MSTP applying to residency without a PhD recommendation letter

[mdphdadvice224]

Hi, I am far along in my PhD, and my relationship with my advisor has recently turned sour (perhaps a long time coming, but it has definitely reached a low point recently). I don't believe this will interfere with my graduating in a couple years, but I do believe there is enough distrust between us that I would not want to ask this advisor for a recommendation letter. If I did, I think it would be weak at best and possibly even harsh. Without getting into details, this PI can be very passive aggressive.

From some searching, I see that not having a PI letter would be a red flag on residency applications. This makes sense because half of my dual degree is in the lab. However, I am trying to figure out what my options would then be. Am I then blocked out of all residencies because of this bad relationship? Is there a particular field or means for MSTPs to return to medicine without a letter from their PhD advisor that I should start considering? Thanks for any advice.

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[Neuronix]

I had some issues with my PhD advisor also. My advice to you is let things cool off and still seek a letter later. Let the med school admin read the letter and hopefully they will agree to throw it in the trash if it is bad.

I'd agree that no LoR from PhD advisor is a big red flag. How much of one will depend on the residency program and the story you tell. That is, do you still want to be a physician scientist or are you done with research? Even then, being done with research as an MD-PhD is a dangerous path because many people are not going to trust you and start assuming bad things about you. Also, you're going to be most competitive for positions intended for physician-scientists, so I wouldn't just throw those out. So therefore, I'd try not to go down that road unless you have to.

On the other side of things, I have an MD/PhD student of my own and can see the other side of the politics. It's going to look really bad on your advisor not to do the bare minimum (i.e. a decent letter) for their own student over something minor. Major issues that might justify no letter would some very good reason like zero/minimal productivity or well documented misconduct. Not everyone behaves rationally, but just pointing out that your advisor also has some motivation to put aside whatever is going on and move on as well.

 

[SurfingDoctor]

I'll be frank... I review MD/PhD applications for residency and I generally have no idea who the mentor is (Dr. Whats-his-face?!... Neat I guess) and frankly don't care (I've also seen enough and personally been apart of enough to realize that some PIs suck).

You got a dual degree and 1) you can talk about your research interests in ernest and with a passion and 2) have a career plan on how you will incorporate them?

You're all good in my book...

I mean, it's helpful to have a letter from the PI. On the other hand... MD/PhDs are generally sought after enough that I'm not sure it makes a huge difference in ones prospects...

 

[Neuronix]

I'll be frank... I review MD/PhD applications for residency and I generally have no idea who the mentor is (Dr. Whats-his-face?!... Neat I guess) and frankly don't care (I've also seen enough and personally been apart of enough to realize that some PIs suck).

You got a dual degree and 1) you can talk about your research interests in ernest and with a passion and 2) have a career plan on how you will incorporate them?

You're all good in my book...

This is a good point. A decent number of people won't even notice that the letter is missing. It's a risky approach, but you might get away with it based on this.

MD/PhDs are generally sought after enough that I'm not sure it makes a huge difference in ones prospects...

YMMV on this point. This is very residency (both program and specialty) dependent.

 

[SurfingDoctor]

This is a good point. A decent number of people won't even notice that the letter is missing. It's a risky approach, but you might get away with it based on this.



YMMV on this point. This is very residency (both program and specialty) dependent.

Yes, that is probably true. I'm speaking from a pediatric perspective.

 

[mdphdadvice224]

What about a recommendation from a pre-PhD research supervisor? If asked, the still suspicious grounds would be (accurately) that my prior research is more relevant and compelling for those applying into x specialty. Or would that draw unnecessary attention to the situation?

Alternatively, are there other fields like peds where my mileage will be high?

Thanks for all the feedback!

 

[SurfingDoctor]

What about a recommendation from a pre-PhD research supervisor? If asked, the still suspicious grounds would be (accurately) that my prior research is more relevant and compelling for those applying into x specialty. Or would that draw unnecessary attention to the situation?

