I did do a home rotation, but I chose not to submit the letter from our chairman to most programs. I had five other excellent letters to chose from, and I had been given advice from a former student that the chairman's letters are lackluster (he doesn't get to know most of the students).

At one of my interviews I was aksed why I had no letters from my chairman. I replied that for that program (one which I had rotated at and gotten 3 letters [two attendings and one chief-resident]) I wanted to submit letters from people they knew. I also said that I wanted to put my best foot forward and only submit letters I knew to be strong from people who knew me well.

I ended up matching there, so they couldn't have been that concerned.

Hey Orthooverhaul,
I think my experience may be useful to you...I am an MS4 and I didn't rotate at my home ortho program. My thought process was as such:
- Only given 2 months in ortho by my med school (anything additional would be dipping into vacation time) Highly influenced by JBJS Nov 02 and wanted to spend those 2 months doing audition electives at other programs (wasn't interested in staying in the home area nor training at my home program)
- Of the 150 something ortho programs participating in ERAS, only about 10 explicitly state that you need a chairman's letter from your home program (yeah, I actually checked websites and/or called almost every program!). Called each of the 10 and 9/10 told me it didn't matter as long as you had strong letters.
- Home program is decent but isn't a big name program and doesn't have big name people (in my estimation) and was not what I was looking for in-terms of strong research/academics.
- Felt going in that I was competitive enough to not rely on my home program as a back-up and also had strong, big-name ortho letters (including a chair letter) from another program where I did research before med school
However, having said all that, keep in mind that you are taking a reasonably big risk by not rotating at home. Regardless of your thought-process or how good your intentions are, your home program will likely feel snubbed and as you know, ortho is a small community and chairmen talk. Also, when you interview, this will come up constantly. I think I was asked at EVERY interview why I didn't rotate at home. Just be prepared for this and have a logical, well-thought out answer (hopefully by that time you will already have thought it out anyway) Keep in mind that this was my experience and yours will likely be very different. If you have any doubts about your competitiveness for ortho, rotate at home. Also keep in mind that if your home program feels snubbed, your chairman will in all likelihood not be your advocate down the road when you may need him to put in a call for you or simply to ask for his advice. By the way, I was still granted an interview at home but could not attend due to a conflict (with a killer midwest program that I could not turn down just for the sake of respecting my home program) Still matched at my No. 1!
Skull

Thanks to the both of you for the great advice. Just to clarify, my medical school does not have an ortho residency program and therefore I do not have to worry about the pitfalls of offending my home program or its chairman. So both of your thoughts make it clear that working hard at another program that I could actually attend for residency would serve me much better than a rotation at my school where the only real benefit is a LOR. It seems somewhat obvious in hindsight, but I had to make sure it would not raise any big red flags. Thanks again. Any other insights are welcome.