i know this has been discussed before, but i am not technical enough to send you the link, so you might try searching for the long discussion.

short answer: as far as most orthopods are concerned, only a pod can judge your fitness as a pod. if you're good with babies or psych pts or anyone else, that's great, but it doesn't tell anyone in ortho anything except you didn't get enough letters from orthopods.

I would get ONE non-ortho letter. So if you really impress one attending, go ahead and get it. However, I would not show up with more than 1 non-ortho letters, and maybe 2-3 ortho letters. You at least need 3 letters minimun, I would get 1 non-o and 2-o as the minimun.

Some places require a chairman's letter, so if you get a chance scrub some cases with the chair so you can get a meaningful chair letter.

I would suggest 1 letter from your chairman, 1 letter from an away rotation, 1-2 letters from two other ortho attendings in your program. If you really want a none ortho letter I would only add a general surg letter otherwise the above.

I am sure it depends on the program, but when I look at applications, I would much rather see a letter from a OB/GYN attending that is truly enthusiastic and genuine than a canned ortho letter. Maybe it is because I had one ortho, one gen surg, and on peds letter. All were outstanding letters. I had positive feedback regarding these letters during my interviews and ended up matchign at my top choice.

Like I said, every program is different, but in general, I think a very strong letter from a non-ortho staff is better than an average letter from a pod that obviously doens't know you that well.

Our perspective is completely in agreement with the previous response. I counsel our students to get at least 2 letters from orthopaedic surgeons (preferably the chairman and 1 other). However, you want your letters to be from your strongest ADVOCATES and if that happens to be from the chairman of general surgery so be it.

If you are fortunate enough to have all of your letters come from orthopaedic surgeons who can support you that's great. There is nothing more disheartening, however, than to see a truly uninspired 1 paragraph LOR from a "well-known" orthopaedic surgeon who doesn't take the time to write a strong letter for the student.

Hope that helps --

William N. Levine, MD
Vice Chairman and Residency Director
Columbia University Medical Center
New York, NY