Antecdotally, does it seem like school tier is playing a more important role now that step 1 is pass fail?

[voxveritatisetlucis]

This is the first match cycle where one can really tell how much school tier will play a role now that step is pass fail.

Antecdotally, a few people at my low tier school didn’t match rads/anesthesiology despite having 10+ interviews.

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[gyngyn]

It was a predictable outcome of this unfortunate decision.

 

[Angus Avagadro]

This is a well known risk of attending new schools or schools of lower tier status. This all begs the question of how did a student pick their school list? Established schools have regional reputations and regional residency programs are familiar with the quality of their students. The residency Match Game is becoming increasingly competetive. Students will have to understand the game well and apply to programs where they are competitive in the coming years.

 

[voxveritatisetlucis]

This is a well known risk of attending new schools or schools of lower tier status. This all begs the question of how did a student pick their school list? Established schools have regional reputations and regional residency programs are familiar with the quality of their students. The residency Match Game is becoming increasingly competetive. Students will have to understand the game well and apply to programs where they are competitive in the coming years.

This is true. But a USMD used to be able to walk into certain specialties. I bet it had just as much to do with school expansion as it does step 1 going p/f

 

[anonymouspanda]

Some of the top ophtho and uro programs (like MGH, UCSF tier) posted their new match classes and top schools weren't that well represented if I recall. I used to think it mattered a lot more than it did but I go to a T10 and was absolutely passed on by programs for students at other schools who had more research than me (which is valid).

Step 2 and publications are still king

 

[Hollow Knight]

I don't know if it's prestige specifically, but it's much harder for people at lower-tier USMDs/DOs to crank out research vs the yale/harvard people. That's definitely going to affect things.

People at my school have a hard time getting the pubs they need, and then they're from a no-name place on top of that.

 

[operaman]

Always hard to tease out school name from all the other advantages that come with a top school, not to mention the quality of student that tends to get accepted there. Probably too soon to tell if it's different now in the post S1 era, but since we have S2 it's not like we're hurting for ways to stratify quickly.

 

[AnonymousDoctorGuyPerson]

A lot of top schools are true P/F, allowing students more time to better use the expanded resources their institution has for research. And, frankly, if you were able to get into a top school you're probably already a step ahead in terms of performing well on Step and what not.

As someone applying IM, the Big 4 (MGH, BWH, UCSF, JHH) are pretty inundated with top schools (outside of Hopkins, which I imagine is a factor of it falling down people's list due to the rigor of the program coupled with its location).

I'll find out where I match shortly, so I can update my anecdotal experience but I am quite confident my school's ranking will have an impact at the programs at the top of my list.

 

[Ho0v-man]

people at my program said that’s 100% what they’re doing. I mean, it was always important but it’s really ramped up for us. I probably wouldn’t have gotten an interview here this cycle.

Step 2 scores weren’t actually that important unless they were really bad in the past. Step 2 is a test you study hard for to crush. But people study their butts off just to pass Step 1, so I feel like high step 1 scores were always more impressive in that regard.

Now that’s gone and so that removes a potential feather in the cap of an otherwise excellent med student who attends a low tier school.

But hey, at least med students aren’t stressed anymore. So mission accomplished, I guess.

 

[jambro]

people at my program said that’s 100% what they’re doing. I mean, it was always important but it’s really ramped up for us. I probably wouldn’t have gotten an interview here this cycle.

Step 2 scores weren’t actually that important unless they were really bad in the past. Step 2 is a test you study hard for to crush. But people study their butts off just to pass Step 1, so I feel like high step 1 scores were always more impressive in that regard.

Now that’s gone and so that removes a potential feather in the cap of an otherwise excellent med student who attends a low tier school.

But hey, at least med students aren’t stressed anymore. So mission accomplished, I guess.

This argument doesnt really make sense to me because if we're talking stratification it doesn't matter how "hard" the test is, what matters is a percentile. A 90% percentile Step 2 should be no less impressive than a 90% percentile Step 1.

I could make the test how many digits of pi you can memorize and it would have the same effect.

 

[Med Ed]

This is true. But a USMD used to be able to walk into certain specialties.

And still can, but the specialties have changed.

40+ years ago the top students went into IM. Ortho and urology were fall-backs, populated by ex-surgery residents who didn't advance through the pyramids. Anesthesiology and radiology have bounced from hot to not (and back again) more times that I can count. Rad onc was brutally competitive, now not so much. EM went from highly competitive (and knowing it) to letting in anyone who can fog a mirror. Psych has gone from mirror fog to actually being picky. Jesus, even pathology has become a little bit competitive. What has the world come to?

 

[Deltasidearm]

40+ years ago the top students went into IM. Ortho and urology were fall-backs, populated by ex-surgery residents who didn't advance through the pyramids. Anesthesiology and radiology have bounced from hot to not (and back again) more times that I can count. Rad onc was brutally competitive, now not so much. EM went from highly competitive (and knowing it) to letting in anyone who can fog a mirror. Psych has gone from mirror fog to actually being picky. Jesus, even pathology has become a little bit competitive. What has the world come to?

Obviously it's a complex multifactorial issue but I wonder how great of a role initial medical school admissions plays in the creep of competitiveness. It's no surprise that most fields are becoming more competitive on average when the average medical student is expected to come in as a M0 with more research, more extracurriculars, and a stronger GPA/MCAT year after year. I think which specialties are hot ends up being at the whim of the times but I'm not sure the overall competitiveness race for residencies will stabilize or improve until the standards for medical school admission do.

 

[mrbreakfast]

School name is important, but the real reason school matters so much is that it is correlated with many other things programs look for, which may be harder to measure. Med students from top schools just happen to be the type of student who scores well on exams, has quality research, and clinical evaluations that are likely replicable. The problem with no-name/new medical schools is residencies have no idea what they are getting; there plenty of medical schools where passing preclinicals (and staying out of trouble) essentially guarantees you'll graduate, regardless of performance. That's how it was at my (bad) medical school; "average" students would go on to not match, or match their last choice, or get failing grades on their aways, etc.

The main downside of Step 1 being pass/fail is, in my opinion, exactly what was feared on this forum before the change. Good students at bad med schools have a harder time "standing out." I personally have no doubt my residency interviews, and match, would have been quite different if my step 1 was pass/fail.

 

[Hollow Knight]

So yeah match day at my school and basically zero competitive specialties.

A couple of years ago we had people match derm, plastics, ENT. This year, zero of those.

It's definitely more complicated than school rank, but this is the worst match list my school has seen in years. Maybe this year's class was a bunch of bleeding heart primary care people...... but I doubt it.

