My home institution is a top ten school with a highly respected ortho residency. It would be a great opportunity to complete a residency here, but unfortunately, the cost of living would be prohibitive for my family (wife and a couple of kids) so I am looking at other solid programs in more affordable cities.
Because of this I was contemplating NOT completing a home institution rotation, but instead completing an extra away rotation (my school allows 3 ortho rotations total). This brings up an issue of home letters, but I have one well known ortho surgeon at this program that will write a strong letter. My other letters could come from several different sources including away rotation faculty, community ortho, general surgery faculty, or a chairmen letter obtained through an interveiw with him.
I should note that my school is unique in that it provides an opportunity to complete all of the 3rd in 4th clerkships in a city away from the main university. I volunteered for this option so doing a rotation at my home institution would be simialr to an away in that i would be leaving my family for 4 weeks and its accompanying costs.
Would I be doing myself a disservice if i did not do a home rotation and in doing so obtain 2-3 home letters? this would allow me to only complete two aways.
Thanks for you time.
PS.
Application summary:
Step 1: 242
Research: two pubs from undergrad in unrelated field + ortho research in med school with possible publication.
Clerkships: so far surgery=honors/medicine=high pass
Programs I am strongly considering:
Utah
OHSU
Wisconsin
Iowa
Penn (Hershey)
Rochester
Dartmouth
This is a challenging one - hmmm?! Your home attendings are often your biggest advocates even if you're not planning on matching at that program. Remember if you go to a top 10 school and there are 10-15 applicants from your school they're not expecting you necessarily to match at their program anyway.
I would advise you to do a home rotation nonetheless and make sure that your home program is on your side and can help advocate for you if necessary.
