Competitive Specialty vs Competitive Program

punkedoutriffs

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    Say you had the scores to match into a competitive specialty (derm, rads, ENT, Ortho, etc.) but not the scores to match into one of the top programs in those specialties. However, your scores are good enough to match into a top program in a less competitive specialty (Gas, IM, Gen Surg, etc.). And say you enjoyed each specialty equally. Which would you choose and why?
     

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      I would choose whatever specialty I wanted to do. Regardless of competitiveness

      Second to a point. if you're hopeless to match in something ultra-competitive, you might want to find something else you'll learn to love.

      But that said, in this game you pick something and match in it. Who cares where you end up for residency as long as you end up board certified.
       
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      punkedoutriffs

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        Well, my thinking was, if you pick the less competitive specialty and get into a top program, you have a better chance of becoming a leader in that field. However, the more competitive specialty might grant you a better lifestyle. I guess it's down to individual priorities...
         

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          Well, my thinking was, if you pick the less competitive specialty and get into a top program, you have a better chance of becoming a leader in that field.

          This is exactly the kind of pre-med/med student thinking that is absolutely untrue in the real world. If you want to be a leader in a field, do extended fellowship, super-specialize, and do a ton of research. Most people, even the ones who want to be "leaders", end up not doing it because the salary is low and you train forever. Instead, you either go make the real money in private practice or stay in academics working 50-80% clinical doing easy fairly unimportant research with residents to make your clinical life cushy while still being "faculty".

          So even if you go to podunk U's internal medicine program, you can still go do your extended endocrine fellowship making ~$60/year, study the hell out of diabetes or whatever, and go become academic faculty making $100k/year at big name academic center. So few people actually want to do this, that it's really not that competitive. The salary differences are so pronounced in the high income specialties between mostly research and mostly clinical practice, that it's very hard to find examples of MD or MD/PhD mostly research faculty within those specialties. At the end of the day, why train longer to make 1/3 of the income. Going to MGH residency vs community residency doesn't change any of that. Unless you can't get the fellowship you want. But still, fellowships are competitive because again... The $$$! If your goal is to be some academic leader, don't worry about the $$$.

          However, the more competitive specialty might grant you a better lifestyle. I guess it's down to individual priorities...

          Not all competitive specialties have good lifestyle. Competitive specialties = $$$. Money + lifestyle = most competitive. But plastic surgery doesn't exactly have a great lifestyle until you make it big in your little surgery center only doing boob jobs and lipos. Until then you're reconstructing car accident victims in the middle of the night.


          At the end of the day, what's important is that you do what you like doing. Yeah, money and lifestyle are important. If you decide you like being out of the hospital a lot, there are a lot of less competitive specialties with good hours. If you decide you like a specialty for whatever reason, go do it. I never fault people for picking a specialty in part based on the money, but that said, you never know if the money is still going to be there in 10 years when you're in your private practice. Meanwhile, maybe pediatrics ends up being the big winner in Obamacare and they end up driving the Ferraris while the cardiologists cry all over SDN. Who knows. If you love them babies, go at them.
           

          D elegans

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            You have to follow your interests, and I find my interests changing all the time.

            For example, if I score > 80% on a UWorld test, I find myself really interested in diseases of the skin. If I score < 60% on a UWorld test, I find myself more interested in the psychosocial aspects of medicine.
             

            John Lannister

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              Well, my thinking was, if you pick the less competitive specialty and get into a top program, you have a better chance of becoming a leader in that field.

              That's not how it works.

              Well said. I've seen no correlation between residency prestige and academic rank. It's all about what you do after residency that matters

              Exactly. Just like in medical school we don't talk about our UG GPAs or MCATs, except maybe the first 3 months into med school. Being the #1 medical student doesn't translate to being a leader in a field - they are different skills. You will find leaders from the top of the class to the bottom.

              General advice for OP: Don't go into med school trying to plan everything out. Go in focused on doing well in your courses for the first year - join a group or club if you're interested. That's all you need to think about. Thinking about choosing a field to become a leader in it - this early in the game, is like thinking of winning an MVP in your rookie season. Focus on your rookie season and playing the game well.
               

              JABWS

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                This is exactly the kind of pre-med/med student thinking that is absolutely untrue in the real world. If you want to be a leader in a field, do extended fellowship, super-specialize, and do a ton of research. Most people, even the ones who want to be "leaders", end up not doing it because the salary is low and you train forever. Instead, you either go make the real money in private practice or stay in academics working 50-80% clinical doing easy fairly unimportant research with residents to make your clinical life cushy while still being "faculty".

