Importance of a chair's letter?

[pocket-medicine]

I have heard mixed opinions regarding a LoR from the chair. A lot of people have told me that it is highly recommended. My dept chair, however, claims that it is not necessary and will only write a letter if I've worked with him extensively. I have had limited encounter with him in the OR and I don't want to harass him for a letter when he's made his point pretty clear. He will likely write me a generic letter based on my CV and personal statement if I really *need* one. What are your thoughts on this matter?
I have been promised a letter from my third year clerkship director - does that have any weight?

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[SouthernSurgeon]

A significant number of programs require a chair letter.

The chair at my med school and my residency writes a letter for every student going into surgery.

If your clerkship director, or the program director, is more approachable I'd seek out their advice on how to proceed.