IMHO california general surgery spots are a competetive commodity in an already extremely competetive market. I imagine, that as a general rule, getting such a spot is even more difficult for an IMG. All else being equal, I do think that getting a letter from someone well known on the west coast will help you more then a letter from someone they have not heard of. Of course it is impossible to quantify the effect this will have on your overall application. So if you can get a letter from someone well known/respected in California it may help you. If that is impossible or too difficult, make sure you have a few letters from nationally respected surgeons as they will make more of an impact.
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