Nothing can toss a wrench into a budding career more quickly than a lousy reference. And it's not just negative information that can do the job. A badly written reference or one providing skimpy, nonspecific information can be just as damaging.
ED hiring authorities say they aren't thrilled with the references they have seen lately. The director of a metropolitan ED told me he sometimes wonders if references are a snow job, an effort to dump a less talented physician. “I get letters that have enough real content to fill a thimble. Then when I try to follow up on the phone, they either duck my calls or give me a quick, ‘Yeah, he's real good,’ and hurry to hang up. How can they justify that? If you are in an administrative position, providing accurate and detailed references is part of the job, not something you blow off.”
But perhaps those writing references just don't know how to write one. I asked a few physicians in hiring positions what they want to see in a reference letter, and first and foremost, they said it had to come from someone qualified to provide it. If you are asked to provide a reference, first ask yourself if you have known the person long enough and worked with him closely enough to have solid knowledge of his skills. Another consideration: Do you think highly enough of the person to provide an enthusiastic reference that will be an asset in his job search?
If the answer to any of these questions is no, you should probably decline politely. Obviously, residency program directors and supervisors of departing physicians are obligated to provide a reference. But there is a right way to do it even if you're providing a reference out of obligation. It is important that the reference include specifics about the nature and length of your relationship with the physician and details on the information provided.
Mark Alderdice, MD, a regional director and partner with CEP America, said reference letters carry less weight if they are impersonal or anonymous. “A good reference letter establishes a relationship between the writer and the evaluator. It is best if the writer is known to the reader. Choice of references is critical in this area,” he said.
Dr. Alderdice said a memorable reference letter makes statements such as “one of the five best residents ever in this program,” or “I have worked with John for 14 years, and consider him to embody the very best attributes of a physician.” Unequivocal statements that place the candidate in the top echelon are the ones that catch his interest.
Cookie-cutter references, however, carry the potential of backlash, Dr. Alderdice said. “Letters that lack any categorical statements sound like they were done by rote, and are to many readers a red flag. I only make follow-up calls if the reference is ambiguous or seems halfhearted. I am more likely to call someone the applicant didn't list if I get the feeling the writer is unenthusiastic. A nurse manager may be more candid than a medical director who is trying to ease a poor performer out of his department.”
Chris Michos, MD, the chairman of emergency medicine at Waterbury (CT) Hospital, could teach a course in writing references. He said he looks for a serious level of interest by the writer, a well-constructed evaluation, and a letter that demonstrates effort and honest assessment. He said the letter should cover the candidate's clinical and procedural skills, information about his current position or program, and interpersonal skills with patients, nurses, colleagues, and consultants.
Dr. Michos said he still follows a rule his mentor taught him about recommending candidates. “If asked to provide a reference, I am going to say nine good things about the person, and mention one area that needed improvement. If it's all good, the reference appears unbelievable,” he said. But when you mention an area where improvement was needed and gained, it shows the person has the ability to listen and accept criticism and the good sense to act on it.”
If you are asked or required to provide a reference, make sure you provide one that benefits the physician, not one that could impede his job search, and take the time and effort to do it right. A reference can make the difference between a physician getting a job or being passed over.