better to go to top 10 and be average or (hopefully) stand out at state school?

Discussion in 'General Residency Issues' started by lalalala, Apr 25, 2004.

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  1. lalalala

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    Hi, I posted awhile back in the allopathic forums about this question, but many of them recommended that I take my thoughts to the residency forum, where you guys have been/are going through this stuff.

    Looking back, is it better to go to a top 10 and, probably, be average in the class or go to a state school where you have a better chance of standing out? Say you do want to do a competitive residency but you don't care about the location. I.e. you aren't gunning for rads at UCSF, but doing rads anywhere for you (although preferably close to family) would be fine.

    What did you guys see on the interview trail? I'm reading posts on the residency forums, where people say standing out at their state school versus being average at a top 10 (excluding hopkins and harvard) makes a difference. then I read stuff about how people at top 10s interview everywhere in spite of no honors in clinicals and okayish step 1s. It would seem to me that applying to residencies is like applying to med school--the kids with the 4.0 gpas from State U do better than the 3.3 gpas from Ivy.

    And as an unrelated question, how important are extracurriculars to the residency app? Is it like med school where they are very key? Or is it only important for purposes of AOA?

    PS-I want to say now that if this post offends anyone (why it would, I don't know, but posts like these seem to spiral down into some kind of antagonistic back and forth), I'm sorry from the get-go! But be so kind to lend yoru thoughts before you sign off :D
     
  2. ny skindoc

    ny skindoc Senior Member
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    If you get into a "top 10" school and hope to end up in a highly competitive specialty or hospital..GO THERE.It is a mistake to assume you will stand out in your state med school.There are many variables which determine your standing in med school.It is not unusual to see people who just made it into med school off the waitlist end up at the top of the class.Often those who enter with high stats end up in the middle of the class.State schools have many who passed up private schools and others who wanted to stay close to home.Very few can end up at the top of the class,and small number of strong students,and those who are work-a-holics, will put everyone else in the middle ,thats the way it is at most schools.A top 10 med school name carries weight,you can do reserch and get LORs from leaders in their field.This can open many doors.sometimes the top students at state schools do better than ivy's..for example when they match in Derm at their home program and "top 10 "students sometimes can not not get Derm at all.But this is the exception to the rule.Overall a top 10 average student is a good thing to be.
     
  3. Masonator

    Masonator Senior Member
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    I agree with nyskindoc. (we could start another derm flamewar if you want by the way). Assuming you will be at the top of your class in state school is a bad assumption. I would only do state over top 10 if you wanted to practice in said state, didn't want an ultracompetitive residency, and you wanted to save money/be with family and friends. From a career standpoint, top 10 schools can open up a lot more options. An "average" top 10 student with good letters can compete with a top 10% of class state person.

    Med school is harder then you think, it isn't easy to ace every exam and still have a life. It is also neigh impossible to predict success in clinical rotations. You can't rely on honoring every rotation. Rotation grades have little to do with hardwork and knowledge, since all the students have these traits. People are weeded out by how much the residents like them. That is the only difference between a high pass and honors. Unless you are johnny schmoozer, you aren't guaranteed honors in every rotation. Sometimes the schmoozers even get hosed.

    School reputation also counts for alot among certain specialties. We can use derm as an example. Most state schools have 2 derm matches. They are usually at the home or regional program. A top 10 school might have 6-12 derm matches. The majority of these are in top 10 programs, and the rest are at really good second tier programs.

    I wouldn't rack up 400-500k of debt for this advantage but if your undergrad debt burden is low, it is worth the extra 100-150k of additional tuition expense.

    I hope this helps, congrats on having this choice...
     
  4. doc05

    doc05 2K Member
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    I agree. the above comments are very accurate.
    [aka- I'm too damn lazy to write out my opinion.]
     