                So even if you go to podunk U's internal medicine program, you can still go do your extended endocrine fellowship making ~$60/year, study the hell out of diabetes or whatever, and go become academic faculty making $100k/year at big name academic center . So few people actually want to do this, that it's really not that competitive. The salary differences are so pronounced in the high income specialties between mostly research and mostly clinical practice, that it's very hard to find examples of MD or MD/PhD mostly research faculty within those specialties. At the end of the day, why train longer to make 1/3 of the income. Going to MGH residency vs community residency doesn't change any of that. Unless you can't get the fellowship you want. But still, fellowships are competitive because again... The $$$! If your goal is to be some academic leader, don't worry about the $$$.



                Not all competitive specialties have good lifestyle. Competitive specialties = $$$. Money + lifestyle = most competitive. But plastic surgery doesn't exactly have a great lifestyle until you make it big in your little surgery center only doing boob jobs and lipos. Until then you're reconstructing car accident victims in the middle of the night.


                At the end of the day, what's important is that you do what you like doing. Yeah, money and lifestyle are important. If you decide you like being out of the hospital a lot, there are a lot of less competitive specialties with good hours. If you decide you like a specialty for whatever reason, go do it. I never fault people for picking a specialty in part based on the money, but that said, you never know if the money is still going to be there in 10 years when you're in your private practice. Meanwhile, maybe pediatrics ends up being the big winner in Obamacare and they end up driving the Ferraris while the cardiologists cry all over SDN. Who knows. If you love them babies, go at them.

                It's funny how there are no Podunk U graduates who are faculty at my school. And also funny how there are very few Podunk U graduates landing great fellowships. If you're set on academic medicine, particularly at a "big name academic center," I'm pretty sure residency matters, a lot.
                 
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                Neuronix

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                  And also funny how there are very few Podunk U graduates landing great fellowships.

                  Shrug, it must be your school. We had plenty, and we have plenty at my residency program also. Where I went to medical school, our top tier radiology department let faculty positions go vacant for years because they couldn't find anyone crazy and qualified enough to accept the long hours and low salary to fill them. The faculty were quite varied as to where they went to medical school, residency, and fellowship.

                  If you're set on academic medicine, particularly at a "big name academic center," I'm pretty sure residency matters, a lot.

                  Fellowship and your own individual productivity/ability matters a lot more. It depends what fellowship you're talking about as to how hard it is to get. It comes down to how much additional earning potential you'd expect that fellowship to give you. It's a very different discussion for OB/GYN where anyone who is sane is trying to get out being a general OB/GYN for the rest of their lives and residency matters significantly to get any fellowship, versus peds and IM which have a number of academic, research oriented fellowship options that are happy to take anyone with a pulse. If you're talking strictly about cardiology or GI, yeah ok you need to get a big name IM residency so you can try to get an academic fellowship at all.

                  In my specialty (rad onc), they can't fill a lot of the big name fellowships. They end up with a lot of people who aren't even board eligible. People only do fellowship when they're deadset on doing mostly research within academics (clinical academic jobs are easy to find), can't get a job in a competitive locale, or they really want to do some subspecialty they didn't get exposure to as a resident. In the end, if you want to be that big name academic guy, where you actually did residency matters basically zero. But that's a less competitive route in general. People really want the 1 million a year private practice partnership, and that's why they go to the biggest name residency they can find. It was the same when I was the radiology department. Or when I was in a cushy TY with a high earning cardiology service (and all the attendings trained at Mayo...).
                   
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                  John Lannister

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                    It's funny how there are no Podunk U graduates who are faculty at my school. And also funny how there are very few Podunk U graduates landing great fellowships. If you're set on academic medicine, particularly at a "big name academic center," I'm pretty sure residency matters, a lot.

                    This is true and is the norm.

                    Yes, anything can happen - and if you are a rock star, you are a rock star no matter where you went. For the other 95% of human beings, going to a name school helps a lot. If you want to be in academics in an academic field (IM), you probably know that academics love prestige and name schools - Ivy and the like. Pretty sure this is common knowledge.
                     

                    John Lannister

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                      Is there any point in score well on Step 1 if didn't go to the IVY!!? My school is low rank. I want very much prestigious academic position in IM.

