LORs - Bad to have zero from home institution?

Dear Dr(s),

I had a couple specific questions regarding LORs --

1. Is it looked down upon if you have zero LORs from your home institution (other than your chair's letter) -- because you feel that you can get letters from other orthopaedic surgeons who truly do know who I am academically and otherwise?

2. (I apologize as this may have been asked long ago, but after an initial screen, I did not see the question) -- If given the choice, would it be favorable to send out 3 or 4 good LORs from all orthopaedic attendings or to show variety and include say, a letter from a general surgeon with whom you worked closely with during your clerkships?

Thank you in advance for your replies.

This message has been lingering here for a while now....

My 2 cents.
If I was in your shoes, I would submit the strongest LORs I have. Regardless if one is from a general surgeon, I think a letter which shines is better than a borderline letter from some eminent orthopod.

As for what to do if you have none from your home program: I guess you could get asked how your home rotation was. But that's less likely to happen if you have strong letters in general. Programs want to know why are applying to them and if you are serious about ranking them. In fact, you could even be dastardly enough to use a weakness you have noted in your home program as one of the reasons for your application to the program you are interviewing in. Don's trash your home program, but just use it to make the program you are applying for shine.

Hope that helps.

definitely helps a lot. thanks for the advice.