  5. RLMD

    RLMD blah
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    Im going to argue for the other side of the argument.
    I do believe there is a clear, large advantage to going to a top 5 or 10 medical school program when applying to residency (whether this advantage is worth the high cost is up to the applicant). However, outside of the top 10 I hear there is very little advantage/consensus of one school over another when applying to residency, and you will be better off going to the school that is the best match for you. What I mean by the best match, is the school that has everything in place that you believe you need to not only prosper, but to excel.
    Just for example: If you get into Cornell and SUNY downstate, and your MCAT scores and gpa are competitive with students at cornell, and you actually favor the downstate curriculum over the PBL curriculum at cornell, I would strongly consider going to downstate. Downstate may not be the best example since I know a lot of competitive students go there, but if there are so many cards stacked in your favor at a state school or other less competitive program, such as curriculum, cost, closeness to family, location, POTENTIAL TO EXCEL, etc., I would go there, save money and kick ass/take names and end up AOA (preferably junior since at most places the clinical rotations are not taken into account, which can be too subjective to predict). It all comes down to confidence. If your scores and gpa are much higher than the mean, and you are confident, willing and competitive enough within yourself to work your ass off (!) to do it, then I think you have a good chance to be at or near the top of class, and save yourself a ton of money at a state school. And I am pretty sure that a student at or near the top of the class (AOA) at downstate will look better than an average to slightly above average student at cornell (again, just an example), everything else (board scores, extracurrics, etc) being equal - those type of things just stand out, and will be a big boost to your application when applying for that competitive residency.
    I know that there are competitive students everywhere and there are no guarantees you will be at the top of the class even if you bust your butt to do it, but there are no guarantees in life. I think this is a time where the potential benefits outway the risks IMHO. In a similar situation, I would even suggest choosing a state school/seemingly less reputable school over a top 10 school, if the student will genuinely be happier at the state school and only if the cards are stacked in his favor to excel there.
     
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  6. Masonator

    Masonator Senior Member
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    Since you are getting conflicting, yet very generalized information, you might as well tell us which schools you are deciding between. That way we could give you more to go on. Cornell isn't technically top 10 I think, but it is close.
     
  7. BigBopper

    BigBopper Senior Member
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    The problem is that you can't be certain that you will be junior AOA at any state school. It is MUCH harder than you think. Confidence is not going to do it. There are tons of over confident medstudents. 90% of people coming into med school think they are hot stuff. After the first year, 80% will resign themselves that they will not be AOA.

    What happens if you go to downstate and end up in the middle of the class? I would much rather be at Cornell or Columbia in the middle of the class than Downstate.
     
  8. RLMD

    RLMD blah
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    Like I said, nothing is guaranteed. You arent guaranteed that competitive residency whether you go to top 10 or the state school. I just think that if you find yourself in such a situation, it is a good idea to think about going to the state school because the potential rewards may outway the risks for you. It is a very individual thing, and does not apply to everyone, but even if you dont end up AOA you will still have considerably less debt when you graduate.
     
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  9. BigBopper

    BigBopper Senior Member
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    Yes but if you are at a top 10 school, you have a MUCH better chance at matching in a competitive residency if you are in the middle of the class than if you are at Downstate in the middle of the class. All you have to do is look at the match lists at top 10 programs and your typical lower to middle tier state school and you will see the difference. The match list at Harvard and Hopkins is almost uniformly impressive from top to bottom with a few exceptions. The thing to remember is that the vast majority of these people on these lists are not in the top 25% of their class.
     
  10. Hop Toad

    Hop Toad Senior Member
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    I chose to attend my state school. I did not have the opportunity to attend a top 10 med school, but top 20 was offered. I decided that my state school could educate me just as well and save a lot of money and hassle.

    I was able to rise to the top of my class and achieve Junior AOA status. I had no extra curr. and no published work. I spent all my "off" time having a good time.

    I was granted interviews at all 15 top programs I applied to. Know for a fact that I would have matched at Hopkins, did not match at BW or MGH as I would have liked. I'll never know what was missing in my application as I thought the interviews went well. Was it the state school? Who knows. I'm at a top 5 program and very happy. You can definitely match well from a state school.
     