                      Haha. Of course it's good to do well.

                      All we are saying is this:

                      Shrinking an application pool to 100 applicants and 10 invites:

                      You have 20 people from Ivy schools, 10 of those people have 250+ scores. You have 20 people from bottom tier schools, and of those 20 - a few have 260+ scores... well, that's a tough competition right there. Of course it's good to do well - but we're talking about limited seats for a high demand spot - so yeah, scoring 10-20 points higher than someone isn't going to matter as much as your pedigree.

                      There are exceptions to every rule. Ask people who have been on the interview trail though, they'll tell you this.
                       

                      Law2Doc

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                        It's funny how there are no Podunk U graduates who are faculty at my school. And also funny how there are very few Podunk U graduates landing great fellowships. If you're set on academic medicine, particularly at a "big name academic center," I'm pretty sure residency matters, a lot.

                        This is very school specific. At MOST big name academic places there are a nice variety of superstars from a pretty wide range of programs. The places who only pick from the same ten places are the minority. And actually often miss out on training the future leaders of the field as a result, which is why most good programs have learned not to take this approach. If you look at the pedigrees of who is running the specialty, writing all the important articles in the specialty journals, naming all the syndromes and procedures, it's probably a good mix. As for fellowships, I don't know what field you are going into but the correlation between big name academia and "great fellowships" is not as impressive as you seem to state.

                        Your perspectives will change when you actually get to residency. Also bear in mind that big name academic places don't necessarily have great residency programs in every (or sometimes even any) specialty. The best residencies in certain specialties are sometimes at hospitals you may not have even heard of as med student until you start looking at residencies. So even though you postulate that "residency matters" (which i think is a statement with a lot of huge qualifiers), big name academic center might not.
                         
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                        Law2Doc

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                          Haha. Of course it's good to do well.

                          All we are saying is this:

                          Shrinking an application pool to 100 applicants and 10 invites:

                          You have 20 people from Ivy schools, 10 of those people have 250+ scores. You have 20 people from bottom tier schools, and of those 20 - a few have 260+ scores... well, that's a tough competition right there. Of course it's good to do well - but we're talking about limited seats for a high demand spot - so yeah, scoring 10-20 points higher than someone isn't going to matter as much as your pedigree.

                          There are exceptions to every rule. Ask people who have been on the interview trail though, they'll tell you this.

                          Meh. The way it really works for residency is programs err toward the places that they've gotten good residents from in the past and err away from the places where they got burned in the past. If your program has a good reputation for people who show up and can get thrown on call without a lot of hand holding or creating headaches, they will give you consideration. If your program has the Reputation for good scores but weak clinical skills, or an alumnus from your program was pretty weak, you might get passed over. In either case we could be talking about a top program. I know a couple of program directors that have top ranked med schools on their $&@? List, and you will have a lot more to overcome to get a residency slot coming from that school than someone from a lesser school with equivalent scores. So it's hit or miss. I wouldn't write yourself off or pat yourself on the back in either case.
                           

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                            Haha. Of course it's good to do well.

                            All we are saying is this:

                            Shrinking an application pool to 100 applicants and 10 invites:

                            You have 20 people from Ivy schools, 10 of those people have 250+ scores. You have 20 people from bottom tier schools, and of those 20 - a few have 260+ scores... well, that's a tough competition right there. Of course it's good to do well - but we're talking about limited seats for a high demand spot - so yeah, scoring 10-20 points higher than someone isn't going to matter as much as your pedigree.

                            There are exceptions to every rule. Ask people who have been on the interview trail though, they'll tell you this.

                            So if got 250 and not ivy, it best to reapply to ivy medical school & try again? then have 270+ "theoretical" prestige step 1 score

                            thank u sir!
                             

                            John Lannister

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                              Meh. The way it really works for residency is programs err toward the places that they've gotten good residents from in the past and err away from the places where they got burned in the past. If your program has a good reputation for people who show up and can get thrown on call without a lot of hand holding or creating headaches, they will give you consideration. If your program has the Reputation for good scores but weak clinical skills, or an alumnus from your program was pretty weak, you might get passed over. In either case we could be talking about a top program. I know a couple of program directors that have top ranked med schools on their $&@? List, and you will have a lot more to overcome to get a residency slot coming from that school than someone from a lesser school with equivalent scores. So it's hit or miss. I wouldn't write yourself off or pat yourself on the back in either case.