 

[voxveritatisetlucis]

My school actually ended up being quite good. One of the best matches in 5 years with a few going to top IM, bunch of ortho, couple optho

 

[GotToGetThatGPAUp]

My school actually ended up being quite good. One of the best matches in 5 years with a few going to top IM, bunch of ortho, couple optho

Ours wound up being underwhelming

I had 3/4 of the Big 4 IVs, matched at a decent "T20" that was my rank #5 and I wound up doing the best in my class.

I do think our school does have a sort of "stink" to it though, unfortunately

 

[voxveritatisetlucis]

Ours wound up being underwhelming

I had 3/4 of the Big 4 IVs, matched at a decent "T20" that was my rank #5 and I wound up doing the best in my class.

I do think our school does have a sort of "stink" to it though, unfortunately

That’s still good though so congrats. By top IM, I didn’t mean big 4, more like top 10-20 which is historically pretty good for my school

 

[JAK2-STAT3]

The VA schools are an interesting study. I don't think VCU and VTC have their lists posted yet, but I was surprised by EVMS and UVA. EVMS had 4 ortho, 3 neurosurgery, 2 derm, 7 rads (DR), 1 plastics, and 3 ENT, while UVA had 3 ortho, 3 neurosurgery, 5 derm, 6 rads, 1 plastics, and 2 ENT. Sure, UVA is matching to "fancier" programs than EVMS, but the point is that it is still possible to match competitive specialties from schools that aren't T20s.

 

[medschoolaspirant]

This appears like a myth now that the data is published. Competitve speciality like ortho. Derm. Ent. Rads. Plastics. Etc…. Appears as competitive as before. Not more or less. Primary care unfilled also appears more or less same as before (with exception of EM, which improved and peds, which fell). Also random looking at match list of top 20 or mid tier ones, ratio of primary care matching to competitive matching appears same as before. Given that, I thnink step 1 pass fail changing landscape of competitveness for specialties or how school match list looks from before and now is a myth. Nothing much has changed then before.

 

[GoSpursGo]

This appears like a myth now that the data is published. Competitve speciality like ortho. Derm. Ent. Rads. Plastics. Etc…. Appears as competitive as before. Not more or less. Primary care unfilled also appears more or less same as before (with exception of EM, which improved and peds, which fell). Also random looking at match list of top 20 or mid tier ones, ratio of primary care matching to competitive matching appears same as before. Given that, I thnink step 1 pass fail changing landscape of competitveness for specialties or how school match list looks from before and now is a myth. Nothing much has changed then before.

What data specifically are you pointing to? Because for many of these competitive specialties there wasn’t much room for the traditional markers of “competitiveness” like step 2 and pubs to go up. But if the question is whether programs are weighing school “prestige” more or less, you really have to compare the match lists of specific schools or, conversely, specific programs side by side and likely over the span of a few years to get a general gestalt of whether more prestigious schools are getting an increased leg up in the match game.

As one of the other posters said, step 2 and research will likely still be king. But while I don’t think we are ever going to get to a point where prestige=top residency and low tier school=locked out of prestigious residency, it wouldn’t surprise me if there is some intangible increased value we see from top schools.

 

[mrbreakfast]

This appears like a myth now that the data is published.

We don't actually have any "data" that would gauge competitiveness, other than match rate. We don't have charting outcomes, program director reports, etc. And no offense, but your "random looking at match lists" isn't very scientific.

Competitve speciality like ortho. Derm. Ent. Rads. Plastics. Etc…. Appears as competitive as before.

Just since you specifically mentioned these specialties, it's worth noting that all of them had a lower match rate (-0.8%, -1.4%, -2.2%, -2.0%, -1.5%) than 2023, while overall match rate rose by 0.1%.

As has been discussed over the years on this forum, there is tremendous variation year-to-year variability in match rate, and it is incredibly challenging to measure "competitiveness" based on small groups of numbers alone - general surgery has a lower match rate than plastics or ENT, for example, and DR has a (much) lower match rate than all three, but would you say DR is "more competitive" than plastics? But I can tell you that (other than an away rotation) the single thing that is most likely to get a random application an interview is an above-average step score, and by eliminating Step 1, I do believe the opportunity to get an interview for an applicant who does not otherwise have a stellar application has dropped. That's the take-away, which will be hard to prove, or disprove, objectively for anyone.

Just anecdotally, my (mediocre) med school sent 8.5% of its graduates into derm or a surgical subspecialty over 2020-2023. It sent 6% this year. We'll have to see if that trend holds.

 

[medschoolaspirant]

Let me put some data to justify my point, that step 1 change has NOT altered match outcome to any conceivable larger difference. Please correct me, if I am missing any significant points.

Following are US MD applicant applied - applicant matched for primary care specialities.for year 2024 and 2023.

IM- 4225-3595 (85%) 4207-3592 (85%)
FM- 1721-1521 (88%) 1718-1484 (86%)
Peds- 1617-1464 (90%) . 1822-1635 (90%)

It shows between 2 years for USMD , there is hardly much difference between candidates applied to matched. I am no where suggesting above are actual match rate in respective primary care specialites, as many dual applicant may be part of pool for applied. However apple to apple raw data suggest, not much difference.

Now following are USMD applicant applied - applicant matched for 2 competitive specialities of Ortho and ENT. For year 2024 and 2023.

Ortho -1008- 726 (72%). 947-690 (72%)
ENT- 422-339 (80%). 379-310 (81%)

It shows again these specialities are as competitive as before, not much difference,

Last piece randonly picking 2 mid tier school Buffalo and SUNY downstate, to show their number of student matching competitive speciality of Ortho - ENT. For year 2024-2023.

Buffalo- 8 ortho- 4 ENT . 6 ortho- 2 ENT
SUNY Down state - 6 ortho -3 ENT. 7 ortho -5 ENT

Shows mid tier school like Bufflalo matched more Ortho and more ENT in 2024 over 2023. Where as SUNY downstate was opposite result. When you compare 2024 matches to 2023 matches.

Last piece randonly picking 2 top tier schoold Hopkins and Stanford, to show their number of student matching competitive speciality of Ortho and ENT. For year 2024-2023.

Hopkins- 4-5. 6-3.
Stanford- 9-2. 5-2.

Shows top tier school like Hopkin matched less Ortho and more ENT in 2024 over 2023. Where as Stanford matched more Ortho and same ENT.

It will still be too early to conclude. But based on above early indications are mid tier schools continue to match similar number for competitive speciality as before. So not much has changed with step 1 going pass/fail. It appears a myth.

 

[SailboatJ]

Let me put some data to justify my point, that step 1 change has NOT altered match outcome to any conceivable larger difference. Please correct me, if I am missing any significant points.

Following are US MD applicant applied - applicant matched for primary care specialities.for year 2024 and 2023.