  11. RLMD

    RLMD blah
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    Okay, I admit you will almost certainly be better off at harvard or hopkins or another top 10 than a state school, unless you are really concerned about money. But like I said in my original post, I think the benefit from schools outside of the top 10 is less certain and you may better off at the state school, which is a better fit for you and at a lower cost and therefore have a better chance to excel. But the OP is talking about top 10 schools, so I guess this point is moot anyway.
     
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  12. pmichaelmd

    pmichaelmd Senior Member
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    I think that going to a "top ten" school will open doors for you, but that isn't always a guarantee. It seems risky to assume that you'll be able to perform at such a level as to stand out at a state school. What happens if you go to said state school and end up in the middle third of the class? All things being equal and using the school examples from above, I would go to Cornell, even if it was only ranked 12th this year by USN&WR.
    I should add the caveat that I went to Cornell for med school and the woman I was dating at the time went to Downstate...she said the experience was crappy and was in the upper third of her class. I was in the middle third of mine. She is currently finishing her OB residency somewhere in the Bronx and isn't really happy. Certainly there are individual circumstances, but I think the prestige factor, real of perceived, fair or not, does count. I attended an Ivy undergrad and that scored big points while interviewing at an Ivy med school, which in turn opened doors when I interviewed and subsequently matched in anesthesia at Mayo.

    Just something to think about and...my $0.02.

    Regards,
    PMMD
     
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  13. RLMD

    RLMD blah
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    This is the perfect example of what I am talking about. Not top 10, but with top 20 or 30 i dont think is enough reputation benefit to outweigh the cost and potential to excel at the state school.
     
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  14. IndyXRT

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    In the original post, one question posed was whether you could obtain a competitive residency (not necessarily in a super competitive location) while going to a state school. I don't know any statistics, but I do know that people from my state school (including me) were generally able to obtain spots in rads, rad onc, ENT, optho, derm, etc. I was in the middle of my class (of 280) and still managed to match into a spot I wanted in rad onc.
     
  15. aliraja

    aliraja Troublemaker
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    You're going to get all sorts of conflicting answers to this question. That being said, I'll add to the mix by stating that, without a doubt, I wouldn't have gotten the residency that I did had I not gone to the med school that I have. My board scores and grades, having come from my state school, would have resulted in a residency farther down my list than my number 1. Of course you could always argue that either my scores or my grades might have been higher at another school...

    God luck, no matter what you choose!
     
  16. BigBopper

    BigBopper Senior Member
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    Yah but once you get a private school ranked #30, reputation really won't carry you. Reputation only carries you with top 10 type of school. I would never pick a state school over a private school ranked #30.
     
  17. ortho2003

    ortho2003 Senior Member
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    Go where you will be happy. You can do well from a state school if you work hard and score well. Yes, you will get a boost from rep if you go to a "top ranked school", whatever that means, but I like at it this way. Do you want to go to some "top school" for it rep, be miserable for four years and average and possibly get a boost when you are applying, or go to a state school where you are happy, work hard, do well and match wherever you want to match. If you truly think you would be happier at the "top school" go there, but in the end, I don't think you match will change much. This coming from a mid-to-low-tier state school grad who is currently in an ortho residency and was offered over 20 interviews in ortho....the state school didn't seem to hurt me.
     
  18. dhooppi

    dhooppi Member
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    For those of you that are applying to residency programs or have applied to them,

    Do you think there's much of a difference (reputation-wise) between U Pitt and UNC-Chapel Hill?

    Thanks
     
  19. rustybruce

    rustybruce Member
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    dhoopi, honestly, how many times are you going to ask this question? Please look deep in side and really think where you would rather be. There are only a couple of differences between these school. The first is location. Would you rather be in Pittsburgh or Chapel Hill. The second is cost. Where are you in state? The third is family/friends. Where do you have more?. The fourth is ranking. As schools they are ranked the same. The fifth is hospitals. As hospitals, Pitt is ranked slightly better. You will get the same residencies coming out of each program. It doesn't matter. UNC has 5 residents at the Pitt Emergency Med program. Pitt has some residents at UNC. Both send residents to UCSF, UCSD, Brigham, U Chicago, Stanford, Hopkins, etc. You will benefit by being happy. That is the only thing that matters.