                              Well, now your talking about intricacies - and I don't doubt you're right. I was just being general.
                               
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                              kjamess

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                                Well I do doubt you're right. Your anecdotes need some actual proof. And considering you can't provide any, I hope most ppl take what you said with a grain of salt. Just nonsense that you may have heard from one or two ppl and trying to make it a generalization for ppl to follow. Bad advice.

                                You must be new 'round here. Everyone knows that statements made by Law2Doc are factual absolutes, while statements made by others are 'anecdotes' and 'bad data'.
                                 

                                JABWS

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                                  This is very school specific. At MOST big name academic places there are a nice variety of superstars from a pretty wide range of programs. The places who only pick from the same ten places are the minority. And actually often miss out on training the future leaders of the field as a result, which is why most good programs have learned not to take this approach. If you look at the pedigrees of who is running the specialty, writing all the important articles in the specialty journals, naming all the syndromes and procedures, it's probably a good mix. As for fellowships, I don't know what field you are going into but the correlation between big name academia and "great fellowships" is not as impressive as you seem to state.

                                  Your perspectives will change when you actually get to residency. Also bear in mind that big name academic places don't necessarily have great residency programs in every (or sometimes even any) specialty. The best residencies in certain specialties are sometimes at hospitals you may not have even heard of as med student until you start looking at residencies. So even though you postulate that "residency matters" (which i think is a statement with a lot of huge qualifiers), big name academic center might not.

                                  I've seen quite a few fellowship match lists. I've also seen big names on nearly every faculty CV I look at. There is most definitely a bias towards big name programs in academia. It's like one giant pissing contest.
                                   

                                  mimelim

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                                    Well I do doubt you're right. Your anecdotes need some actual proof. And considering you can't provide any, I hope most ppl take what you said with a grain of salt. Just nonsense that you may have heard from one or two ppl and trying to make it a generalization for ppl to follow. Bad advice.

                                    I'm at one of the big programs for one of the most competitive specialties. I sit in our discussions of applicants. Pedigree matters very little, if at all. Never mind that virtually all available evidence supports Law2doc's points. PD surveys, who ended up at the 'top' programs etc. Sorry, no randomized controlled trials, but that is about as good as it gets.
                                     

                                    Law2Doc

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                                      You must be new 'round here. Everyone knows that statements made by Law2Doc are factual absolutes, while statements made by others are 'anecdotes' and 'bad data'.

                                      I don't really care how you regard my advice, but its truly amazing that med students "know" with such certainty how these decisions are being made that they are willing to tell residents they have no clue. Who is really presenting the "anecdotes" here? :)

                                      Also see mimelim's post above if you'd rather choose to believe someone other than me.
                                       

                                      mimelim

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                                        I've seen quite a few fellowship match lists. I've also seen big names on nearly every faculty CV I look at. There is most definitely a bias towards big name programs in academia. It's like one giant pissing contest.

                                        You don't take into consideration 2 major factors. #1 Not everyone wants to be faculty in academia. People that are interested in academia gravitate toward places with lots of research dollars. #2 Top talent tends to stay top talent. The overall quality of students in top schools is higher than other schools. Better students match at better residencies.

                                        Correlation != causality.
                                         

                                        Law2Doc

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                                          I've seen quite a few fellowship match lists. I've also seen big names on nearly every faculty CV I look at. There is most definitely a bias towards big name programs in academia. It's like one giant pissing contest.

                                          It's always going to be somewhat school/specialty specific, but you have to be careful in terms if whether there's a bias for particular programs vs taking ones own residents, and whether these big names are actually "good programs" to start with. Eg. Who cares if a "big name" place with a very weak program (common BTW in at least one specialty at every big name place) keeps mostly it's own residents -- that skews the data but doesn't really suggest that superstars from elsewhere don't do well at the programs that are actually respected in the field.

                                          At any rate it's problematic to mix and match residency and fellowship into one thread -- it's not even fair to say all residency specialties are equivalent let alone lumping in fellowships too.
                                           

                                          kjamess

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                                            I don't really care how you regard my advice, but its truly amazing that med students "know" with such certainty how these decisions are being made that they are willing to tell residents they have no clue. Who is really presenting the "anecdotes" here? :)

                                            Also see mimelim's post above if you'd rather choose to believe someone other than me.