IM- 4225-3595 (85%) 4207-3592 (85%)
FM- 1721-1521 (88%) 1718-1484 (86%)
Peds- 1617-1464 (90%) . 1822-1635 (90%)

It shows between 2 years for USMD , there is hardly much difference between candidates applied to matched. I am no where suggesting above are actual match rate in respective primary care specialites, as many dual applicant may be part of pool for applied. However apple to apple raw data suggest, not much difference.

Now following are USMD applicant applied - applicant matched for 2 competitive specialities of Ortho and ENT. For year 2024 and 2023.

Ortho -1008- 726 (72%). 947-690 (72%)
ENT- 422-339 (80%). 379-310 (81%)

It shows again these specialities are as competitive as before, not much difference,

Last piece randonly picking 2 mid tier school Buffalo and SUNY downstate, to show their number of student matching competitive speciality of Ortho - ENT. For year 2024-2023.

Buffalo- 8 ortho- 4 ENT . 6 ortho- 2 ENT
SUNY Down state - 6 ortho -3 ENT. 7 ortho -5 ENT

Shows mid tier school like Bufflalo matched more Ortho and more ENT in 2024 over 2023. Where as SUNY downstate was opposite result. When you compare 2024 matches to 2023 matches.

Last piece randonly picking 2 top tier schoold Hopkins and Stanford, to show their number of student matching competitive speciality of Ortho and ENT. For year 2024-2023.

Hopkins- 4-5. 6-3.
Stanford- 9-2. 5-2.

Shows top tier school like Hopkin matched less Ortho and more ENT in 2024 over 2023. Where as Stanford matched more Ortho and same ENT.

It will still be too early to conclude. But based on above early indications are mid tier schools continue to match similar number for competitive speciality as before. So not much has changed with step 1 going pass/fail. It appears a myth.

I haven’t looked at all the data so I’m not saying I have an answer to the question of school prestige, but I just want to point out that comparing two years worth of data for certain handpicked specialties and schools is almost completely uninformative. As the poster above mentioned, match statistics are incredibly variable year-to-year; for a believable conclusion, one would need to look at many years of data across all specialties.

 

[medschoolaspirant]

I haven’t looked at all the data so I’m not saying I have an answer to the question of school prestige, but I just want to point out that comparing two years worth of data for certain handpicked specialties and schools is almost completely uninformative. As the poster above mentioned, match statistics are incredibly variable year-to-year; for a believable conclusion, one would need to look at many years of data across all specialties.

100% agree. Few hand picked specialities and few hand picked schools should not be bench mark. With same token, to suggest prestige of school is now driving factor for getting in competitive speciality also is misguiding.

 

[mrbreakfast]

Let me put some data to justify my point, that step 1 change has NOT altered match outcome to any conceivable larger difference. Please correct me, if I am missing any significant points.

One more try:
Match rate is not a measurement of competitiveness. It's a measurement of two things: the number of available spots, and the number of applicants. Both vary per year, but generally speaking, you would not expect a major change year-to-year. So for match rate to drop substantially, for example, it would mean a number of programs closed, or significantly more people applied. Even big statistical changes in other statistics will barely affect match rate: e.g. derm had an 8% increase in USMD applicants, which I think we would agree is notable; that only dropped the match rate by 1.3%. One would not expect making Step 1 pass/fail to change the number of applicants, and thus would be unlikely to change the match rate.

If a field is more competitive, that means the quality of the successful matches has changed. So if the average Step 2 score, or AOA %, or number of publications, went up a good bit for a specialty (both across matched and unmatched applicants), you could argue that field has become more competitive.

We're not saying making Step 1 pass/fail is going to significantly change the number of given applicants to a field. The same number of people will apply, and the same number of people will match. What we are saying is that if you have two otherwise identical applicants, one from a top quartile med school and one from a bottom quartile med school, and remove step 1 from the equation, the bottom quartile med student may now be less likely to match than before, and that difference may be small (~5-10% less likely), which may be hard to represent by trying to compare match lists, but across the entire specialty would make a difference.

 

[GoSpursGo]

100% agree. Few hand picked specialities and few hand picked schools should not be bench mark. With same token, to suggest prestige of school is now driving factor for getting in competitive speciality also is misguiding.

The overall match percentages really are irrelevant when you're talking about prestige. The match percentage shouldn't change unless your denominator of total people applying to the specialty nationwide changes.

I don't think anyone was suggesting that there was definitive evidence showing that prestige is more important now, though obviously that is a common hypothesis that is more or less untestable until we have several years of data. You explicitly said that the "data" proved your counter-point... which seems premature.

 

[nibhighfootballrules]

One more try:
Match rate is not a measurement of competitiveness. It's a measurement of two things: the number of available spots, and the number of applicants. Both vary per year, but generally speaking, you would not expect a major change year-to-year. So for match rate to drop substantially, for example, it would mean a number of programs closed, or significantly more people applied. Even big statistical changes in other statistics will barely affect match rate: e.g. derm had an 8% increase in USMD applicants, which I think we would agree is notable; that only dropped the match rate by 1.3%. One would not expect making Step 1 pass/fail to change the number of applicants, and thus would be unlikely to change the match rate.

If a field is more competitive, that means the quality of the successful matches has changed. So if the average Step 2 score, or AOA %, or number of publications, went up a good bit for a specialty (both across matched and unmatched applicants), you could argue that field has become more competitive.

We're not saying making Step 1 pass/fail is going to significantly change the number of given applicants to a field. The same number of people will apply, and the same number of people will match. What we are saying is that if you have two otherwise identical applicants, one from a top quartile med school and one from a bottom quartile med school, and remove step 1 from the equation, the bottom quartile med student may now be less likely to match than before, and that difference may be small (~5-10% less likely), which may be hard to represent by trying to compare match lists, but across the entire specialty would make a difference.

Does data regarding step 2 scores, AOA, and publications typically get released soon after match? Also, would be very interesting to see what percentage of applicants that matched competitive specialties matched into programs that they did aways at or their home programs. Doubt this information is reflected in any dataset but would definitely be interesting to see.

 

[mrbreakfast]

Does data regarding step 2 scores, AOA, and publications typically get released soon after match?

No, and sometimes not at all. But you can check out Residency Data & Reports for some examples.

 

[ontiquicuo]

Does data regarding step 2 scores, AOA, and publications typically get released soon after match?

Charting the Outcome should come out in the summer.

 

[anonymouspanda]

Some of the top ophtho and uro programs (like MGH, UCSF tier) posted their new match classes and top schools weren't that well represented if I recall. I used to think it mattered a lot more than it did but I go to a T10 and was absolutely passed on by programs for students at other schools who had more research than me (which is valid).

