all, EVERY letter should come with the waiver, LOR's aren't a pick and choose kind of thing.

 

[Winged Scapula]

I am SO hurt.....

Oops...sorry! I guess I DO know a famous pediatrician!

 

[Rippy087]

If you were applying to a surgical residency like GS, would it be ok to have a LOR from a surgical subspecialist like an ENT? Or does the same hold true that you would only want LOR from your exact specialty choice?

 

[gutonc]

If you were applying to a surgical residency like GS, would it be ok to have a LOR from a surgical subspecialist like an ENT? Or does the same hold true that you would only want LOR from your exact specialty choice?

IANAS buy this strikes me as totally acceptable. In IM and Peds, people will typically have a LOR from a subspecialist as their 4th letter.

 

[ThoracicGuy]

If you were applying to a surgical residency like GS, would it be ok to have a LOR from a surgical subspecialist like an ENT? Or does the same hold true that you would only want LOR from your exact specialty choice?

I don't see any problems with that. They are both procedural, surgical fields.

 

[Winged Scapula]

If you were applying to a surgical residency like GS, would it be ok to have a LOR from a surgical subspecialist like an ENT? Or does the same hold true that you would only want LOR from your exact specialty choice?

That is fine.

The only exception would be if you were applying to GS as a back-up and your application appeared to be swayed toward ENT. Then the letter would appear "suspicious" and allude to your real plan.

 

[FlowLimited]

In my opinion, if you get at least three great letters, don't stress over the diversity of the specialties.

I had three letters and they were all from pediatricians. I received more interview offers than I knew what to do with. No program ever asked why I didn't have a letter from any other specialty. I matched at a well-regarded program and am very happy. The end.