Expensive top-tier School vs Cheap, pretty-good in-state

[onthevirge]

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I’ve been lucky to be accepted to a top-20 school ("School A") and also a top-40 in-state school ("School B"). Both are good in training clinicians with good reputations, but school A is a little better on research and training academics.

If I go to school A, I’ll easily be at least 210k in debt; at school B with no more than 80k in debt.

I do not plan to go into academic medicine per se, but I do not want to do all clinical either. I’m leaning toward surgery (or maybe even IM with a fellowship), and my plan is 90% clinic and 10% research/ bioengineering (eg. medical device development). Any large-scale hospital is my ideal working place (not necessarily associated with a school).

Any and all advice on which school to choose is welcomed.

 

[fahimaz7]

It doesn't matter where you go, as long as you perform well, get great board scores, and LORs. If you do this at either, you'll be fine.

I'm going to an in-state school for this reason.

 

[RoadRunner17]

So for me, where I'm in a similar situation, I have to decide whether the difference between the more expensive private university and the cheaper state university is worth paying the extra money for the private university. I think this is basically what you're asking. Every man has a price, so I would try to figure out what that is (it can be quite amorphous but find some kind of ballpark figure), and wait for the financial aid packages to see what the true difference is. Like people on this forum like to say, the more expensive private school may actually be the cheaper one after financial aid. But bottom line, every man has his price and you need to decide what that is.

 

[pianola]

If I go to school A, I’ll easily be at least 210k in debt; at school B with no more than 80k in debt.

That's a huge difference. If it were less, maybe it would be worthwhile to consider school A.

Think of it this way, maybe: $130K (the difference between the two schools) is the cost of a whole extra person's medical education. I don't know if that even includes interest, which would widen the gap even further.

You would be paying the equivalent of your own medical education at school B + my medical education at an OOS private school (I estimate taking out $112 before interest).

$80K is a fantastically low amount of debt to get away with. I would do that if I were you.

 

[pianola]

Like people on this forum like to say, the more expensive private school may actually be the cheaper one after financial aid. But bottom line, every man has his price and you need to decide what that is.

👍👍

DEFINITELY wait for financial aid packages before doing anything.

 

[zpiff]

If the financial aid comes in and the difference in tuition is still that big I would most likely pick the state school.

Which school gave you a better impression putting aside any ranking differences?

 

[zpiff]

.

 

[crazycooljoel]

I agree with all the above dudes, your goal is M.D. with less debt, take the cheaper route if it's that big of a difference.

 

[45408]

I don't see any reason to go to A over B. I'd go to B.

 

[Handy388]

I am going to sound different, but I am going to try to attend a higher ranked school if rank difference is larger than 50 places regardless of fin-aid

my reasoning is that the match will get much more competitive for US students in the next few years. since there are more allo enrollment, the maligant residency spots are going to be taken by AMGs.

the previous thinking that all US schools are the same may be because no AMG have to go to maligant residencies because there were so few of us.

I have a feeling that we may be looking at a trend where rank of LCME med school may begin to matter a lot for residencies. Granted, you can still do well in a lower tiered school (such as the case for law school), but the incredible amount of competition will make it very diffcult.

For example, if I say you HAVE to make AOA at a lower tiered school now to match out of primary care,would you still go for that school if it's 10k cheaper per year comparing to a top 25 school?

just an observation and discussion, please no flames.

 

[pianola]

I am going to sound different, but I am going to try to attend a higher ranked school if rank difference is larger than 50 places regardless of fin-aid

my reasoning is that the match will get much more competitive for US students in the next few years. since there are more allo enrollment, the maligant residency spots are going to be taken by AMGs.

the previous thinking that all US schools are the same may be because no AMG have to go to maligant residencies because there were so few of us.

I have a feeling that we may be looking at a trend where rank of LCME med school may begin to matter a lot for residencies. Granted, you can still do well in a lower tiered school (such as the case for law school), but the incredible amount of competition will make it very diffcult.

For example, if I say you HAVE to make AOA at a lower tiered school now to match out of primary care,would you still go for that school if it's 10k cheaper per year comparing to a top 25 school?

just an observation and discussion, please no flames.

I'd say your reasoning is probably legit. But even with your reasoning, the OP here is talking about a difference of 20ish places and a difference of $130K...

 

[Anotherface]

I'd say your reasoning is probably legit. But even with your reasoning, the OP here is talking about a difference of 20ish places and a difference of $130K...

Based on the title of the thread, it seems that OP strongly favors one school over the other. Since the that is the case, the OP is hesitating because of the cost difference, so OP should wait until he gets his financial aid packages before making a decision.