Step 2 and publications are still king

Updating that I fell on my list despite scoring above a 270 and coming from a T10, which I kind of expected given my lack of research. The other people in my class that fell also had a weak spot on their applications. Looking up the best programs in my specialty (radiology), most of the students are not from top schools and there is good IMG representation. Prestige. does. not. matter. Top schools have great match lists because everyone is completely cracked. There are many 265+ in my class and everyone I know has multiple pubs. If you're an average applicant from a top school (like me) you'll match at an average program. If you're an excellent applicant at a non top school you'll outcompete people like me every time.

No PD is giving bonus points for school name alone anymore, that is completely dead. The only argument is that top schools provide better access to research, but if you don't utilize it you're in the same group as coming from any other school.

 

[pierty]

Updating that I fell on my list despite scoring above a 270 and coming from a T10, which I kind of expected given my lack of research. The other people in my class that fell also had a weak spot on their applications. Looking up the best programs in my specialty (radiology), most of the students are not from top schools and there is good IMG representation. Prestige. does. not. matter. Top schools have great match lists because everyone is completely cracked. There are many 265+ in my class and everyone I know has multiple pubs. If you're an average applicant from a top school (like me) you'll match at an average program. If you're an excellent applicant at a non top school you'll outcompete people like me every time.

No PD is giving bonus points for school name alone anymore, that is completely dead. The only argument is that top schools provide better access to research, but if you don't utilize it you're in the same group as coming from any other school.

I wish this reality was more public. The obsession with prestige on forums like this is a confirmation bias of undergrad obsession and the type of student who frequents these types of sites (hyper-neurotic, type A, extremely sensitive to external validation).

Reputable people give institutions prestige - not the buildings or administration surrounding them. More people like this tend to go to what they perceive as prestigious schools because many of them think they should (see above), and come from wealthy backgrounds that can afford the exorbitant fees to attend wherever they choose. But the truth is that if they wanted to, these students would succeed anywhere:

Estimating the Payoff to Attending a More Selective College: An Application of Selection on Observables and Unobservables

Founded in 1920, the NBER is a private, non-profit, non-partisan organization dedicated to conducting economic research and to disseminating research findings among academics, public policy makers, and business professionals.

www.nber.org

 

[Mr.Smile12]

What I posted

[PBS documentary, 2024] "Dream School: A Journey to Higher Ed"

forums.studentdoctor.net

 

[Saturday’s Child]

The VA schools are an interesting study. I don't think VCU and VTC have their lists posted yet, but I was surprised by EVMS and UVA. EVMS had 4 ortho, 3 neurosurgery, 2 derm, 7 rads (DR), 1 plastics, and 3 ENT, while UVA had 3 ortho, 3 neurosurgery, 5 derm, 6 rads, 1 plastics, and 2 ENT. Sure, UVA is matching to "fancier" programs than EVMS, but the point is that it is still possible to match competitive specialties from schools that aren't T20s.

Very interesting. I would say that competitive specialties are still entirely on the table for students at “less competitive” med schools since it seems that like attracts like.

Students at higher-ranking med schools generally do not target lower-ranking residencies in a given competitive specialty, such as ortho. Similarly, those residencies also tend to not highly rank students from those higher-ranking schools—don’t know exact reason… they could be going off of historical bias in thinking that, even if signaled, a UVA student is unlikely to want to end up at their program compared to a student from EVMS, who regularly matches students there.

A solid applicant from a lower-ranking school therefore has a very good chance of matching at a similarly ranked residency, even if it’s for a competitive specialty.

 

[collegestud2013]

This is the first match cycle where one can really tell how much school tier will play a role now that step is pass fail.

Antecdotally, a few people at my low tier school didn’t match rads/anesthesiology despite having 10+ interviews.

As others have said, it may be too soon to tell if this is happening, though this has been the predicted outcome of moving towards a P/F step 1. You would have to compare medical school graduation lists for incoming interns at top programs before and after the change to P/F Step 1 and control for other variables (for example like residency slot expansion and how many people overall are applying to a given specialty) to see if being from a top-tier research med school is giving one more of advantage than before. And ideally would need a few years of data to show some consistency. The prediction that step 2 would just replace step 1 as the new screening tool is likely happening, though it's role compared to step 1 may not be big so far, hence still pushing more weight onto other factors.

Agree with others that being from a top-tier med school already had is advantages in the past besides stool prestige name alone, like having more easy access to resources for research, even when controlling for caliber of students (previous data from before P/F1 step 1 have shown that on AVERAGE, top med schools do have high Step 1 scores). Also the having true P/F at many top schools is another advantage as it gives them more time to do research and other ECs without the worry about essentially having to compete against your own classmates over grades.

However, keep in mind that the shift to P/F step 1 alone wont' change overall competitiveness of a specialty; it just redistributes the relatively importance of criteria used. You can make any competitive specialty less competitive and have nearly everyone who wants that specialty match simply by expanding residency spots. However, there must also be a proportional increase in the volume of work across the board in the specialty to not kill the job market (especially for new grads). However, this is not happening in many specialties due to the increased use of midlevels, and in some specialties like radiology or pathology AI is about to play a big role very soon.

 

[collegestud2013]

This appears like a myth now that the data is published. Competitve speciality like ortho. Derm. Ent. Rads. Plastics. Etc…. Appears as competitive as before. Not more or less. Primary care unfilled also appears more or less same as before (with exception of EM, which improved and peds, which fell). Also random looking at match list of top 20 or mid tier ones, ratio of primary care matching to competitive matching appears same as before. Given that, I thnink step 1 pass fail changing landscape of competitveness for specialties or how school match list looks from before and now is a myth. Nothing much has changed then before.

Still mostly due to med students responding to financial incentives. Peds and primary care are still notoriously underpaid compared to procedural specialties (though they do have the advantage of having shorter training times so they come out ahead financially the first few years post-residency). Changes in reimbursement structure from CMS could slowly change that (which has traditionally favored procedural specialties).

EM match rate went up this year because more of the spots were being filled with DOs and IMGs after seeing how easy it was to get in last year (in the past past many more would have self-selected out).

 

[Cornfed101]

Still mostly due to med students responding to financial incentives. Peds and primary care are still notoriously underpaid compared to procedural specialties (though they do have the advantage of having shorter training times so they come out ahead financially the first few years post-residency). Changes in reimbursement structure from CMS could slowly change that (which has traditionally favored procedural specialties).

EM match rate went up this year because more of the spots were being filled with DOs and IMGs after seeing how easy it was to get in last year (in the past past many more would have self-selected out).

more and more private and for profit med schools are popping up. I can’t afford a pediatrician salary with my $500k in student loans

 

[ChordaEpiphany]

Some of the top ophtho and uro programs (like MGH, UCSF tier) posted their new match classes and top schools weren't that well represented if I recall. I used to think it mattered a lot more than it did but I go to a T10 and was absolutely passed on by programs for students at other schools who had more research than me (which is valid).