                                            :laugh: Are you kidding me? Nice strawman.

                                            Both of my advisors (who are attendings btw, since we want to play the 'status' game) happen to be members of the admissions committee, one for residency and one for fellowship. Guess what? Their statements completely contradict what mimelim said. Sorry boss, there is a wide spectrum (depending upon specialty/particular program) to which prestige is taken into account. And no, I'm not impressed with NRMP survey data that does not distinguish between top programs and others (especially when 'others' can skew the data).

                                            And for what its worth, I've already gone through the match so I don't need to depend upon a mimelim (especially when I've spoken to multiple informed residents/attendings outside of SDN) to form my own opinion on the role of prestige.
                                             
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                                              Go into a field that you enjoy (as long as it's within your reach). If you like derm, go into derm. If you like IM or one of its subspecialties, go into IM. In the end tailor your education and training to what helps you the most.
                                               
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                                              kjamess

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                                                Reading all these contradictory responses, I don't know what to think...

                                                Regarding the role of prestige? In my opinion, it depends. In general, I think it factors in more at the top programs within most specialties. However, there will be many programs that simply dont care. The problem I have with some of the advice being given is that personal experience/opinion is being used to paint broad strokes across the board. Its false to state that it doesn't matter, the same way its false to say its the end all be all. You can post this same question in the IM/Psych/Anesthesia/Surgery/Ortho etc forums and receive varying opinions from those with experience. You dont have to base everything off of a few people who happen to frequent the preallo/allo forums. For instance, if you post in the IM forum, you will definitely have multiple posters (including attendings who serve on committees) agree that prestige plays a role at the top programs.
                                                 

                                                punkedoutriffs

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                                                  Regarding the role of prestige? In my opinion, it depends. In general, I think it factors in more at the top programs within most specialties. However, there will be many programs that simply dont care. The problem I have with some of the advice being given is that personal experience/opinion is being used to paint broad strokes across the board. Its false to state that it doesn't matter, the same way its false to say its the end all be all. You can post this same question in the IM/Psych/Anesthesia/Surgery/Ortho etc forums and receive varying opinions from those with experience. You dont have to base everything off of a few people who happen to frequent the preallo/allo forums. For instance, if you post in the IM forum, you will definitely have multiple posters (including attendings who serve on committees) agree that prestige plays a role at the top programs.

                                                  I see. Is it fair to say that in general, if something's competitive, it's competitive for a reason? Maybe that's a good gauge?
                                                   

                                                  punkedoutriffs

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                                                    Sorry, I dont think I understand your question.

                                                    Well, I was thinking that top programs in any specialty are competitive. But you say that prestige matters more in some specialties more than others. This led me to question then whether some of the competitiveness for the top programs of specialties where prestige doesn't matter may be inflated. Then I thought, well maybe prestige =/= competitiveness in all cases, and top programs may not be the most prestigious ones. So then it might follow that if a program is very competitive but not necessarily prestigious, then it might be competitive for reasons other than prestige (i.e. case variety/volume/quality of teaching/etc.). So then, regardless of prestige, the most competitive programs will be the ones that offer the best training. Is that how it works?

                                                    That was probably somewhat convoluted. I'm just trying now to get a sense of how to judge which programs will give you the best training in any specialty.
                                                     

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                                                      I think it's very specialty dependent in how much prestige plays a role, but I generally agree with the residents so far in that it only plays a small role in the overall package.

                                                      Though It is a little unnerving that a significant number of the faculty in my school has done a Harvard residency or fellowship.
                                                       

                                                      John Lannister

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                                                        So I guess we can summarize the thread like this:

                                                        Some med students have said: Prestige matters and helps to land top academic internal medicine programs (i.e. top 10 programs). Btw, no one said it's the end all be all, just that it is an important factor - like a Step 2 score or something.

                                                        Residents have said: Prestige doesn't matter for top academic internal medicine programs.


                                                        Ok. Well, no one has any data to back either of these statements - but I'll be the first to say I would trust a more experience person over a medical student. I'm just referring to advice I've received from a variety of people who have matched (current residents). Maybe they lied to me. Good luck bottom tier schools - wish you the best.
                                                         

                                                        kjamess

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                                                          Well, I was thinking that top programs in any specialty are competitive. But you say that prestige matters more in some specialties more than others. This led me to question then whether some of the competitiveness for the top programs of specialties where prestige doesn't matter may be inflated. Then I thought, well maybe prestige =/= competitiveness in all cases, and top programs may not be the most prestigious ones. So then it might follow that if a program is very competitive but not necessarily prestigious, then it might be competitive for reasons other than prestige (i.e. case variety/volume/quality of teaching/etc.). So then, regardless of prestige, the most competitive programs will be the ones that offer the best training. Is that how it works?

