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

[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.

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[JuicedToTheSocks]

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).

I agree with this. Your home dept is everything

If I were to do it again, I'd do a very deep dive (almost to the point where ppl are wondering wtf a premed is doing asking about this sht), and choose a school with a strong ortho home dept that goes to bat for its students. This doesn't really correlate with school prestige ie my school's home dept picks favorites (women/urm for ortho and selectively mentors only them, but this is kinda true for a lot of schools/societies now which is absolutely pathetic), compared to Gtown which matches at least 10 students into ortho every year

 

[ChordaEpiphany]

This doesn't really correlate with school prestige ie my school's home dept picks favorites (women/urm for ortho and selectively mentors only them, but this is kinda true for a lot of schools/societies now which is absolutely pathetic), compared to Gtown which matches at least 10 students into ortho every year

In my experience people mentor who they like. Mentorship doesn't happen exclusively at the department level, and there is no ortho department in the country that actively dislikes white men since inevitably at least 50% of the faculty will be white men. They likely go out of their way to mentor women/URM applicants because they are the most likely to need extra mentorship and the most likely to drop ortho because they don't fit in. This is also an excellent way for the program to match women/URM applicants that are well-known/vetted and recruit people who might otherwise go elsewhere.

If you aren't getting mentorship in your specialty of interest, then you aren't putting yourself out there enough. For my specialty, my school's department doesn't traditionally go to bat for students. The match list every year is extremely underwhelming given the school's overall prestige, and we routinely put together better looking match lists and higher match rates for far more competitive specialties. Knowing this, I pursued research and mentorship with a number of well-connected physicians at another institution in my city. I'm an ORM and no one has batted an eye.

 

[Student189045]

Y'all are getting way too into this but until you can show that the average publications from a top 10 school is the same as a mid tier school your arguments are meaningless. An enormous amount of people take research years at T10's, giving them much stronger applications.

Student's from T10's match better because they are better applicants, it's not that complex.

The only people that say otherwise are premeds and med students trying to feel better about their school choice or match performance.

 

[goldenfloofers]

n=1. I do not attend a T10 or T20 school, but will be starting residency at a T5 in an extremely competitive Specialty this summer. The school I attend doesn't have prestige, but has a very good home program with connections to some top programs. In my opinion, school name does probably give you an edge because they have amazing resources, connections and their top students (1st quartile) all have amazing stats. But it comes down to the student because school name has a point of diminishing return also if you are below average student there. I thrived where I was planted and matched a T5 in an extremely competitive specialty because of hard work and determination. No matter the school name or prestige, thrive where you are planted is all I will say to med students reading this thread.

If your name implies that you go to a T30, that's also pretty good too. Many top programs match students from T30s. It's rare to find people from schools ranked, for example, in the T75-100s. It's not impossible, but definitely not the norm.

I agree with you though that it takes determination and hardwork to match to any T5 program. You have to study, do research, make connections, although like you said it's much easier at a top program to do said things.

I will say that you have some room to "mess up" more than other students if you're from a more highly ranked program (T20 is top tier, T30 is also definitely well-regarded, upper-mid tier if you may). This is just my personal anecdote so take it with a grain of salt but somebody I worked with during my gap year who attends a T30 medical school matched into a prestigious and competitive program for a surgical subspecialty despite being bottom quartile and having a below average Step score because his home program has big name faculty members who essentially wrote him LORs and made phone calls to programs on his behalf (his words, not mine). I have friends at my home program (low-tier) who were AOA, first-authors, and 260+ on step 2 and "barely" scraped by into mid to low tier programs for the same surgical subspecialty in a state far away from family despite both doing aways and having regional ties to the same institution that my gap-year friend matched to.

But to answer OPs question, school tier is playing a more important role with Step 1 becoming pass fail and this was predicted years ago when they first announced the change for Step 1 and just another reason why the switch to P/F Step 1 was not a good idea imo. Likely on average T20 medical students will typically have stronger applications but I think it would be false to deny that prestige is a factor.