Step 2 and publications are still king

Connections are king. Step 2 has diminishing returns around 260, especially for students at top schools. Pubs are useful, but truthfully PDs have no idea how to evaluate them, and it's very specialty dependent. I don't go to a T10, but the students who make the jump into the T10 in competitive specialties at my school almost inevitably do it through connections. We had a T10 match in a surgical sub this year with 0 manuscripts (just a few abstracts/posters). However, they did an away at this institution and were extremely well-liked by the faculty.

You have to be a known entity going in. PDs aren't interested in collecting the smartest and hardest working students. They're interested in matching high on their list for internal appearances, filling their residency with top school grads to look competitive to future applicants, pleasing big names in the field by ushering in their mentees, and also getting hard workers. Step scores really only help with that last one.

Very interesting. I would say that competitive specialties are still entirely on the table for students at “less competitive” med schools since it seems that like attracts like.

Students at higher-ranking med schools generally do not target lower-ranking residencies in a given competitive specialty, such as ortho. Similarly, those residencies also tend to not highly rank students from those higher-ranking schools—don’t know exact reason… they could be going off of historical bias in thinking that, even if signaled, a UVA student is unlikely to want to end up at their program compared to a student from EVMS, who regularly matches students there.

A solid applicant from a lower-ranking school therefore has a very good chance of matching at a similarly ranked residency, even if it’s for a competitive specialty.

Students at top schools take as much pride in being at the top of their field as they do in making money or having a good lifestyle. Plenty of T10 students avoid competitive specialties even if they could match because they don't want to match at a lower-tier program. The culture of Ivory Tower institutions can be very snooty, and the social pressures to stay at top programs is pretty intense. I'm at a lowly T40, but my primary research advisor is at a T10. Sometimes I think they just forget I'm in the room, and the way they talk about even a "solid" academic program and the faculty there is extraordinarily dismissive. I imagine this attitude rubs off on students. I know for a fact a few of my friends at T10s have avoided confronting rejection with this exact approach (e.g., low step score or poor research output, so they apply IM instead of derm even though they could absolutely match derm somewhere).

I also think that mid- and low-tier residencies know they want the hardest working/smartest residents, and they're cultivating relationships with similarly ranked institutions rather than groveling with the T10s who, as illustrated above, don't think all that highly of them anyway. If you're measuring clinical talent or even intelligence, the populations at a T10 vs. a T100 are two highly overlapping bell curves. T10 students have marketable backstories or "out-of-the-box" accomplishments, but they're not cut from a different cloth. I'd bet just about everything that a top student at a T100 could mop the floor with an average student from a T10 clinically. The ortho PD at some community hospital almost certainly feels the same way and also gains very little by matching someone from the Ivory Tower, who may ultimately just be salty about a drop in prestige. Plus, the community ortho PD isn't trying to train the person who will cure osteosarcoma. They're trying to train yet another person to be proficient with a bone saw.

 

[ChordaEpiphany]

Updating that I fell on my list despite scoring above a 270 and coming from a T10, which I kind of expected given my lack of research. The other people in my class that fell also had a weak spot on their applications. Looking up the best programs in my specialty (radiology), most of the students are not from top schools and there is good IMG representation. Prestige. does. not. matter. Top schools have great match lists because everyone is completely cracked. There are many 265+ in my class and everyone I know has multiple pubs. If you're an average applicant from a top school (like me) you'll match at an average program. If you're an excellent applicant at a non top school you'll outcompete people like me every time.

No PD is giving bonus points for school name alone anymore, that is completely dead. The only argument is that top schools provide better access to research, but if you don't utilize it you're in the same group as coming from any other school.

While I absolutely believe it's possible to fall on your list from a T10 with 270 and no research, it's insane to say being at a top school isn't a massive advantage. This is even more true in specialties like IM, where school name reigns supreme.

Saying everyone is completely "cracked" and that's why is also easily proven false. When step 1 was scored, there was massive overlap between top and mid-tier schools in student's scores. Stanford's average was 238, Columbia 236, Emory 231, and UCLA 230. Meanwhile, UVA's was 242, Boston U 239, Cincinnati 241, and Einstein 236. I'm sure you hear about the top scores, but ultimately the stats tell a different story. Even at a T40, match lists look completely different from a T20 despite similar average scores. Take the median match at Columbia and it's still likely a more competitive placement than a top 20% match at Einstein.

The difference is connections, having people pulling for you, and definitely a school name boost.

 

[JuicedToTheSocks]

I also think that mid- and low-tier residencies know they want the hardest working/smartest residents, and they're cultivating relationships with similarly ranked institutions rather than groveling with the T10s who, as illustrated above, don't think all that highly of them anyway. If you're measuring clinical talent or even intelligence, the populations at a T10 vs. a T100 are two highly overlapping bell curves. T10 students have marketable backstories or "out-of-the-box" accomplishments, but they're not cut from a different cloth. I'd bet just about everything that a top student at a T100 could mop the floor with an average student from a T10 clinically. The ortho PD at some community hospital almost certainly feels the same way and also gains very little by matching someone from the Ivory Tower, who may ultimately just be salty about a drop in prestige. Plus, the community ortho PD isn't trying to train the person who will cure osteosarcoma. They're trying to train yet another person to be proficient with a bone saw.

We get it bud, u didn't get into a t10 and now have a chip on ur shoulder for whatever reason....

Fact is lot of top ortho programs didn't use applicant med school choice at all. U people just love to cry about not being at a "t10" but when u compare the match rates of t10 applicants to ur schools applicants or the national median, they aren't that different.... ur school doesn't mean nearly as much as people love to complain about

 

[eyeeye_captain]

In small competitive specialties like ophtho, it’s more department tiers than school name. Connections and research, especially connections, are key. Everybody knows each other, it’s like 2 degrees of Kevin Bacon.

I don’t think anyone would call Miami or Thomas Jefferson a T10 school, but those are 2 of the top 3 departments/residencies in the country. Everyone has heard of Yale, but they’re average as can be. If I got a glowing review from Harry Flynn or Julia Haller, you have an interview. If I get one from Yale, I have to Google the attending. (I do get the irony that you folks would have to Google Drs. Flynn and Haller.)

It’s also possible for high school/department tiers to hurt you. Mid and low tier programs may say “there’s no way they’ll come here” and throw out your application. I had a PD tell me exactly that at an interview years ago, thanks for having me fly out here.

 

[Student189045]

While I absolutely believe it's possible to fall on your list from a T10 with 270 and no research, it's insane to say being at a top school isn't a massive advantage. This is even more true in specialties like IM, where school name reigns supreme.

Saying everyone is completely "cracked" and that's why is also easily proven false. When step 1 was scored, there was massive overlap between top and mid-tier schools in student's scores. Stanford's average was 238, Columbia 236, Emory 231, and UCLA 230. Meanwhile, UVA's was 242, Boston U 239, Cincinnati 241, and Einstein 236. I'm sure you hear about the top scores, but ultimately the stats tell a different story. Even at a T40, match lists look completely different from a T20 despite similar average scores. Take the median match at Columbia and it's still likely a more competitive placement than a top 20% match at Einstein.

