I split all schools into Category A and Category B. Category A includes roughly the top 40 in US News. I consider everything in Category A roughly equivalent. Harvard, Cleveland Clinic, UVA, Case Western, Einstein, Rochester, BU etc. All of these schools have phenomenal research, education, residency, and training opportunities. Category B is everything not in Category A.
I am going to be very honest. At any medical school you will be a great doctor but outside of the top 40 in US News the overall opportunities medical schools offer tends to drop. You will not have the same research and clinical opportunities at Tufts, GW, SUNY Buffalo, VCU etc. that you would at Harvard, Rochester, Mayo etc. You can actually see the differences in facilities, research funding opportunities, financial aid etc. Also note that in general, outside the top 40 financial aid is much different than inside the top 40.
Now, some people talk about which schools are better within Category A "BU vs. Harvard vs. Rochester" etc. I honesty believe in the medical community you can come out of all three of those schools with the similar "prestige", research, and clinical skills. But, some people may want to split hairs, and in my case I split Category A into Category A-1 and Category A-2. Category A-1 are schools in the "top 10" roughly. Harvard, Yale, Hopkins, Duke, Columbia, Stanford, UCLA etc. I would also throw schools like Mount Sinai in there too. These schools are truly superior. Research, clinical opportunities, curriculum financial aid etc. Category A-2 are the other schools I did not list. For example, Cleveland Clinic. I consider it elite, but its not Harvard or Hopkins.
You can go to any medical school and be successful. Any medical school you go becomes the "best" medical school for you. I get that. However, I think it is important to remember than schools are considered "better" than others.
I also understand that for most students there is no reason to make tiers because the chances are it won't really matter. You got into two medical schools. Go to the one with more financial aid. Simple. For some students that are holding 4, 5, 6, 7 or more offers, tiering helps the decision process easier. For example, I have a friend I met at Hopkins. He got in there, got in at Cleveland, and GW. He withdrew from GW immediately because he wasn't going to go GW over Hopkins or Cleveland (CatA>CatB). However, now he is strongly considering Cleveland over Hopkins because Cleveland's aid would be substantially better than Hopkins. (Both CatA).
Tiering is flawed and imperfect. I'll give you that. But it helps a lot and I think it is necessary for some people.
*Fit is very important but you can find fit at every tier if you net is wide enough.