 

[JuicedToTheSocks]

In my experience people mentor who they like. Mentorship doesn't happen exclusively at the department level, and there is no ortho department in the country that actively dislikes white men since inevitably at least 50% of the faculty will be white men. They likely go out of their way to mentor women/URM applicants because they are the most likely to need extra mentorship and the most likely to drop ortho because they don't fit in. This is also an excellent way for the program to match women/URM applicants that are well-known/vetted and recruit people who might otherwise go elsewhere.

Pretty debatable on who 'needs' the extra mentorship considering ortho still attracts students who come from very privileged backgrounds. When u factor in that there are scholarships directly excluding certain groups, based on sex/race...

If you aren't getting mentorship in your specialty of interest, then you aren't putting yourself out there enough. For my specialty, my school's department doesn't traditionally go to bat for students. The match list every year is extremely underwhelming given the school's overall prestige, and we routinely put together better looking match lists and higher match rates for far more competitive specialties. Knowing this, I pursued research and mentorship with a number of well-connected physicians at another institution in my city. I'm an ORM and no one has batted an eye.

Glad it worked out for u - personally seen a lot of stellar applicants falling through the cracks not just in ortho but other surgical fields as well... Also I have emailed faculty outside of my institution before and was hard pressed to get much back. Most depts will put their students above u.

 

[jhmmd]

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.

First of all, my goodness.
Second of all, correlation > causation ratio <1 so...

 

[madmed18]

n=1. I do not attend a T10 or T20 school, but will be starting residency at a T5 in an extremely competitive Specialty this summer. The school I attend doesn't have prestige, but has a very good home program with connections to some top programs. In my opinion, school name does probably give you an edge because they have amazing resources, connections and their top students (1st quartile) all have amazing stats. But it comes down to the student because school name has a point of diminishing return also if you are below average student there. I thrived where I was planted and matched a T5 in an extremely competitive specialty because of hard work and determination. No matter the school name or prestige, thrive where you are planted is all I will say to med students reading this thread.

Totally agree! I went to a mid tier (top 60ish) med school but worked my *$* off - managed to get a 270+ step score and honored all M3 rotations. Had roughly 15 pubs along with other EC's. It was not easy but hard work never is. Really leaned into my mentors as well and they went to bat for me at my top choice program. Received 20+ res interviews and matched at my top choice (top 10 in optho). Regardless of pedigree, PDs still recognize hard work no matter where you went to med school.

 

[WJV031]

Totally agree! I went to a mid tier (top 60ish) med school but worked my *$* off - managed to get a 270+ step score and honored all M3 rotations. Had roughly 15 pubs along with other EC's. It was not easy but hard work never is. Really leaned into my mentors as well and they went to bat for me at my top choice program. Received 20+ res interviews and matched at my top choice (top 10 in optho). Regardless of pedigree, PDs still recognize hard work no matter where you went to med school.

Wanted to give some perspective as someone at a T5. My housemate is very similar to me in that they're generally average/below average in effort that they've put in during medical school. He also matched at top 10 in ophtho this year, step 2 was <60th percentile and our rotations are true P/F with only 4th year SubIs being graded. Not sure exactly how many research items, but looking on pubmed it looks like he has 2 first author pubs in decent journals and a just a few other random papers in ophtho where he was not first author.

If your stats, which are stellar by the way, are the norm for people matching into T10 ophtho programs then the difference school prestige makes is even bigger than I thought.

 

[ChordaEpiphany]

Wanted to give some perspective as someone at a T5. My housemate is very similar to me in that they're generally average/below average in effort that they've put in during medical school. He also matched at top 10 in ophtho this year, step 2 was <60th percentile and our rotations are true P/F with only 4th year SubIs being graded. Not sure exactly how many research items, but looking on pubmed it looks like he has 2 first author pubs in decent journals and a just a few other random papers in ophtho where he was not first author.

If your stats, which are stellar by the way, are the norm for people matching into T10 ophtho programs then the difference school prestige makes is even bigger than I thought.

It has to come down to culture of the specialty and the institution. Everyone is taking their narrow experiences at their own school or specialty and extrapolating, but trying to put aside my personal biases, it seems like it varies from massive advantage to very little.

Ophtho shines some interesting light on this debate. Theoretically, MEEI, Will's Eye, and Bascom Palmer can all match the best applicants in the country. MEEI has exactly two non-T20 residents. Will's Eye and Bascom Palmer have an even mix of T20 and T100 MD students. You see a similar trend even at the less "elite" residencies that are traditionally ranked similarly. UCSF and Columbia have mostly T20 residents, but OHSU and USC are a mix.

