Shadowing Semantics

What is the general consensus as to where letters of recommendation should come from? I initially wanted to apply to PA school and started shadowing a couple of PA’s this past year. I have decided instead to apply to medical school, but have acquired around 300 shadow hours between the University Hospital E.R. where I live in San Antonio and down in the valley at a rural health clinic. I know for a fact that these 2 PA’s who both have nearly 20 years in the profession each would each write me solid letters. How would a medical school admissions board view letters coming from a PA? I know I can say that instead of “shadowing” a PA I have “volunteered” for said amount of hours at an ER an a family practice. At both the ER and the family practice I have cultivated relationships with different physicians who I know would allow me to shadow them. Should I start shadowing a couple of physicians to establish a great rapport for solid letters of recommendation down the road? I am still going to continue to shadow said PA’s as they both allow me to perform tasks (ordinarily reservd for clinicians) such as taking history’s and the other night I was able to participate in stapling a superficial laceration on the back of the skull. What do ya’ll think?

Your medical school LORs should mostly be academic, from professors in courses you’ve taken. A LOR from someone you shadowed can embellish your credentials but the most important thing admissions committees want to hear from letters is, “Can you do the work?” Someone you shadow can’t comment on that, and their letter is weighed accordingly.

So don’t stress over this. The letters you may be able to get from these people are of very small importance in your overall application. Other stuff is going to be WAY more important.


That’s interesting to hear. I would’ve thought that the relationship I could potentially cultivate with a clinician would be more in depth than with a professor who I may see now and again in office hours Are you saying that Admissions will favor a letter from a prof over a physician I’ve shadowed for over 200 hours each? I hardly know my professors other than a brief office hour visit or two. I thought the ability to show if I can handle the load is inversely proportional to my final grade. What “other stuff” are you referring to?

I second what Mary said. Most medical schools want strictly academic letters unless you request permission to waive that requirement due to the amount of time you’ve been out of school. It wouldn’t hurt you to have one of your PA’s write you a letter. There are some schools who have no limit on LOR’s and others that allow you to submit a work/personal reference in addition to your academic letters. I had a friend/co-worker who is a paramedic write one such letter for me. I think I was only able to submit it to one school, though.

As for the “other” stuff - good grades, decent MCAT score, extracurricular activities (including volunteer work), clinical/research experience . . . I think those are the things that Mary is referring to as being more important. (some would also throw the personal statement in there). The point being that the best letter in the world isn’t going to get you very far if you don’t have the above stuff.

Yes, that’s a concise listing of all the “other stuff.” Basically you can be a great person but med school is academically intense and they need to know that you can hack it. They want to know that you’re a great person, too, but if you don’t have the academic chops, being nice doesn’t help.


The clear evidence that many medical school faculty members are themselves not nice suggests that this is not a major factor!

Seriously, though, nice is important, but I agree that academic stuff is most important. A surprising proportion of the med school application process is designed to accomplish two things: first, limit the supply of doctors; and second, ensure that admitted students do not drop out since there is a huge financial investment in them. The MCAT was designed for the latter purpose and this is basically its only real utility.

Interviews and letters do also help the more intangible part of choosing people who “fit” the school. The college interview was originally designed to help enforce more or less explicit quotas limiting or excluding Jewish students from elite Eastern universities in the early part of the 20th century. Some significant part of the function of the med school interview–a derivative of the same ritual–remains similar: making sure that you will be a good part of the club. Thankfully that club is a somewhat more diverse and democratic one these days. Still, it’s a club.

That brings me to the PA letter problem, for which I would advise a work-around. These PAs are supervised by some physician, right? And that MD has likely at least nominally signed off on you hanging around, or would be willing to. Therefore I’d have the MD and the PA “co-write” the letter, with the PA really writing it but the MD signing it. This is likely to pull more weight in admissions, since it will be endorsed by a club member. (See above.) Even better if the club member has an academic affiliation, but the MD part is the part I’d rally for. Ask the PA if that’s OK first, explaining to the PA that this is not to diminish your appreciation of their support of you but that others have told you that some doctors are a-holes and need another doctor to verify any statement made by some other kind of clinician. The PA will likely understand this right away; if they are bothered by this then have the PA do it alone.