If you're entering med school locked in on competitive specialties, then you obviously should go to the (much) higher tier school, but you don't really have the choice yet do you? Hard to give advice when you're holding a hypothetical A to one of the choices. But you got into a USMD so any specialty is open to you if you're flexibile. Congrats on the admission. In terms of money: the cost difference here is significant, but if you're gunning for a high-paying specialty, then it's probably a good investment.