I third penpen and ismet on choosing Pitt despite the so-called cost. I did receive some need-based aid which I'm grateful for, but on the whole I feel that I am spending about the same if I attend school elsewhere.
I worked in an adademic center hospital prior to coming to Pitt and I remember telling attendings that I'll be attending PittMed and they all said something along the lines of, "Oh, that's a great program. You'll definitely have opportunities coming out from there." People know people, and in the medical world, Pitt definitely stands out.
You may be pressed to consider your state-school alternatives perhaps, and while I think it might be cheaper, having the connections from a school like Pitt allows you to truly have a higher level of freedom to choose whichever specialty you want to pursue. Many state schools tend to perform stronger in primary care fields, whereas Pitt has a decent balance between the two, if I may say so. And to be honest, people aren't lying you when they say that "you'll change your mind in terms of specialties over the course of med school." I mean, that's what the purpose is, for your four years in school-so why not go to an institution that has the resources and flexibility to choose whatever path you want to take?
If I had chosen my state school, I know my outlook in EM would be more shaky simply because it's program is not as developed as Pitt's. Did I know I wanted to pursue EM during the interview trail? Nope. I actually was considering primary care. But things change. You learn more about yourself and the specialties as you shadow, and connect with attendings/faculty. Can't blame yourself or anyone for having a change of heart.
Another consideration I would make is that Pitt is also a highly regarded academic institution. Academic as in "academic medicine." Therefore, if you're one of those who wants to be at an academic residency (which most often tends to be the more coveted ones), it's far better having coming from a bloodline that is part of the academic atmosphere. This also applies to those who want to pursue a fellowship, etc etc. To give an example, PittMed strongly boasts a research component to their curriculum. And yes, I hated research in undergrad. I did bench research for four years, and yeah I got a pub out, but seriously, I hated it. I even had an AMAZING PI but bench research was not my thing. But, there are so many clinical research opportunities here and it's definitely an amazing way to connect with departments and professors while improving your CV that it's common sense why students truly benefit from it. And, because research is a common facet to the PittMed experience, professors are conditioned to take students under their wing and really become accessible to students. Other schools put research as a lesser priority, and I believe students can suffer because they lose a fine opportunity to become involved in a specialty/division/department in a meaningful way other than shadowing during the first two years.
A neat thing I found out was that while I was approved for a summer research program that funds most projects students come up with, one of the deans just sent me an email saying my project qualified for a T35 NIH training grant and they just asked if I wanted to accept it. Boom. Did I even apply for it? Nope. Now I can't say that this will happen to everyone, but I'm just providing a testament to the fact that UPMC has the resources and connections to help its students out.
Where you go, and who you know, does play a role. Why? Because at the end of the day, there will be many many many qualified applicants that want those coveted spots, and it may come down to the fact that a PD might respect one of their friend's opinions who happens to be your letter writer. People from highly regarded academic institutions are revered and their recommendations are taken seriously. So, take what you want from that, but for me that was something that paying a little more was well worth it.
I can go more in depth but I think I'm going to stop on volume ONE for now. lol. PM if you have any further questions. haha.
(PS: because my response was longer than penpen's and ismet's...this also implies I'm going to bomb friday's neuro exam for not studying now...lolz)