The difference is connections, having people pulling for you, and definitely a school name boost.

You're pulling old numbers as your only source, but can you comment on the amount of publications, strength of writing, strength of ECs, strength of recs from people at different tiers of school? The fact is people like to feel better about themselves and will say "they only matched there because they're at a T10" when in reality the student from the T10 was just a better applicant than them. I agree with the above poster that people from T10s will have the strongest applications on average, simply because it is people obsessed with achievement. How do you think they got into a T10 in the first place? Also, the percentage of people taking research years at these schools can be HUGE. Someone told me Harvard was like 40% of the class or more? (not verified)

The only real data we have is PD surveys which rank school prestige as one of the lowest matters of importance if I remember correctly.

It's difficult to evaluate specific program matches because we don't know the structure of the applicant rank lists, but there are a few where it's easy to infer. For example, Mass General Radiology is top 3 program in the country, whereas BIDMC radiology is considered a fringe t20 (not bashing at all, it is still a great program). However, it is safe to assume everyone that matched at BIDMC would have rather matched at MGH if they had the chance. So let's look how their match lists compare!

MGH: 2 IMGS, UCLA, Dartmouth, Temple, UPenn, 2 Harvard
BIDMC: 2 Duke, 2 Yale, 1 Columbia, 2 Brown, 1 Georgetown, 1 Ohio State, 1 UVM

If prestige was that important why exactly did MGH pass on FIVE students from T10s and instead take IMGs, dartmouth, temple. Oh I know! it's because they had better applications and PDs don't actually care about prestige.

Perhaps in an absolute tiebreaker prestige makes up the difference, but it does not make up for weak points in applications.

 

[indebtedsaddle23]

You're pulling old numbers as your only source, but can you comment on the amount of publications, strength of writing, strength of ECs, strength of recs from people at different tiers of school? The fact is people like to feel better about themselves and will say "they only matched there because they're at a T10" when in reality the student from the T10 was just a better applicant than them. I agree with the above poster that people from T10s will have the strongest applications on average, simply because it is people obsessed with achievement. How do you think they got into a T10 in the first place? Also, the percentage of people taking research years at these schools can be HUGE. Someone told me Harvard was like 40% of the class or more? (not verified)

The only real data we have is PD surveys which rank school prestige as one of the lowest matters of importance if I remember correctly.

It's difficult to evaluate specific program matches because we don't know the structure of the applicant rank lists, but there are a few where it's easy to infer. For example, Mass General Radiology is top 3 program in the country, whereas BIDMC radiology is considered a fringe t20 (not bashing at all, it is still a great program). However, it is safe to assume everyone that matched at BIDMC would have rather matched at MGH if they had the chance. So let's look how their match lists compare!

MGH: 2 IMGS, UCLA, Dartmouth, Temple, UPenn, 2 Harvard
BIDMC: 2 Duke, 2 Yale, 1 Columbia, 2 Brown, 1 Georgetown, 1 Ohio State, 1 UVM

If prestige was that important why exactly did MGH pass on FIVE students from T10s and instead take IMGs, dartmouth, temple. Oh I know! it's because they had better applications and PDs don't actually care about prestige.

Perhaps in an absolute tiebreaker prestige makes up the difference, but it does not make up for weak points in applications.

Do you have a link to the PD surveys on how they rank different factors for residency apps?

 

[Angler]

a link to the PD surveys

Most recent survey with useful information is from 2021. Summary is here. Gory details here.

 

[LIFS7]

But hey, at least med students aren’t stressed anymore. So mission accomplished, I guess.

I would argue we are more stressed now by not knowing if we are truly competitive for a given specialty based on our step 2 score that we receive only a few months prior to submitting ERAS. Previously you would sort of know a year in advance based on your step 1 score, which gave more time to pivot to alternate specialties, beef up your CV, etc.

 

[Med Ed]

I would argue we are more stressed now by not knowing if we are truly competitive for a given specialty based on our step 2 score that we receive only a few months prior to submitting ERAS. Previously you would sort of know a year in advance based on your step 1 score, which gave more time to pivot to alternate specialties, beef up your CV, etc.

Conversely, I have had students get locked out of certain specialties based on Step 1 performance, only to go on and do very well in the clinical years and post high Step 2 scores. In the past they were hamstrung, but in the current environment they are still competitive. So it's not all bathwater.

Besides, everyone who is applying to a competitive specialty should be thinking about alternative plans long before Step 2. That was true even when Step 1 was a scored exam.

 

[EngineerPreMD]

You're pulling old numbers as your only source, but can you comment on the amount of publications, strength of writing, strength of ECs, strength of recs from people at different tiers of school? The fact is people like to feel better about themselves and will say "they only matched there because they're at a T10" when in reality the student from the T10 was just a better applicant than them. I agree with the above poster that people from T10s will have the strongest applications on average, simply because it is people obsessed with achievement. How do you think they got into a T10 in the first place? Also, the percentage of people taking research years at these schools can be HUGE. Someone told me Harvard was like 40% of the class or more? (not verified)

The only real data we have is PD surveys which rank school prestige as one of the lowest matters of importance if I remember correctly.

It's difficult to evaluate specific program matches because we don't know the structure of the applicant rank lists, but there are a few where it's easy to infer. For example, Mass General Radiology is top 3 program in the country, whereas BIDMC radiology is considered a fringe t20 (not bashing at all, it is still a great program). However, it is safe to assume everyone that matched at BIDMC would have rather matched at MGH if they had the chance. So let's look how their match lists compare!

MGH: 2 IMGS, UCLA, Dartmouth, Temple, UPenn, 2 Harvard
BIDMC: 2 Duke, 2 Yale, 1 Columbia, 2 Brown, 1 Georgetown, 1 Ohio State, 1 UVM

If prestige was that important why exactly did MGH pass on FIVE students from T10s and instead take IMGs, dartmouth, temple. Oh I know! it's because they had better applications and PDs don't actually care about prestige.

Perhaps in an absolute tiebreaker prestige makes up the difference, but it does not make up for weak points in applications.

This is a little disingenuous. While I agree that school prestige isn't everything, it makes a massive difference. Saying the students are all just "cracked" really disregards the talent of students who go to other schools, who may not have gotten into a top school for any number of reasons including socioeconomic status, poor mentorship in undergrad, late decisions to apply to medical school, etc...

This is coming from someone at a T20, btw.

You're pulling old numbers as your only source

Those numbers are step 1 scores from 2021. I don't think anything has changed dramatically since then, and I absolutely believe scores overlap. I have plenty of friends who scored 220 or lower on step 1. They all stressed a lot, but most matched at T20 residencies (fwiw).