 

[dakker]

I'm in a very similar place. I have opted for the School A route because of a number of reasons. Not only did I like School A better, it was close to home and had so many opportunities in terms of research and interesting people beyond what School B could offer.

But honestly, if you have no strong preference, go with School B. 80k is pretty good.

 

[fahimaz7]

why is it that all the pre-meds on sdn think that going to a top 30 school is going to get them in to a "good" residency? I also think it's interesting how they all think that making AOA and a 250+ board score is likely. Reading this site would make you think that there is only one way to a ROAD residency, and that is through an Ivy League school.

LOL

 

[Handy388]

why is it that all the pre-meds on sdn think that going to a top 30 school is going to get them in to a "good" residency? I also think it's interesting how they all think that making AOA and a 250+ board score is likely. Reading this site would make you think that there is only one way to a ROAD residency, and that is through an Ivy League school.

LOL

read my explanation. My purposed scenario for certain low tier medical school can only match people into non-PC specalty if they are AOA is similar to what's happening with second tier law school now, where only the top 10% can possibly land a good law gig.

this scenario is only valid when LCME graduates equal or exceed residency positions offered.

 

[pianola]

Based on the title of the thread, it seems that OP strongly favors one school over the other. Since the that is the case, the OP is hesitating because of the cost difference, so OP should wait until he gets his financial aid packages before making a decision.

Yeah, definitely waiting is important. OP, I absolutely wouldn't make a decision until you absolutely had to. But it's probably a good idea to have a default plan just in case the expensive school offers you $0 financial aid.

 

[Leejwwc]

...this scenario is only valid when LCME graduates equal or exceed residency positions offered.

that is an interesting point. i would argue that our class (c/o 2013) still has nothing to worry about since only 4 new allo schools have opened up, each with inaugural class sizes ~40. But in a or so decade, after the other 5 schools currently in planning open and all are at full capacity, along with the increase in class sizes at existing allo schools, this may be a real issue.

 

[PremedIowa]

The lower debt of attending school B will probably open as many doors as going to school A. The (at least) $200k difference after interest could go to a number of other things, such as buying a house, paying for your children's college, allowing you to not worry as much about compensation when choosing a specialty.

Every accredited allopathic school has an excellent match list. The most likely reason school A's is slightly better is because it attracts slightly better students. All in all, the stats say it doesn't really matter which school you graduate from in matching to a competitive specialty.

From Charting Outcomes in the Match: Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2007 NRMP Main Residency Match

"U.S. seniors who graduated from top 40 NIH research intensive medical schools and who preferred the competitive specialties had median predicted probabilities of match success of .98 compared to .97 for graduates of other medical schools. Being a graduate of a top 40 NIH research medical school was not a significant predictor of match success for U.S. seniors who preferred highly competitive specialties."

 

[Impromptu]

From Charting Outcomes in the Match: Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2007 NRMP Main Residency Match

"U.S. seniors who graduated from top 40 NIH research intensive medical schools and who preferred the competitive specialties had median predicted probabilities of match success of .98 compared to .97 for graduates of other medical schools. Being a graduate of a top 40 NIH research medical school was not a significant predictor of match success for U.S. seniors who preferred highly competitive specialties."

There you go again with your logic, reason, and facts. But you forgot to include ego. How are those with large egos supposed to make a decision if you leave it out of your logic?

 

[ChubbyChaser]

There you go again with your logic, reason, and facts. But you forgot to include ego. How are those with large egos supposed to make a decision if you leave it out of your logic?

Hahaha

 

[PremedIowa]

There you go again with your logic, reason, and facts. But you forgot to include ego. How are those with large egos supposed to make a decision if you leave it out of your logic?

 

[EveeSTi]

The most likely reason school A's is slightly better is because it attracts slightly better students.

Why wouldn't you want to surround yourself with better students? It's more motivating, at the very least. Don't get me wrong, I am going to my inexpensive state school, but that's only because I didn't get in to any of the top tier expensive schools. If I had, I would certainly be going there.

 

[EveeSTi]

And what the heck, ChubbyChaser your avatar went from slightly disturbing to slightly distracting. Why the change of heart?

 

[ChubbyChaser]

Why wouldn't you want to surround yourself with better students? It's more motivating, at the very least. Don't get me wrong, I am going to my inexpensive state school, but that's only because I didn't get in to any of the top tier expensive schools. If I had, I would certainly be going there.

Lol because UTSW is full of idiots🙄 Whats the difference between a 3.9 average at WashU and a 3.8 average at most other schools? a 93 average verse a 95 average.

 

[ChubbyChaser]

And what the heck, ChubbyChaser your avatar went from slightly disturbing to slightly distracting. Why the change of heart?