Alternatively, are there other fields like peds where my mileage will be high?

Thanks for all the feedback!

Emergency Medicine.

I probably would throw Anesthesiology and Orthopedics into those mixes, just based on the number of MD/PhDs I’ve encountered in those fields, but I’m less familiar from an actual residency standpoint.

 

[love2chis]

Aren't MSTP program director supposed to help students in OP's situation? MD PhD students have to overcome many hurdles and long haul to be where they are. How could any PD allow any PI to hold MD PhD hostage like this? What this PI does would discourage a lot of MD PhD prospects.

 

[EsseQuamVideri]

Aren't MSTP program director supposed to help students in OP's situation? MD PhD students have to overcome many hurdles and long haul to be where they are. How could any PD allow any PI to hold MD PhD hostage like this? What this PI does would discourage a lot of MD PhD prospects.

Yes. Good PDs should do this. In my experience on the trainee side, the results are mixed due to politics. Remember, students come and go, faculty are more long-term so profs are less inclined to step on each others' toes.

 

[love2chis]

Yes. Good PDs should do this. In my experience on the trainee side, the results are mixed due to politics. Remember, students come and go, faculty are more long-term so profs are less inclined to step on each others' toes.

This is not right. PD's job should be for the best interest of the program. The most important assets of programs are MSTP students, not some PIs who probably do not even belong to the MSTP program.

 

[foxygrandpa]

Did the OP (or any other MD/PhD reading this) end up applying without a letter from their advisor? If so, could anyone comment whether they think this hurt their match cycle?

I know match day hasn’t happened but am interested to hear if this was brought up in interviews. Or if people got less interviews than expected.

 

[deleted1132405]

Emergency Medicine.

I probably would throw Anesthesiology and Orthopedics into those mixes, just based on the number of MD/PhDs I’ve encountered in those fields, but I’m less familiar from an actual residency standpoint.

neurosurgery as well?

 

[SurfingDoctor]

neurosurgery as well?

Probably… but you’re already spending 7 years as a resident. Generally speaking, pursuing a PhD would be a poor financial decision in that field.

 

[deleted1132405]

Probably… but you’re already spending 7 years as a resident. Generally speaking, pursuing a PhD would be a poor financial decision in that field.

Some people dream of being Academic Neurosurgeons leading big labs in BCI

 

[SurfingDoctor]

Some people dream of being Academic Neurosurgeons leading big labs in BCI

Fair enough. I definitely bet the MD/PhD neurosurgeon is few and far between.

 

[mstpdude]

I applied without a letter from my research mentor. Like you, the relationship soured.

I'll be honest: it probably worked against me. I did not match into a research track residency. This was unfortunate only because the "research heavy" institutions are also the most well-respected clinical institutions in my field - think MGH, Hopkins, Penn and the like. Those are the places where the absence of a PhD mentor letter will be noted. In any case, by the time I graduated medical school my interest in research had faded as well.

I did match at a clinically strong program midway down my list, where they didn't give a damn about my research. It would have been nice to have a "fancy brand name" on my resume, but I was happy at the training at the program I matched out.

I am about to finish residency, and had multiple job offers - so it all worked out for me in the end. Hopefully it will work out for you too.

 

[Thimble]

@foxygrandpa

I'm thankful my research mentor is great, but I had some unlucky friends over the years with terrifying mentors who applied without a PhD mentor LOR. Two got LOR from others who know their research well, one from a thesis committee member, and the other from a research collaborator. Two others did additional research, one during M3 (non-first author, but presented a poster), the other during a post-doc between M3/M4. A few others applied without a replacement letter at all and did fine in the match, but they weren't applying to IM PSTPs.

The only one I know who had trouble in the match also didn't publish during the PhD, but they also had significant interference to their training from some really unfortunate, one-off life events that interviewers were (incorrectly, in my opinion) worried could happen again in the future.

Good luck to the both of you!