The fact is people like to feel better about themselves and will say "they only matched there because they're at a T10" when in reality the student from the T10 was just a better applicant than them. I agree with the above poster that people from T10s will have the strongest applications on average, simply because it is people obsessed with achievement. How do you think they got into a T10 in the first place? Also, the percentage of people taking research years at these schools can be HUGE. Someone told me Harvard was like 40% of the class or more? (not verified)

I think it's a little of both. Muddy waters for sure. T20 students are remarkably adept at curating an attractive application. That said, we get a lot of people here who get to med school and find they have lost their advantage. Some picked easy majors or continually gamed the system in college to get a 4.0 (personally I saw a ton of people at my university who left engineering because they were on track for an atrocious GPA, went to public health or a liberal arts major, and then got into top schools). Others got here by grinding, but you lose that advantage in med school when everyone is grinding. Definitely had a lot of friends who entered as extraordinarily type A students and found they simply couldn't outgrind the competition any longer.

As for research years, I imagine it also scales with the increased number of students pursuing surgical subs + derm.

The only real data we have is PD surveys which rank school prestige as one of the lowest matters of importance if I remember correctly.

First, that's a survey of all PDs. Top program PDs are completely washed out statistically. They also list clinical grades as their #1 criteria, yet top schools feel comfortable eliminating that entirely. I think it's safe to say that top PDs feel differently. Certainly the PDs at my school do. They completely put up with the fact that top schools have no clinical grades because they want to match students from top schools. Frankly, filling your class with top grads is an easy way to get kudos from the dean, who is hyper-focused on maintaining strong relationships with other top schools. PDs are very aware of this.

It's difficult to evaluate specific program matches because we don't know the structure of the applicant rank lists, but there are a few where it's easy to infer. For example, Mass General Radiology is top 3 program in the country, whereas BIDMC radiology is considered a fringe t20 (not bashing at all, it is still a great program). However, it is safe to assume everyone that matched at BIDMC would have rather matched at MGH if they had the chance. So let's look how their match lists compare!

MGH: 2 IMGS, UCLA, Dartmouth, Temple, UPenn, 2 Harvard
BIDMC: 2 Duke, 2 Yale, 1 Columbia, 2 Brown, 1 Georgetown, 1 Ohio State, 1 UVM

If prestige was that important why exactly did MGH pass on FIVE students from T10s and instead take IMGs, dartmouth, temple. Oh I know! it's because they had better applications and PDs don't actually care about prestige.

This is definitely a stretch and a weak argument. I don't think anyone is saying school prestige trumps all. However, if you consider the total applicant pool, T20 schools are overrepresented by a large margin, and this holds for most top residencies. This is basically saying that MGH will take 4 students from a pool of 20 schools vs. 2 students from a pool of 100 schools. Which pool would you rather be in?

I guess overall I'm reluctant to just accept the argument that T20 students are inherently better than T50 students. They are a little better on average, but that doesn't account for the discrepancy in match lists. It's not even really close. I have friends from undergrad who, for some reason, had great but not amazing apps to med school and went to mid-tier USMDs. Maybe it was a single bad year in undergrad because of a personal tragedy. Maybe it was deciding on med school late and thus having a few lackluster semesters on the record. Maybe it was a lack of mentorship or role models on entering college. Maybe it was sticking with engineering and pulling a 3.6 in the top 10% of the class instead of transferring to something easy where the average student was pulling a 3.7. Maybe it was needing to stay in a certain area for family or personal reasons.

My classmates are awesome. Some are truly rockstars with incredible tenacity destined to succeed in any environment. Most put on their pants one leg at a time like the rest of the world. Many of them had struggles in med school. It's hard to ignore that if those struggles had happened 2-3 years earlier, they likely wouldn't have put together a T20-caliber application. It's also hard to ignore that other incredibly talented friends of mine from college, who went to unranked USMD schools, struggled to match anywhere for competitive specialties with clinical grades in the top 10%, step 1 scores > 260, and solid publication records. Students at my school with very average clinical grades, step 1 ~240, and the same 2-3 low impact pubs/case reports as everyone else were only stressing about whether it would be Stanford or UCSD. A lot of it is political. A lot of it is behind the scenes. The powers that be at top schools have relationships with physicians from other top schools that need to be maintained. Because of this, going to a top school confers a huge advantage.

 

[EngineerPreMD]

Students at top schools take as much pride in being at the top of their field as they do in making money or having a good lifestyle. Plenty of T10 students avoid competitive specialties even if they could match because they don't want to match at a lower-tier program.

This is rarely talked about but absolutely true. No one wants to say it out loud because, as evidenced above, it elicits a poor reaction. I think this is relatively innocent compared to the motivations of people in other industries (e.g., finance, business, law) who chase clout through almost obscene incomes and make exclusively financially-driven career decisions.

As @Student189045 said, students at top schools are obsessed with achievement. Anyone at a top program for anything knows this. Being at a "top" program confers a level of pride that is hard to replicate. For many people, there is absolutely more pride in saying, "I always wanted IM and matched at MGH" vs. "I went for derm and matched mid-tier," especially if you've gotten used to people swooning over your college/med school name for the last several years.

We all have our motivations. Personally I find the above pretty palatable and even reasonable. There is something to be said for being at the top of your field. It allows for a different type of career. I went from a state school to a T20 med school and the environment isn't comparable. There's just so much more going on and far more ambitious faculty. Going mid-tier is distinctly leaving behind some aspects of your career. For many high achievers, staying in an environment where you are the "best-of-the-best" is a higher priority than heart vs. skin. Nothing wrong with that.

 

[JuicedToTheSocks]

This is a little disingenuous. While I agree that school prestige isn't everything, it makes a massive difference.

What are u on about? This ortho app cycle literally proves it doesn't make a difference at all. Maybe a little, but when u consider that T20 students are usually more active among online forums, know the criteria of a strong app, etc it basically normalizes any 'advantage' due to their med school pedigree.

This is rarely talked about but absolutely true.

What brings u to this conclusion? Are u talking to every single person at ur school who was interested in ortho but switched to FM to match a T10 program and interrogating them on their motivations for switching? A lot of ppl don't even say what they're really interested in... Not saying that some people at t20s don't care about prestige more than avg, but the fact that ur speaking in absolutes about something so transient is utterly fanciful.

Ppl just froth at the mouth to sht on T20 students at any opportunity

That said, we get a lot of people here who get to med school and find they have lost their advantage. Some picked easy majors or continually gamed the system in college to get a 4.0 (personally I saw a ton of people at my university who left engineering because they were on track for an atrocious GPA, went to public health or a liberal arts major, and then got into top schools). Others got here by grinding, but you lose that advantage in med school when everyone is grinding. Definitely had a lot of friends who entered as extraordinarily type A students and found they simply couldn't outgrind the competition any longer.