I dont discriminate. I plan on having a 3 some with this avatar and my previous avatar.😀

 

[PremedIowa]

Isn't UTSW considered one of the better schools in the country, especially for clinical medicine?

 

[funkydrmonkey]

Lol because UTSW is full of idiots🙄 Whats the difference between a 3.9 average at WashU and a 3.8 average at most other schools? a 93 average verse a 95 average.

Hey the UTSWers are not idiots😡

 

[Gut Shot]

Any and all advice on which school to choose is welcomed.

I'll break it down for you.

Pre-med consensus: don't worry about the money, go where you'll be happiest.

Post-med consensus: you'd be out of your f**king mind to pick A.

 

[ChubbyChaser]

Hey the UTSWers are not idiots😡

I have anecdotal evidence to support this. COugh Cough...you cough


JK monkey.

 

[fahimaz7]

read my explanation. My purposed scenario for certain low tier medical school can only match people into non-PC specalty if they are AOA is similar to what's happening with second tier law school now, where only the top 10% can possibly land a good law gig.

From Charting Outcomes in the Match: Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2007 NRMP Main Residency Match

"U.S. seniors who graduated from top 40 NIH research intensive medical schools and who preferred the competitive specialties had median predicted probabilities of match success of .98 compared to .97 for graduates of other medical schools. Being a graduate of a top 40 NIH research medical school was not a significant predictor of match success for U.S. seniors who preferred highly competitive specialties."

Lol.. Look up the match list for the schools that rank 50-70 and show tell me one that doesn't match into a "competitive" residency.

 

[EveeSTi]

I didn't mean to say that UTSWerners are idiots or anything like that, I know it is a very solid school, I'm just saying that there is clearly a difference between it and say, Harvard or Mayo. Didn't mean for that to come off as me knocking my own school, I used to dream about going here in high school. My bad!

Bottom line, my vote goes to the best school you can get in at.

 

[VincentAdultman]

I'll break it down for you.

Pre-med consensus: don't worry about the money, go where you'll be happiest.

Post-med consensus: you'd be out of your f**king mind to pick A.

It seems to me that the pre-med consensus is that name recognition and top 20 rankings rule all and are the sole determinant of how good a MD you can be.

 

[EveeSTi]

It seems to me that the pre-med consensus is that name recognition and top 20 rankings rule all and are the sole determinant of how good a MD you can be.

Not at all, but are you really going to argue that ALL OTHER THINGS BEING EQUAL (gpa, step, research, etc), school A's big name wouldn't give you an advantage over school B?

I find that hard to believe...

 

[VincentAdultman]

Not at all, but are you really going to argue that ALL OTHER THINGS BEING EQUAL (gpa, step, research, etc), school A's big name wouldn't give you an advantage over school B?

I find that hard to believe...

Except all things are never equal, so it's irrelevant.

 

[halekulani]

debt should be your #1 factor over everything else IMO.
considering there is a 6 figure difference between option A and B, i'd have to say school B.

 

[EveeSTi]

Except that you never know how you will do at one school vs. the other, so you should assume they will be equal while assessing which school to attend, so it's completely relevant.

 

[Handy388]

Lol.. Look up the match list for the schools that rank 50-70 and show tell me one that doesn't match into a "competitive" residency.

how did you do on MCAT verbal? because you obviously ignored my statement can only be valid UNDER THE ASSUMPTION that LCME seats = residency seats.

 

[Gut Shot]

Except that you never know how you will do at one school vs. the other, so you should assume they will be equal while assessing which school to attend, so it's completely relevant.

You do realize that you are lecturing two residents, don't you? If you honestly think that top-20 versus top-40 is going to be the deciding factor between success and failure, then go with God. No one can help you.

Since I'm too lazy to rephrase it, here is something I wrote awhile back on a similar topic:

"Prestige" is worth something, but for the vast majority of medical students, paying a great deal for it is akin to swatting a fly with a Buick.

If you were shopping for a house, and house A cost $150,000 and a similar-appearing house B cost $300,000, you'd surely want to know what you'd be getting for extra expense. You would want something tangible (nicer interior, better appliances, bigger yard, etc.) and/or something of widely agreed upon intrinsic value (safer neighborhood, closer to the beach, better school district, etc.) to explain the significant gap in cost.

When shopping for a medical school, however, this logic sometimes seems to dissolve. Some individuals will spend vast amounts of presumed future earnings for something that is intangible, has no agreed upon value, and isn't even certain to have any meaning or impact down the road. Personally, I'd have a very difficult time forking over a ton of extra cash for the possibility that maybe, perhaps my school's prestige might help me with my career. There are far better strategies in existence.