    Be happy you are accepted to medical school and now focus on what's important to you. These are two of the top state schools in the nation. That means they are 2 of the top SCHOOLS in nation. You can't lose, except if you are unhappy. Neither program will help/hurt you.

    Good Luck.

    Go to UNC.
     
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  20. dhooppi

    dhooppi Member
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    Thanks for your advice.
    This will be the last time, honestly :)
    I don't know where I really want to be, which is why I'm trying to gather as much feedback as possible.
    To answer the first two of your questions: I did my ugrad at UNC and have lived in NC for 5 yrs, so I would rather be in Pittsburgh (change of environment and more diverse class).
    3rd... my family lives abroad, so I don't need to consider that.
    And you've helped me answer the last two questions.

    I am truely grateful for getting into (any) med school. But given a choice, I feel that I should still weigh the pros and cons carefully.
     
  21. tcpro

    tcpro Junior Member
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    Or you could attend a top 10 school (most of the years) and IS a state school (UW). :)
     
  22. pekq

    pekq Gunner
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    bump

    any other thoughts? I am pondering this same issue as well.
     
  23. yaah

    yaah Boring
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    Just be careful about how you weigh advice that people are giving. A lot of times, the most vociferous proponents of going to the "highest ranked" school that you can get into are people who have not even gone through the match yet, and their only experience with it is looking at match lists and comparing just how competitive they appear to be based on reputation. There are a few things you have to consider: people who go to highly ranked schools often have competitiveness in their character, thus they will not be satisfied unless they continue to ascend the rankings ladder, no matter how relevant this is to their future happiness and success. Second, a lot of those who attend state schools do so by turning down "higher ranked" private schools out of a desire to either save money or go to a school or location that appeals to them. What match lists don't tell you (and the NRMP doesn't release anymore) is just where on their match lists people end up. Just because people are ending up at so called competitive residencies doesn't mean it was even in their top 5 of choices.

    People at state schools often have different priorities. You will see more people going into primary care, family med, pediatrics, etc. This is not because they are inferior students as many would have you believe, it is because they have made the honest choice to pursue that field. They also may choose to attend a "less competitive" residency site for personal or professional reasons (because the best training often comes from places that are unexpected). Residency curriculums are different. The most successful physicians come from all over. You are not assuring yourself of anything by going to a top ten school other than the personal ego boost and probably a higher tuition rate. Things are not handed to you just because of your pedigree. A lot of people at these schools succeed because they work hard, no different from those at less well regarded institutions.

    My advice: Don't let anyone, be it aggressive premeds, ratings junkies, ratings books, disgruntled students (like those who don't do well at a state school and then whine about how they should have gone top ten), or even passionate state school advocates tell you what to do. You have to decide for yourself, what is the best situation for you, where you will succeed. Ultimately it is up to you how you succeed in life. Most american med schools are quality institutions with inspiring faculty and many opportunities for personal growth.

    There seems to be a tendency in this country to put oneself on the highest pedastal possible, creating a superior resume (at least on the surface) so that people have no choice but to continue elevating you to positions of power and prestige. Don't forget though, that patients don't care (at least, the vast majority of them don't, and the ones that do no one wants to treat anyway) where you went to school. They want you to be a good doctor.

    As someone who just went through the match, from a state school (UMass) which is somewhere low on the rankings, probably mostly because no out of state students are accepted, all I can say is that rankings lists and match list discussions are a bunch of hooey. Most of my class got one of their top choices in the match, and a lot of them would surprise people (like, why are you turning down an MGH program?). And in talking to people at other med school going through the same thing, what I can say for certain is that going to a top ten school doesn't guarantee you jack in the match. I matched at my #1 in a field where some would say going to a state school is a detriment (path). I know it's tough to decide on a med school to go to, because the only information you really have to go on is 1) hearsay, 2) rankings lists, and 3) your own experience in visiting them, which is often not a realistic portrayal of life there. But look deeper, study them, and avoid depending too much on rankings. Your school ranking is probably about #10 on the list of what is important to most quality residency programs.
     
