Get letters from people who know you well and can write great letters. A great letter from an internist that knows you well is better than a form letter from a ortho chairman.

Also, letters from well know people, especially if they are personable, are the best letters. At many of my interviews, people just thumbed through the letters looking at who they were from, because that was the first and last time they ever looked at them.

I sent 2 ortho (1 well known, 1 nobody knew), but the letter from the guy nobody knew was the letter that everyone commented on, ir was so good. The remaining letter I sent was from a FP who knew me very well.

Good luck with the process!

Does anyone know the general rule for sending in more than three LOR's? Any specific programs people know of that either allow or reject a fourth letter of recommendation?

Thanks in advance.

This list is definitely not exhaustive, but...
Required 4 LOR
*Arkansas
*Miami
*Harvard (4th from your ortho Chief Resident)
*Johns Hopkins
*UMKC

Some program websites specifically state that they want 3 letters, others don't. I would only send 3 unless otherwise requested--programs already have more than they want to look at and are adding "exclusionary" criteria to weed out applicants (MCAT, SAT, handwritten PS, "Why xxx program?," etc...).

Read Harvard's site carefully and it says letter doesn't have to be from Ortho chief resident, or even a chief resident. It can be from a non-chief it says. However, I imagine an ortho chief letter is probably the best way to go.

Cool... In answer to your original question, I'll probably send 2 ortho and 1 non-surgical to most programs (with a CV as the 4th LOR).