There's absolutely nothing wrong with matching at your home program, especially if its of good quality (I matched @ home btw).

You get more face time with home ortho attendings and residents since:
1) you run into them in the OR/ER as you plough through your other rotations.
2) You do research with them.
3) You skip lame medicine/obs/geriatrics rounds and go to ortho rounds!

When I walked into my home program interview, I felt relaxed because I knew everyone in the room, they knew me, and I knew what the program was all about and what resident life was like. This is a tremendous advantage to have since you know they are going to ask you: 'why ortho?', 'why here?', 'tell me about your research', etc.

Get to know your home attendings and let them know about your ambitions...they are usually in the same hospital you are in!

Thanks for the response. Hope more people could comment on this topic as I keep checking to hear what others are seeing out there. Thanks everyone for the info.

This is a very interesting question. One that plagued me my entire 4th year of medical school. I ranked very highly and did end up matching at my home program.

I think you have to ask yourself some very important questions.
Is this the right move for you or are you doing it out of fear/comfort.

I think the most important part of a program is DO YOU FIT IN? If you dont fit in then this will be a long 5-6 years. I felt I fit in best at my home program.

There is a huge advantage to knowing the area and the city. You can buy a house because you know the area. Whereas if you went to a new city, you will lilely rent for the first year at least unless you have a family.

SO do you fit in? Do you like the city?

My other major reason was that some of the faculty were excellent mentors to me. And these were relationships I wanted to preserve and be guided by these attendings.

another consideration, does your progam excell at areas you are interested in? You likely do not know what you want to do yet but this is definately a consideration?

Lastly, my mentor told me "You know all the skeleton's in the closet of your home program" This is a double edged sword. If you only interview at a place for 5 hours. They can present almost any image they want to you. However, You know a lot about your home program. All programs have dirt....you just have to ask yourself if you can accept the flaws of your home program.

with all this said. I do sometimes ask myself If I missed out on some opportunity had I explored another city/program. But in the end I am very happy and fit in well at my home program so I am glad I stayed.

But I do understand the emotional debate you are having in your head. Ultimately, the most important thing is do you fit in with the faculty and residents.....I think that is the most imortant predictor of happiness.......

But thats just my free advice....

i think you always have the best chance to match at your home program and anywhere you do an away rotation - provided that you do a good job.

the previous comments are good ones. however, you also run the risk of being overbearing at your home program - skipping rounds on ob/gyn, medicine, neuro, etc to go to ortho conference at my home program will likely get the residents here thinking that you don't work hard where you are currently and may be a bad thing.

your home program is going to know you better than anyplace you interview for a day, for better or for worse. if your home program is big into numbers, your work ethic may not help as much unless you also have the numbers.

in my opinion, programs that match a lot of their own students probably value hard work very highly and select/rank those with a good track record which benefits hard working students from that program. also, a program that matches a lot of their own students can be a good thing b/c the students probably know the program better than outside applicants and probably rank that program highly, even though they know the dirt/downsides better.

that being said, i can add the disclaimer that my home program and my 2 aways are my top 3, so maybe i have some comfort factor bias