                                                          That was probably somewhat convoluted. I'm just trying now to get a sense of how to judge which programs will give you the best training in any specialty.

                                                          Well the most prestigious programs in a given specialty are usually the most competitive to match into, but things like location, malignant reputation, style etc can have an influence on match competitiveness at different programs. You really have to speak to someone who has experience in the specialty area you are considering to determine the best places to train. You can also search older threads in your field of choice to get a general idea of which places are top notch/malignant/give more autonomy, etc.
                                                           

                                                          notbobtrustme

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                                                            Reading all these contradictory responses, I don't know what to think...

                                                            I'm just working with this rule of thumb:

                                                            In a non-competitive field (eg internal medicine), competitive programs (eg MGH) help you land the fellowship you want. A non-competitive residency in a non-competitive field is basically FMG-land; those programs are passed over by the vast majority of AMGs because they lack in a number of ways (fellowship, location, patient population).

                                                            In a competitive field (eg Derm/Plastics), there's no such thing as a non-competitive residency because all spots are highly coveted.


                                                            Finally, pedigree matters, but there's nothing you can do about it so just deal with it. Sure, it sucks that a U-Chicago grad can have an easier time of it, but that's the way the chips fall. If you want to head to a competitive residency, then you just have to work that much harder and realize that you may need to rely on backups and second choices in order to match.
                                                             

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                                                              Not to mention Law2doc isn't even in a top program in a competitive field. His advice in general seems helpful for FMGs, but outside of that realm it doesn't always seem to be the case.

                                                              It's well known that the prestige of the residency program is mainly important for academia and less important for private practice. The countless physicians I know is > Law2doc's residency experience trying to rule as king over his med and pre-med minions. Med students, unlike premeds, actually have some knowledge to refute him at times when necessary.

                                                              You do provide some good advice at times, for sure. And as a premed, I remember I used to read your posts and think everything you said was 100% accurate. Now that I'm almost done with med school myself and have had lots of discussions with residents and attendings, I can now easily flag inaccuracies when I see it.

                                                              I also used to follow l2d as a premed minion but found much better sounding boards from faculty at my med school.
                                                               
                                                              Last edited:

                                                              John Lannister

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                                                              Apr 4, 2013
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                                                                I also used to follow l2d as a premed minion but found much better sounding boards from faculty at my med school. Having gone through the match myself from a top med school and matched into a very competitive residency at a top program, I tend to have a much different perspective than his.

                                                                Yeah, I've heard what you guys are saying more than what L2D is saying. I guess it doesn't matter - just do the best you can everyone. Good luck.
                                                                 

                                                                mimelim

                                                                Vascular Surgery
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                                                                Sep 19, 2011
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                                                                  In all fairness, if it's your goal to just match into a competitive field then going to any US allopathic med school will be fine. If you want to only match to a top 10 program in a competitive field, then going to a top 10 med school helps immensely. The problem is there's no guarantee you'll get into that top 10 program even if you come from a top med school. Your odds are certainly better though. Go look at the residency website of some of the top programs. For ophtho I usually see a bias towards top schools in the same region as the program.

                                                                  I'm not sure how you can say the bolded part with any real confidence. The average applicant coming out of the top schools is going to be a lot stronger than the average applicant from other schools. It stands to reason that those students will fill the majority of those slots. I mean I can think of a couple dozen examples of 'randoms' from non-top schools that are all over the most competitive/"top" residencies that make no sense if 'prestige' had any real value.

                                                                  Also, I'm not really sure what "top 10 medical school" means or "top 10 program" since those are essentially pre-med terms that are fairly nebulous.
                                                                   
                                                                  I'm not saying residency reputation means nothing. But a resident at random state U (say, Indiana or Iowa--programs that are not particularly competitive), will have just as much an opportunity to be a "leader in their field" as one at MGH.

                                                                  And to the person who asked

                                                                  Yes--top academic programs pay terribly compared to their "low tier" peers in private practice
                                                                   
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