To some degree I think that comes down to maturity.
Premeds are chasing that USNews ranking. Prestige drives all, even at the cost of hundreds of thousands of dollars of extra loans in many students' cases.
Four years, a lot of hard work, and a little growing up later - people's priorities change a bit. Some people just want to get off the rat race as quickly as possible and get a real job. Others have families and kids and don't particularly want to move to Boston just because that's where the "BEST" program is. Others have realized they don't actually like research or academics all that much and their definition of a "top" program may be very different.
This is really important here. The bottomline is that it depends on your goals. Some people want the big academic job, competitive fellowship, etc. Other people want to finish their 4-5 years at the program where they'll be able to stay close to family and where they like the atmosphere. All of these factors shape the programs that are perfect for you.
I know some people that left high ranking programs in the middle of PGY1 to transfer elsewhere, because they didn't like the environment. Obviously good academic programs are essential for certain fields and in order to pursue fellowships, but that's not always (nor does it have to be) the most important thing to everyone.
This is much of what I had originally typed up in response to DopaDO's post. But I was typing on my iPhone and for some reason the cut and paste thing is all screwed up and the formatting ended up ruined and I just bagged the response.
My response that there was a lot of misinformation in Dopa's post was too harsh. I certainly respect DopaDO and I see his/her point. I just think it was stated in a way that seemed too overreaching to me.
I guess I was just going to write that there are alumni bases from every program out there that's been around a while, community and academic alike. In Phoenix, there's a huge base of doctors from almost all the specialties that trained at Banner Good Samaritan, a community program (and a really good one at that). Mayo-Scottsdale is starting to make it's mark too. One thing I've noticed is that people tend to settle near where they train for residency. This is nowhere near universal but in Oregon a goodly chunk of the docs trained at OHSU, the Providence IM places, and UDub. In AZ, the vast majority had trained at Banner Good Samaritan, UofA, and Mayo-Scottsdale. I suspect this trend holds true across the country.
What I guess I'm saying is that academic or not, you're most likely to find locally trained docs in any given location. And the non-local ones tend to be from all over. I really don't think that if you train at University of Iowa, that you're going to have an easier time finding a job in Portland, OR because there's going to be this large "alumni base" there that will help get you the job.
Where residency ranking means something really important IMO is fellowship opportunities. As has been mentioned by racerwad earlier, name recognition matters there. But if your goal is to become a regular old Dermatologist, Urologist, Radiologist, Anesthesiologist, Hospitalist etc etc and just go to work at a hospital and make a living, you can do that anywhere. In other-words, if you want to go to residency, learn to practice your field to the best of your ability, and then go to work, you will be able to do that from anywhere. If you want to really subspecialize and be the dermatologist that focuses on esoteric dermatologic manifestations of psychiatric disorders or something strange like that, then going to a big academic center is going to be in your best interest.
But most aren't interested in that, they just want to get off the ride they've been on for the past decade or so as soon as possible. They want to spend their residency training years in a nice program, in an area they're comfortable living in, or in a place that makes sense for a significant other and/or kids that may be in the picture. Then they want to find the best job possible, and start making some friggin money for once and get out of the pile of debt they spent the prime of their life accumulating.
The other thing about high ranking academic programs (and it's related to the esoteric specialization thing I mentioned above) is that they are essential for folks vying to become an academic practice doc. This career path tends to pay far less, but has important perks for some. For example: there's a lot of prestige out there in being an authority on something, and some folks are looking for that more than they're looking for anything else. But most folks aren't hoping to become Chair of surgery at University of Ivory tower when they're applying for residency though, so this again is a fairly small and select group IMO.
Academic residencies are good for fellowship matching (in most fields) and for putting residents on a track for academic medicine practice. But if one's goal does not include those things, I really think it's best to pick a place you want to be regardless of whether it's highly ranked or not.
This post shouldn't be construed as me saying anything even in the realm of community programs being better for most than academic centers. Just that a good community program can teach you everything you need to learn and more, and shouldn't be dismissed as "not worthy of the effort expended through medical school" as some here seemed to imply. I don't think the differences are anywhere near as significant as some here have implied for the majority of students.
