I told myself I wasn't going to make one of these threads but I keep going around in circles on this and have seen some good thoughts given in similar threads. As some background, I'm interested in Cards and GI, though not completely set in either.

My top five are BWH, the University of Chicago, Duke, the University of Colorado, and Hopkins. Of these, I really "clicked" at BWH more than any of the latter four, but could see myself happy quite easily at any of those programs. Now, the rub: I have strong personal connections in Chicago, hence my primary deliberation between BWH and UChicago (though I'm certainly still considering the other three strongly).

BWH clearly has top-notch clinical training, research opportunity, match list (and particular strength in cards), etc - but more than anything else I fell in love with the atmosphere of the program, from house staff to senior faculty. Laid back but hard-working, supportive, and a strong humanistic vibe.

Chicago also has outstanding clinical training, plenty of research, and a strong match list (admittedly probably not on par with BWH, though their GI program is particularly strong). A very different overall feel compared to BWH: smaller, more of an intellectual/academia feel.

So the dilemma: go with my gut for the program with the superior reputation...or go for the program in the city I would rather be in that is still very solid by any measure I can figure. If anyone has any thoughts or insights into these programs or can provide perspective on this, I'm all ears :). In the end I realize I don't think I can really make a wrong choice here but what the hell, I figured I'd toss it out there.

I can't answer this question for you, although I feel your overall assessments are probably on par. If you are strong enough to get interviews @these places, you probably will match in your top 2 (top 3 for sure) so be very careful when you make your rank list. You have to decide if favorite program trumps favorite location. Nobody can answer that for you. Career-wise, it would be hard to trump a Harvard hospital, particularly if you felt you'd fit in well there.

I think it depends on your career goals as well. Are you going to do academics/teaching? If not then it hardly matters where you go. Just go where you feel you will be the happiest. Whether location > prestige is totally an individual choice. You will get good training no matter where you go, even if it isn't one of the "top 20" programs that everyone seems so keen on touting.

If you are wanting to be an academic clinician and do research, etc. then the prestige factor will help you down the road when other people are looking at your resume.

There are clinicians in my hometown who went to Harvard, JHU, etc. and some that went to no-name community hospital programs. In the end, the ones who are liked most by their patients are the ones who are the most successful. (success in this sense being measured by making money). And in general, these guys are the ones who went to lesser known places, well outside of the "top 50" IM residency programs.

If it was me: If it's for family, they'll forgive you for three years in boston. If it's a girl/guy/whatever person you love who needs to be in chicago, then I would stay in chicago. Seems pretty simple to me.

But I'm not you. Totally a personal decision that strangers can't help you with much. Do I want the ferrari or the landrover? Ferrari's pretty awesome, but less practical for the family. Landrover is less awesome, but will be better for the family.

remember around rank list time that BWH does the best sell job in medicine. there thing is to make everyone who interviews there that they really want feel like there is no other place for them. not that it's not a special place but it is work just like all good medicine residencies and you will probably work much more there than you would be led to believe from interview day. I would go with maintaining your personal life as medicine regardless of where you go will be taking up more of your time than you would like over the next couple of years.

Thanks for the thoughts, all. I appreciate it. ForeignBody: my plan is to stay in academic (most likely) subspecialty medicine.