Residency Advisor
It’s late at night. Your laptop screen is the only light in the room. You’re staring at your medical school application checklist, and your stomach drops when you hit the line: “Letter of recommendation from a physician.”
You thought you had this covered.
You shadowed Dr. X for weeks. You showed up early, stayed late, tried to be helpful, stayed out of the way, asked good questions, didn’t annoy the staff (you hope). You finally worked up the courage to ask for a letter… and they hesitated. Or worse, they flat-out said no. Or even worse than that, they said “I’m not sure I can write you a strong letter.”
Now your brain is going:
- Did I screw everything up?
- Does this mean I’m not cut out for medicine?
- Will med schools think I’m a red flag?
- Is this exactly the nightmare scenario every advisor warns you about?
You’re already rehearsing how you’ll explain this in an interview, imagining the adcom committee whispering: “Their own shadowing physician didn’t want to write for them? Yikes.”
Let’s slow this down.
(See also: What If I Say Something Wrong in Front of a Patient While Shadowing? for more details.)
You’re not the first person this has happened to. You won’t be the last. And as destabilizing as it feels, a physician refusing to write you a letter does not automatically mean you’re doomed or that you’re secretly terrible.
It just… really, really feels like that right now.
First: What Their “No” Actually Might Mean (That Your Anxiety Won’t Tell You)
When someone says no, especially someone in a position of authority, our brains love to translate it as: “You’re not good enough.”
But with letters of recommendation, the reality is usually way more boring and way less personal.
Common non-you-are-terrible explanations your mind is probably ignoring:
They barely know you. You shadowed for 10 hours total, they saw you in the corner of the room, maybe talked to you three times. Writing a strong, specific letter from that is hard, and many physicians know that generic letters can actively hurt an application. So they say no rather than write fluff.
They don’t feel comfortable with “evaluative” language. Some doctors hate the formality and responsibility of LORs. They might not understand what med schools want, or they’ve been burned before by writing for someone who didn’t get in and now feel weird about it.
They’ve committed to not writing letters for shadowing students. Some docs have a personal policy: “I don’t write letters for shadowing alone. I only do that for people I’ve worked with more closely.” They won’t necessarily say that elegantly. Sometimes it just comes out as: “I don’t think I can write you a strong letter.”
They’re overwhelmed. Behind the scenes, they’re drowning in clinic, EMR messages, maybe a lawsuit, maybe family issues. Adding a thoughtful letter to their plate feels impossible. Instead of saying “My life is falling apart,” they say “I’m not the best person to write for you.”
Could it still sometimes mean they genuinely don’t see you as an outstanding candidate? Yes. That’s possible. But your brain is probably going straight to that explanation and ignoring the others.
The important thing is this: A “no” on a letter does not automatically equal some kind of formal negative evaluation of you as a future doctor. It just equals “no letter from this person.” Full stop.
Did I Mess Something Up? (The Paranoia Spiral)
The next thing that usually happens is a replay of every moment you spent with them:
- That time you were 7 minutes late because of traffic.
- That question you asked that felt kind of dumb the second it left your mouth.
- The one time they looked annoyed and you assumed it was definitely at you.
You start retrofitting all of that into a story: “They saw that I’m not cut out for this, and that’s why they won’t write a letter.”
Pause.
Sometimes, yeah, maybe something wasn’t ideal. Maybe you were on your phone a bit more than you should’ve been. Maybe you asked for the letter in a rushed hallway conversation instead of a thoughtful email. Maybe you didn’t give them enough time or info.
Those are mistakes in process, not proof that you’re fundamentally flawed.
The good news is: process mistakes are fixable. Especially going forward with anyone else you ask.
If you really want to sanity-check your own behavior, you can ask yourself:
- Did I show up consistently and on time?
- Did I seem engaged (questions, eye contact, interest) without taking over?
- Did I respect patient boundaries and privacy?
- Did I ask for the letter with enough notice and information?
If most of that is “yes,” you probably did fine. You might have just run into a physician with their own constraints or policies.
If some of that is “ehh, not really,” okay. That’s not the end either. That just gives you a game plan for how to handle your next shadowing or clinical experience better.
How to Ask for a Letter Without Triggering Another “Weak Letter” Response
Your anxiety probably wants to never ask anyone for anything again. Totally understandable.
But you still need letters.
The trick is to ask in a way that:
- Gives them an easy out before they say yes and then write something lukewarm.
- Gives them enough context to actually write something good if they agree.
A better way to ask (email or in person), for future situations, goes something like:
“Dr. Smith, I’ve really appreciated the chance to shadow you over the past X weeks and learning about [specific thing]. I’m applying to medical school this upcoming cycle and I was wondering if you’d feel able to write me a strong letter of recommendation based on your experience with me. If not, I completely understand—I only want you to feel comfortable saying yes if you truly feel you can write something positive and specific.”
Is this a little scary to say? Yes. But it forces the outcome you actually want:
- If they hesitate or say no → they probably weren’t going to write you a strong letter anyway. You just avoided a vague, lukewarm LOR that might have hurt you.
- If they say yes → more likely they actually mean it.
Then, if they agree, follow up with:
- Your CV or resume
- A short paragraph about your goals and what you hope to highlight
- The deadline and clear instructions for the submission portal
Most premeds never do this. They ask: “Can you write me a letter?” Not: “Can you write me a strong letter?” The second version is scarier, but safer.
Okay, But What If the Only Physician I Shadowed Said No?
This is the real nightmare scenario your brain keeps looping.
You might be thinking:
- “Med schools require a physician letter. I’m done.”
- “Everyone else has a family doctor or some close mentor. I had one shot, and I blew it.”
Take a breath.
There are a few realities here:
Not all schools require a physician letter.