In ortho, a specialty with tons of emphasis on aways/sub-Is and no shortage of absolutely stellar candidates, we see completely different patterns where med school name matters much less.

Also, I think we're internalizing our own position and safe-guarding our egos. Those at T20s are discarding the obvious advantages and claiming it's all just grit and talent, so if they match where they want, it's clearly because they deserve it. Their perspective is also maybe skewed if they are applying ortho or another specialty that seems to value med school prestige less. Those at non-T20s are catastrophizing and upset that they need to be absolutely perfect to break into the ranks of the T20 residencies. So if they fail to match in the top, it's because of school name bias. The reality is that some people are right, and others are wrong, but it comes down to your specific situation. If you're a Tufts, BU, or UMass student hoping to stay in Boston but match a top tier institution in ophtho... well you may have an actual bone to pick. If you're an IM applicant from Harvard, a Big 4 residency spot is yours to lose, but if you're applying into ortho you're going to have to stand on your own merits. People saying you'll match automatically or with far inferior stats probably gets old.

Overall, I think it's a major net positive. People wouldn't be bending over backwards to get into these schools if they didn't confer an advantage. Obviously prestige has its limits, and certain specialties and programs place different levels of emphasis on school name. I have no doubt that T20 applicants matching T20 programs are fantastically talented people. I'd bet plenty matching lower down have similar talent, and many likely have more talent, but it's all so variable by program and circumstance that trying to summarize it all with one blanket statement is pointless.

 

[JuicedToTheSocks]

Also, I think we're internalizing our own position and safe-guarding our egos. Those at T20s are discarding the obvious advantages and claiming it's all just grit and talent, so if they match where they want, it's clearly because they deserve it. Their perspective is also maybe skewed if they are applying ortho or another specialty that seems to value med school prestige less. Those at non-T20s are catastrophizing and upset that they need to be absolutely perfect to break into the ranks of the T20 residencies. So if they fail to match in the top, it's because of school name bias. The reality is that some people are right, and others are wrong, but it comes down to your specific situation. If you're a Tufts, BU, or UMass student hoping to stay in Boston but match a top tier institution in ophtho... well you may have an actual bone to pick. If you're an IM applicant from Harvard, a Big 4 residency spot is yours to lose, but if you're applying into ortho you're going to have to stand on your own merits. People saying you'll match automatically or with far inferior stats probably gets old.

Nice writeup and I agree w most of it. However, I genuinely don't believe the t20 advantage is as strong as just a departmental advantage, as I said earlier. Obviously I am only speaking about the field I want to go into, but T20 students are also disadvantaged bc 'lower' tier programs will yield protect them (have witnessed this firsthand across multiple surgical fields) and the T20 programs are also being rotated at by people at lower tier schools and based on the match lists of t20 programs, there isn't at all a preference for t20 applicants. Furthermore, those at lower-tier schools also won't get yield protected at mid/low tier programs, thus will have higher odds of just matching in general, everything else being equal.

Sure being at a t20 school has advantages in research but tbh u can do (most) the same research literally anywhere else. There's people pumping crazy bs research out of DO schools too.

When ur talking about hypercompetitive fields it's just much more granular than saying t20s have a net benefit.

 

[goldenfloofers]

Nice writeup and I agree w most of it. However, I genuinely don't believe the t20 advantage is as strong as just a departmental advantage, as I said earlier. Obviously I am only speaking about the field I want to go into, but T20 students are also disadvantaged bc 'lower' tier programs will yield protect them (have witnessed this firsthand across multiple surgical fields) and the T20 programs are also being rotated at by people at lower tier schools and based on the match lists of t20 programs, there isn't at all a preference for t20 applicants. Furthermore, those at lower-tier schools also won't get yield protected at mid/low tier programs, thus will have higher odds of just matching in general, everything else being equal.

Sure being at a t20 school has advantages in research but tbh u can do (most) the same research literally anywhere else. There's people pumping crazy bs research out of DO schools too.

When ur talking about hypercompetitive fields it's just much more granular than saying t20s have a net benefit.