  24. musicman1991

    musicman1991 Senior Member
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    Go to the best school you can get into. Don't assume if you go to a lower-tier school you will be #1 there because you got into Harvard. There are many factors and many smart people.

    If you go to a top school you can be average and get a good residency, but if you are average to below-average at a lower-tier school you are SOL.

    Also, what's not to say you wouldn't be #1 at your top-10 med school?

    Take this from someone who is graduating from a top 10 med school this year.
     
  25. AAKRAZY

    AAKRAZY Member
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    I am so at wit's end, I'm finally coming out and asking this question to the general public in this forum.

    I have to choose between UC Davis and Univ. of Pittsburgh (with awesome financial aid).

    Here are the circumstances.

    I'm definitely committed to an academic career (possibly neurology/neurosurge). I love the research I'm doing, and I hope to find time to make this a continued reality as a medical student.

    I love the West Coast. Unfortunately, no S. California schools showed me any interest. Davis, at the very last second, somehow decided they wanted me, which I feel is a miracle in itself.

    My primary goal is to match back to S. Cali (UCLA or USC, give or take a UCSD or UCI). I repeat: My primary goal is to match back to S. Cali.

    Here's more: I went back East for school. I did terribly (for lots of reasons both within but mostly beyond my control). Along with the distance from home, the weather, and overall "vibe" difference, I really suffered. I did work for a year in NYC after I graduated, and that was awesome. Granted, a 9-5pm job is not the same as being a medical student, but I want to point out that I can be happy back East. But as a med student?

    Davis is going to cost me a lot of money, and it's not really the CA I envisioned for myself (no surfing). Pitt, no matter how cold, is a good place to be, and I truly felt like the resources are really at students' disposal.

    I know I'll be happier at Davis, but given my primary objective (and interest in academics) I think Davis' edge isn't all that much sharper than Pitt's.

    Do you guys have thoughts on this? Seriously, please PM me or post. I don't have much longer to commit, and I'm in agony. I can't separate my past from making a forward thinking decision, but my doubts about succeeding back East may be unfounded in the end. I'm so much older/wiser/hungry than I used to be, but I sure love my t-shirts, flip-flops, proximity to the folks, and the potential surf session every now and then.

    Help. I'm going in circles. Again, I apologize if this isn't the right forum to be posting such a question.

    AAK
     
  26. Ringo_Man

    Ringo_Man Member
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    I will make an assumption that you are trying to choose a school at which you would be most happy and able to pursue your career goals. You are therefore not choosing based on prestige/buried statistics regarding residency programs, etc... Clearly, you will be able to pursue your goals at either most efficiently if you are HAPPY with your environment, or in other words, achieving personal best is far more significant factor in future success than school reputation. Besides, there are not many significantly distinguishing ranking characteristics between both schools. I see the personal issues that are most significant from your post as:


    1. Financial Aid
    2. West Coast Medicine
    3. Family
    4. Fear of failing on the East Coast --again--

    I will give you my thoughts on each.


    1. Money does matter. Consider your material requirements and your ability to manage debt. Most people are quite good at it. Not many flinch at the awesome debt prospect of a home with a mortgage. How will you react to a large debt from medical school? Debt does limit choice, but not to significantly in the areas of medicine you are interested. Meaning, you will be well paid. It would be imprudent to ignore this attribute, but the question is often over stressed because of the aggregate amounts (Lots of trailing zeroes). Having personally left a far more lucrative profession than medicine, I do not over value this factor. Money isn't everything, if you live by other qualities.

