Two (2) Letter of Recommendation dilemmas

You all know the saying that “just when it looks like it is going to rain, it pours.”

I have two (2) dilemmas regarding letters of recommendation (LORs).

Dilemma 1: For the past dozen years, I have been volunteering at a free health project in Mexico, which consists of both urban clinic and rural clinics. I have been working closely with the nurse who started the project, and am currently her righthand “go to” person.

I run the urban clinic (in a border city).

I also volunteer occasionally at the rural clinic which requires me to fly to it.

But now the nurse wants to retire (she’s nearly 80) and she is expecting me to take over for her at the rural clinic. She announced this to me just as I was considering asking her for a letter of recommendation to medical school. But, going to medical school would also mean I would be leaving my coordination of the urban clinic as well.

She is terrified of the prospect that I may leave her as she depends on me for so much as so very few volunteers are willing to drive across the border into Mexico or work in rural Mexico (perhaps due to the fear of crime and drug cartels). Nobody else seems qualified to her and nor is anybody else interested.

So I am afraid she is not going to write me an LOR as she does not want me to leave her project.

Any suggestions regarding how to approach this dilemma?

Dilemma 2: I also help run an urban U.S. health project for the poor and homeless a few times a year. I started it with a few other volunteers. The MD whom I recruited to be our medical director was originally going to write me an LOR, but given my public health work, he is now encouraging me to go to Public Health school instead. He is right that I like public health, but it would be so much easier to start and run such projects having a medical license, i.e. being a physician.

Any ideas on how to handle this issue?

Yes, these are dilemmas. But what wonderful dilemmas to have! Both of these experiences sound amazing. And both of these potential recommenders want you to follow in their footsteps - that is quite a recommendation in itself!

Here are my suggestions of how to approach your issues:

  1. I would be honest with your mentor. I would argue it is better to let her know you will be leaving than to leave her in a lurch. Further, you could possibly work out coming back to help the organization on a semi-regular basis while you are in med school and help transition in the next leader. I have a sneaky suspicion she wants you to succeed and pursue your dreams.

  2. Sit down and chat with him about your desire to work public health into a MD career (or get a MD/MPH). As long as he knows you will be focusing on public health, I bet he’ll be happy to write a rec for you.

    Best of luck!

    –Dr. Miller

Thanks for your suggestions, Dr. Miller.

I will consider your options. I wish I had more time to figure these things out.

As far as returning to help the nurse, that is one of my goals as I very much enjoy doing public health. (The other urban project already has enough volunteers; so that its future continuation is not an issue). As you have already suggested, ideally, I would like to do so through a dual degree MD/MPH or DO/MPH program (assuming I get into such a program; if not, I can always do an MPH and then an MD or vice versa, although I am aware that man AdComms don’t give any weight to an MPH (perhaps because they feel that applicants only do it to shore up their GPA and are not really serious about public health?)

And, if worse comes to worse, I can always get other LORs from previous volunteer work. Before getting involved in these projects, I ran/started other long-term projects and clinics in another part of my home state (yes, I am that old).

In the meantime, I will be doing recruitment of not just clinicians but public health personnel.

On the bus a man discovered a pickpocket’s hand thrust into his pocket.

“sorry,” he said to the pickpocket, “you are too late. My wife did it before you.” ura…