I still think students from T20s still have a net advantage when it's all said and done. In terms of yield protection, maybe, but also for smaller specialties such as ophtho, regional ties and connections play a role, hence why you'll see a Harvard grad for example at an ophtho program ranked in the 100+, presumably because they have ties to that region or they just really vibed with that program/got in with their own merit.

In terms of research, I think going to a T20 really helps because you can work with big name people who publish more frequently and at more prestigious journals. I'll use ophtho as an example since I'm familiar with it but I have a friend who attends a T20 med school and the ophtho program is one of the best in the entire nation. He connected with one of the big name faculty. Got a TON of publications in big name journals and even some free publications with minimal work (i.e no chart review, no writing up the manuscript, maybe some basic stats plug and chug) simply because he was part of this big name faculty member's "group". He got a strong LOR that was mentioned in multiple interviews because these faculty members are well known within the ophtho community. He eventually matched at a top ophtho program without doing an away rotation there despite being 4th quartile and scoring a <50th percentile Step 2 whereas students from my school (low tier MD) who have ties or family around the region of this program and was AOA, 265 step scores, and multiple first author pubs albeit in smaller journals didn't even land an interview or an away rotation offer.

I have another friend too who goes to a T5 and he tells me how easy it is to get published at his school because the faculty will bust their ass to make sure you have something on your CV prior to ERAS whereas the faculty at my school struggle (despite having a respectable ophtho program) to provide research opportunities. He matched ortho at his #1 choice this past cycle while being an average student.

Of course this is merely anecdotal but my main point is that the resources and connections and ease of obtaining such resources is far more advantageous at T20s, thus overall is a net advantage. The name itself, and by itself, isn't going to get a bottom-tier student into Hopkins. But having these connections and research opportunities and LORs from big-name faculty goes a long way. I'm certain that the students at my low tier MD school would've found the same success had they attended a T20 and not our low tier MD because I don't think it was a matter of lack of effort or drive.

Obligatory, yes it's still possible to match at top programs at a lower tier school as the above posters have mentioned. Attending a T20 just puts you at an advantageous position in many aspects.

 

[JuicedToTheSocks]

I still think students from T20s still have a net advantage when it's all said and done. In terms of yield protection, maybe, but also for smaller specialties such as ophtho, regional ties and connections play a role, hence why you'll see a Harvard grad for example at an ophtho program ranked in the 100+, presumably because they have ties to that region or they just really vibed with that program/got in with their own merit.

In terms of research, I think going to a T20 really helps because you can work with big name people who publish more frequently and at more prestigious journals. I'll use ophtho as an example since I'm familiar with it but I have a friend who attends a T20 med school and the ophtho program is one of the best in the entire nation. He connected with one of the big name faculty. Got a TON of publications in big name journals and even some free publications with minimal work (i.e no chart review, no writing up the manuscript, maybe some basic stats plug and chug) simply because he was part of this big name faculty member's "group". He got a strong LOR that was mentioned in multiple interviews because these faculty members are well known within the ophtho community. He eventually matched at a top ophtho program without doing an away rotation there despite being 4th quartile and scoring a <50th percentile Step 2 whereas students from my school (low tier MD) who have ties or family around the region of this program and was AOA, 265 step scores, and multiple first author pubs albeit in smaller journals didn't even land an interview or an away rotation offer.

I have another friend too who goes to a T5 and he tells me how easy it is to get published at his school because the faculty will bust their ass to make sure you have something on your CV prior to ERAS whereas the faculty at my school struggle (despite having a respectable ophtho program) to provide research opportunities. He matched ortho at his #1 choice this past cycle while being an average student.

Of course this is merely anecdotal but my main point is that the resources and connections and ease of obtaining such resources is far more advantageous at T20s, thus overall is a net advantage. The name itself, and by itself, isn't going to get a bottom-tier student into Hopkins. But having these connections and research opportunities and LORs from big-name faculty goes a long way. I'm certain that the students at my low tier MD school would've found the same success had they attended a T20 and not our low tier MD because I don't think it was a matter of lack of effort or drive.

Obligatory, yes it's still possible to match at top programs at a lower tier school as the above posters have mentioned. Attending a T20 just puts you at an advantageous position in many aspects.