Many say “recommended” or “preferred.” You need to go school by school, read their LOR instructions, and not assume the worst. Some schools are fine with science faculty + PI + another supervisor.You can still get a physician letter from future experiences.
Your first shadowing experience isn’t your only chance ever. You can:- Arrange another shadowing opportunity with a different physician.
- Build a longer-term relationship by volunteering in a clinic or working as a scribe/MA.
It might feel like you’re too late, but plenty of applicants line up letters later in the cycle.
Schools care more about substance than title alone.
A bland “I barely know them but they watched me work” letter from a physician is not as powerful as a detailed letter from someone who genuinely supervised you (like a research mentor, employer, or volunteer coordinator).
If you’re really close to submitting and don’t have a physician letter yet, you can still adjust:
- Apply to a list of schools where your existing letters meet their stated requirements.
- In the meantime, work on setting up a new clinical relationship so you can add a physician LOR later or for secondaries/updates, if allowed.
The part that feels fatal (“they said no”) is actually just a logistical problem (“I need to find someone else who knows me better to write on my behalf”).
Logistical problems can be solved.
Should I Try to Change Their Mind?
Your instinct might be to send a long heartfelt email begging, apologizing, or trying to explain yourself. Or to ask what you did wrong, hoping for some closure.
Be careful here.
If they said:
“I don’t think I can write you a strong letter”
…that is actually a kindness, even if it hurts. They’re protecting you from a weak letter.
Trying to push back can come across as:
- Not understanding boundaries
- Needy or unprofessional
- Trying to force them into saying nice things they don’t fully mean
A better approach is something like:
“Thank you for your honesty—I really appreciate you being upfront about that. I’ve been grateful for the chance to shadow you and I’ve learned a lot from [specific experience]. If you’re comfortable, is there any feedback on how I could be a stronger candidate or team member in the future?”
They might not answer. They might say something generic. But you’ve shown maturity, respected their boundary, and opened the door to improvement without pressuring them.
Don’t send an email demanding specifics like: “Why exactly can’t you write a strong letter? What did I do wrong?” That almost never yields anything good and just leaves you feeling worse.
How Do I Stop Interpreting This as a Major Red Flag About My Future?
The hardest part of this is not the letter itself. It’s what your brain is doing with it.
Thoughts like:
- “Real future doctors don’t get rejected for letters.”
- “If I were truly impressive, they’d have wanted to write for me.”
- “This is a sign I’m not meant to do this.”
Reality check:
There are amazing, compassionate, high-achieving med students and residents walking around right now who:
- Never got a physician letter from their first shadowing experience.
- Had a PI tell them they “weren’t ready” for a letter.
- Lost a letter writer because someone went on leave, retired, or just never submitted.
Your application is not one interaction. It’s a pattern of experiences, grades, activities, and other humans vouching for you.
This situation tells you one thing: You and this particular physician, in this context, were not a match for a strong letter. That’s it.
If anything, responding to this thoughtfully—finding other letter writers, improving how you ask, building deeper relationships—becomes part of your growth story.
Fielding a “no” professionally is actually something physicians do all the time: from patients, colleagues, systems. Learning to not crumble completely when it happens? That’s part of your training too, even if it doesn’t feel like it.
FAQs
1. Should I list this shadowing experience on my application if they refused a letter?
Yes. List the shadowing if it was a meaningful clinical exposure. Your application doesn’t link shadowing experiences to specific letter writers. Committees won’t know (or care) whether that particular physician wrote a letter for you. They care what you learned and how you reflect on it, not whether that exact doctor endorsed you.
2. Can I use another type of clinical supervisor instead of a physician?
Often, yes. Many schools accept letters from nurse practitioners, PAs, clinical coordinators, charge nurses, or volunteer coordinators who actually observed you in a clinical setting. Always check each school’s exact wording. If they say “clinician” or “healthcare provider” instead of “physician,” you have more flexibility.
3. What if the physician agreed to write a letter but then ghosted and never submitted it?
This is painfully common and feels awful. Send one or two polite reminders spaced a week apart, offering to resend your materials. If they still don’t submit, pivot. Secure another writer instead of waiting indefinitely. Don’t badmouth them in your application; just protect yourself by not depending on someone unreliable.
4. Is a generic physician letter better than no physician letter?
Not necessarily. A truly generic letter (“They shadowed me. They were polite. I wish them well.”) can make you look forgettable or weak. A strong letter from a non-physician who really knows you—like a PI, professor, or clinical supervisor—is often more powerful than a meaningless MD signature. If a doctor basically hints the letter would be generic, you’re better off without it.
5. How many hours of shadowing do I need before asking for a letter?
There’s no magic number, but if you’ve only shadowed 5–10 hours, that’s usually not enough for a strong letter. Somewhere in the range of 20–40 hours, especially if spread over multiple days with real interaction, gives them more to write about. More important than the number is the quality of your engagement and whether they’ve seen you enough to comment on your curiosity, professionalism, and growth.
6. Will med schools ask me why I don’t have a physician letter?
Usually, no. Many applicants don’t have one, and committees often just read what’s there. If a school explicitly requires a physician letter and you don’t submit one, they might flag your file as incomplete or ask for clarification. In that case, you can calmly explain that your primary clinical exposure physician didn’t feel they knew you well enough for a strong letter, so you chose writers who could speak to you in more depth. That answer is honest and reasonable.
Key takeaways:
- A physician refusing to write you a letter doesn’t automatically mean you’re a bad candidate—it often reflects their own limitations, policies, or lack of enough contact with you.
- You can protect yourself by explicitly asking for a strong letter and being okay when someone says no; that “no” might save you from a weak LOR.
- This is a setback, not a verdict. You still have multiple paths to secure solid letters and build the kind of application that shows who you really are.