    2. There is something called "West Coast Medicine." It is an attribute of relaxation, and less formality in professional relations present in institutions on the West Coast (except in Surgery). It is available at Davis not at Pitt, although you can do your residency anywhere (if you do well).

    3. Family: I derive an enormous amount of support from my family. Others do not. Living close to family gives you opportunity to continue to grow and share in more of the everyday with the persons you were born to. Some people need the space. Some people want less of it. You know where you are.

    4. I have the most to say about this. Just because East Coast academia was a source of pain for you in the past doesn't mean it needs to be redressed. There are of course numerous factors that go in to a grade, most of all though it is about commitment and environment. You can not know for sure what your performance will be where ever you choose to go, but you can choose to create the optimal circumstance for your best performance. If that means going East or West, you know. I would not make the choice about PROVING yourself in difficult circumstances. Aka. Choosing Pitt because you want to erase the pain of the past. You maybe recreating the circumstances that eventually lead to your pain. You are at least suspicious your pain had something to do with the East Coast environment. Maybe the grades precipated feelings of worthlessness, but perhaps that they were not about YOU. Perhaps, They were a natural conclusion to a statement about your enivironment. So...Choose to care for yourself. Doing well is about knowing how to create the best circumstances for yourself and then giving it your best shot.

    Good Luck,

    Maybe I will see you at Davis :)
     
  27. You're the only one that knows what will make you happy. Also, if there's one thing I've learned in life, don't let the issue of money make the decison for you. Otherwise, you'll always think "what if?" Good luck. Hope to catch you in Davis.
     
  28. digimon

    digimon Member
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    i was in a similar situation. i got into a couple of schools, a highly ranked private school, and my state school. if you want to go to a highly academic, "prestigous" residency, you'll probably be at an advantage by goingt to an ivy. but if money is an issue, and you don't necessarily care about matching at the best name program, i think it's worth it to save some bucks and go in state.

    i agree with everyone that says that medical school is different beast from undergrad. i did very well in undergrad, graduating with great grades, getting good mcats, phi beta kappa, etc etc. i went into medical school (my state school for money reasons) thinking i'd rock and roll and have my choice of residency. well, i ended up in the middle of my class, but did well on my boards, and made some solid connections in the field of my choice (radonc). i applied far and wide, and pretty much got snubbed from most of the elite programs. however, i was able to match at one of my top choices having graduated from a state school.

    did any of this make sense? bottom line, you'll have to bust a$$ anywhere you end up. just remember that your USMLE's will be the great equalizer. on the flipside, you'll be at a slight advantage with a bigger name if you end up being average.
     
  29. zoolander

    zoolander Blue Steel
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    Think hard about Davis, and how you feel about Sacramento (good to be near Tahoe? basically a nightmare?). All things being equal it might be easier to rotate, get relevant recommendations (from profs who know each other), and network locally if you stay in California.

    Do you plan to go back to So Cal much during med school? There's a huge difference between a 1.5 flight and a 6 hour one. Does Pittsburgh have direct flights to LA? After moving from CA to the E coast, the flights are _much_ more painful, even direct. As you probably remember that red-eye home Sunday nights can be brutal, even more so during clerkships.

    Finally, how does Pitt place people? Check out their match list to see if people go out of state or out of the area much.

    Whatever you do definitely don't get too hung up on the cost of med school. Unless there's a tremendous differential (ie, one is free), the marginal differences will narrow out in monthly payments over a 30-year consolidation loan w/3% interest (optimal situation this year).

    This from someone who just matched, so take it with a grain of salt :)
     
  30. NedStark

    Removed

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    Better to stand out at a state school, but that doesn't mean that you'd surely stand out there if you got into a top 5 school. So it's a risk either way. If you go the state route, you'd definitely need to do very well.
     
  31. gutonc

    gutonc No Meat, No Treat
    Administrator Physician PhD 10+ Year Member

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    Solid 9 year bump bro.
     
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  32. 487806

    487806 Life of the Party!
    Rocket Scientist

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    :shrug: He does this in preallo all the time. Not sure why.
     
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