Not really sure what this has to do w anything

My classmates are awesome. Some are truly rockstars with incredible tenacity destined to succeed in any environment. Most put on their pants one leg at a time like the rest of the world. Many of them had struggles in med school. It's hard to ignore that if those struggles had happened 2-3 years earlier, they likely wouldn't have put together a T20-caliber application. It's also hard to ignore that other incredibly talented friends of mine from college, who went to unranked USMD schools, struggled to match anywhere for competitive specialties with clinical grades in the top 10%, step 1 scores > 260, and solid publication records. Students at my school with very average clinical grades, step 1 ~240, and the same 2-3 low impact pubs/case reports as everyone else were only stressing about whether it would be Stanford or UCSD. A lot of it is political. A lot of it is behind the scenes. The powers that be at top schools have relationships with physicians from other top schools that need to be maintained. Because of this, going to a top school confers a huge advantage.

This also happens at T20s.... about 40% of my t20 school goes unmatched for ortho at any program...

Are u a 1st year? Bc ur perspective seems like u are; otherwise, u would know everyone who applied into these fields and realize that the match rate isn't great, even at T20s. Hell, we even had ppl not match GS and our GS program is supposedly among the best...

 

[Augustoweiner]

My classmates are awesome. Some are truly rockstars with incredible tenacity destined to succeed in any environment. Most put on their pants one leg at a time like the rest of the world. Many of them had struggles in med school. It's hard to ignore that if those struggles had happened 2-3 years earlier, they likely wouldn't have put together a T20-caliber application. It's also hard to ignore that other incredibly talented friends of mine from college, who went to unranked USMD schools, struggled to match anywhere for competitive specialties with clinical grades in the top 10%, step 1 scores > 260, and solid publication records. Students at my school with very average clinical grades, step 1 ~240, and the same 2-3 low impact pubs/case reports as everyone else were only stressing about whether it would be Stanford or UCSD. A lot of it is political. A lot of it is behind the scenes. The powers that be at top schools have relationships with physicians from other top schools that need to be maintained. Because of this, going to a top school confers a huge advantage.

Fully agree with this as someone who is from a top undergraduate and now at a top medical school. I also have lots friends from undergrad at different medical schools who have very recently matched, and this definitely reflects what we have been seeing as well.

I will say however, my experience is that the politics at each school or even each department is different. There are very competitive surgical subspecialties at my school who have never failed to match an applicant from my medical school. Ever. No matter how spectacular or unimpressive the medical student crop that year may be. There are other departments that fail to match someone every year. My guess is that it varies greatly depending on the department itself- the leadership and their network, how much the faculty loves to advocate for their students, the reputation of the department as a whole, etc. Its hard to predict as a pre-med what the mentorship at your school/program is going to be like, but I honestly believe that these uncontrollable things may actually be more important in matching a competitive residency than actual controllable factors (Step scores, clinical grades, publications, etc).

 

[EngineerPreMD]

This also happens at T20s.... about 40% of my t20 school goes unmatched for ortho at any program...
What are u on about? This ortho app cycle literally proves it doesn't make a difference at all. Maybe a little, but when u consider that T20 students are usually more active among online forums, know the criteria of a strong app, etc it basically normalizes any 'advantage' due to their med school pedigree.

You've got a point about not matching. It's not like a weak applicant from a T10 can go to a community ortho program and expect them to fawn over their pedigree. It's very possible for a T10 applicant to fail to match if they get passed over by other prestigious programs. This is especially true in specialties that prioritize aways (e.g., ortho, plastics, etc...). I've heard community PDs say they tend to avoid ivory tower students because they've had experiences with them coming in with a chip on their shoulder. I'm not saying this has real merit, but the advantage of a T10 pedigree definitely falls off once you're out of the academic residencies.

I don't think this "proves" anything though. The matches at T10s and T20s are significantly more prestigious than those elsewhere, and more students feel competitive enough to apply.

Ppl just froth at the mouth to sht on T20 students at any opportunity

Why would I, a T20 student, be "frothing at the mouth to sht on T20 students"?

What brings u to this conclusion? Are u talking to every single person at ur school who was interested in ortho but switched to FM to match a T10 program and interrogating them on their motivations for switching? A lot of ppl don't even say what they're really interested in... Not saying that some people at t20s don't care about prestige more than avg, but the fact that ur speaking in absolutes about something so transient is utterly fanciful.

Anecdotally, I've seen a lot of students make changes s/p step 1 who likely could have matched if they were open to any academic residency. This is especially true in MD/PhD, where the research environment is paramount to your success (and it's perfectly logical to prioritize that). I've definitely also seen this in MD-only friends, who subsequently did a lot of fretting about interviews, consistently prioritized program prestige, and matched T20 in their new specialty.

Humans all take some preemptive action to avoid rejection (this is true for a lot more than just residency apps). For students at a mid-tier school, this means avoiding a risk of going unmatched. For students at top tier schools, this often means avoiding a risk of matching somewhere outside of the recognized top tier programs. At top tier schools, many students' career goals don't stop at landing a competitive residency. They care equally about the specialty itself and their career trajectory. Again, many would rather be So-and-So MD, Chief of Department, Interventional Cardiology vs. an average urologist. The post above stating that a T10 advisor talks poorly about lower tier programs also rings fairly true. At my home hospital, I've seen tons of attendings poo-poo lower-ranked programs. Going outside of the name-brand places is sometimes regarded as "falling off" in the eyes of these attendings. This is yet another factor pushing students towards name-brand residencies.

Are u a 1st year? Bc ur perspective seems like u are; otherwise, u would know everyone who applied into these fields and realize that the match rate isn't great, even at T20s. Hell, we even had ppl not match GS and our GS program is supposedly among the best...

No I'm an 8th year (M4) in an MD/PhD program. I've seen a lot of match cycles. Internally, they've showed us match rates and they've traditionally been fantastic, but it's true not everyone matches. My "boots on the ground" observation is that most who don't match in competitive specialties fall into one of two buckets.

A) Not truly competitive enough for the specialty, but hoping school name/connections get them in. Their letters can't overcome lack of research and low scores, and community programs don't bite because they're not focused on prestige.

B) Highly competitive on paper, but not great in person. I've seen a few of these in surgical subs. They have amazing scores and publications, but do 4-5 aways and likely get DNR'd for their personality. Lower tier programs assume they have no interest. Top-tier programs don't rank them.

My advisor told me he can usually see it coming. It's hard to discourage the group A because there's still a chance they'll match, and why take that away from them? It's hard to discourage group B, because it's hard to tell someone to their face that they have an attitude problem, a personality disorder, or a social deficit.