Must be a really nice department. I can tell u that bc my school's dept doesn't gaf about u and I know other t20 depts that just aren't invested in setting their students up for success (if ur not a woman/minority, from my exp as a white dude). We have top tier apps going unmatched every yr no qs asked. The yield protection I've seen in GS too not just the surgical subs.

I can tell u that having a bunch of pubs doesn't mean sht. Anyone can get a bunch of middle author crap out but 1st author pubs are what matter. I highly doubt faculty are hand-delivering 1st authors to their students - they'd just take that for themself. That being said, ur friend likely busted his behind in research to prove to the big dogs that he's competent which lead to a strong LOR. There's not a single person in our ortho dept who will get u easy pubs, u really gotta grind ur ass off.

I will concede that the odds are higher at t20s of having big names at ur school and if u can get in w these big names and buddy up, then ur prolly set. However, these big names are like hot chicks and everyone is trying to get em, u got ur home ppl, u got away rotators, and they have very high expectations bc they know they're hot. And even if u do all that, they could still not vouch for u, and I know for a fact this happened to ppl and they didn't match..

If u go to a non t20 u can still get really strong letters bc the competition is less, still find the big dogs bc there are few at every institution, adopt the underdog ethos for ur app, not get yield protected, and likely end up with more interviews from a broader range of schools and have higher odds of matching somewhere

 

[MDMechEngr]

...these big names are like hot chicks and everyone is trying to get em, u got ur home ppl, u got away rotators, and they have very high expectations bc they know they're hot. And even if u do all that, they could still not vouch for u, and I know for a fact this happened to ppl and they didn't match..

The hot chick I was trying to get had so many good looking studs persuing her. It was to a point that I was discouraged that she will not want me because she was sooo HOT and there were sooo many hot dudes from very well off famillies persuing her. I got up the courage and proposed to my hot chick. SHE SAID YES. I am moving to her location in July and we are getting married. I also had 7 other hot chicks I was pursuing, but I wanted my top choice.

 

[medschoolaspirant]

The hot chick I was trying to get had so many good looking studs persuing her. It was to a point that I was discouraged that she will not want me because she was sooo HOT and there were sooo many hot dudes from very well off famillies persuing her. I got up the courage and proposed to my hot chick. SHE SAID YES. I am moving to her location in July and we are getting married. I also had 7 other hot chicks persuing me, but I wanted my top choice.

Wow! Ditto same story for me. Just difference is, I was very nervous she will say yes. Rather not expecting Yes. Was ready to settle with choice 2 or 3, ones persuing me. Got yes from my hot chick. All good looking studs were stranded and surprised I got the hot chick and they all settled for 2nd and 3rd best. Some were left empty handed.

 

[ChordaEpiphany]

I have another friend too who goes to a T5 and he tells me how easy it is to get published at his school because the faculty will bust their ass to make sure you have something on your CV prior to ERAS whereas the faculty at my school struggle (despite having a respectable ophtho program) to provide research opportunities. He matched ortho at his #1 choice this past cycle while being an average student.

Another N=1 here. I have a mentor at a T5 from research and attend a "solid" MD program. When I decided on my specialty, I reached out to mentors at my school, signed up to have an advisor, and arranged some research with people in the department. The response from the faculty was a whole lot of nothing. I had weeks to put together apps for aways, and they couldn't find a time for even phone call for over a month. Tried multiple faculty with the same response. They're busy people, and I understand, but my T5 mentor called me on their only day off to strategize as soon as I told them I was applying, offered a sub-I with them and called a friend who was, "more connected than me, so probably a better option for you," to get them to support my away rotation application. It's easy to get down on yourself during med school, but I have to say that despite objectively being at the top of my class, it was the first time I'd felt worthy of being there. The approach could not have been more different.

Top tier faculty are there because they are talented and hardworking, but likely much more important is that they all received incredible mentorship. Without good mentorship, you won't succeed in academia, so it's a near perfect selector. There is a collective expectation at these schools that the culture of mentorship be passed down. In my experience at an Ivy League college and now with the mentors above, many of the faculty don't even realize that blowing off students is an option. At least from what I've seen, the level of support is not comparable.