 

[onthevirge]

Wow, thanks for all your comments thus far! My fin aid package is still pending, but we'll see. Somehow, i feel that the final price differential will be similarly large.

My impressions of both schools are almost equal. School A appears to have stronger research opportunities that interest me, while School B is very supportive of its students, and I'm really excited about their clinical training program.

For you residents that have been through this conundrum: how did your choice of school affect your residency decision (not necessarily your match)? I mean, did you feel compelled/ more interested to apply to programs in the region surrounding your school? Also, was your match result skewed at all to more regional acceptances or equally distributed throughout the country?

I would imagine that having worked and done rotations in the region surrounding your med school may help you better apply and interview for regional internships. Is this a myth or does the similarity of the region help in your decision for residency applications?

 

[Gut Shot]

I mean, did you feel compelled/ more interested to apply to programs in the region surrounding your school?

No, not at all. I applied from coast to coast, and interviewed from Georgia to Oregon. People fall broadly into one of two camps: those that prefer familiarity, and those that want an adventure. It's up to you.

 

[PremedIowa]

I suspect the regional bias of an individual school's match is far more student- than institution-dependent, and if you are interested in another area of the country you could take an elective clerkship there and make some contacts.

 

[drizzt3117]

I suspect the regional bias of an individual school's match is far more student- than institution-dependent, and if you are interested in another area of the country you could take an elective clerkship there and make some contacts.

My anecdotal experience with this (I have a lot of family members in medicine) is that sometimes this works, and sometimes it doesn't. My relative did an away rotation at a place, impressed the PD enough that the PD collaborated on a paper with him that was accepted for publication before match day, had awesome stats, research, ECs, recs, graduated from a top ten program that happened to be on the other side of the country, and still didn't match there. They ended up in a lower choice (for them, on ERAS) but probably better program in the end anyways, that happened to be located very close to their home institution, even though they did undergrad at the school they tried to match at and clearly had strong ties to the area. The program in question took two of their own students <shrug> Then again, another relative did manage to match into their first choice program in CA from a midwestern school two weeks ago, so sometimes it worsk I guess.

 

[PremedIowa]

My anecdotal experience with this (I have a lot of family members in medicine) is that sometimes this works, and sometimes it doesn't. My relative did an away rotation at a place, impressed the PD enough that the PD collaborated on a paper with him that was accepted for publication before match day, had awesome stats, research, ECs, recs, graduated from a top ten program that happened to be on the other side of the country, and still didn't match there. They ended up in a lower choice (for them, on ERAS) but probably better program in the end anyways, that happened to be located very close to their home institution, even though they did undergrad at the school they tried to match at and clearly had strong ties to the area. The program in question took two of their own students <shrug> Then again, another relative did manage to match into their first choice program in CA from a midwestern school two weeks ago, so sometimes it worsk I guess.

It is very difficult to find anything more than anecdotal evidence on the match. Although they do publish a fair amount of info on factors that affect the match, I think they should be required to do significantly more disclosure considering the NRMP has been given an anti-trust exemption.

 

[drizzt3117]

It is very difficult to find anything more than anecdotal evidence on the match. Although they do publish a fair amount of info on factors that affect the match, I think they should be required to do significantly more disclosure considering the NRMP has been given an anti-trust exemption.

Yeah, we talked about this in that other USC vs SUNY-Buffalo thread but personally I think a well-designed study on the match would be a great research project for someone 🙂

 

[fahimaz7]

how did you do on MCAT verbal? because you obviously ignored my statement can only be valid UNDER THE ASSUMPTION that LCME seats = residency seats.

Lol.. I was in the 90th %tile on the Verbal section.. I guess with those scores, and my in-state medical school education, I'll be forced to go into a residency abroad since there won't be enough spots for me here, in the US, when I finish.

With increasing enrollment (by 2020) comes increased residency slots.

Oh well, arguing on this thread reminds me that no matter what we say on here it won't change anyone's opinion. Pre-meds really love to hear people talk... they just hate to listen to it.

 

[Handy388]

Lol.. I was in the 90th %tile on the Verbal section.. I guess with those scores, and my in-state medical school education, I'll be forced to go into a residency abroad since there won't be enough spots for me here, in the US, when I finish.

With increasing enrollment (by 2020) comes increased residency slots.

Oh well, arguing on this thread reminds me that no matter what we say on here it won't change anyone's opinion. Pre-meds really love to hear people talk... they just hate to listen to it.

haven't take the step 1 yet, i suppose.

with this economy i doubt about huge increase in residency slots

 

[drizzt3117]

haven't take the step 1 yet, i suppose.

with this economy i doubt about huge increase in residency slots

Residency spots are funded by medicare... so it's definitely possible that the slots will increase with a new health care plan.

 

[fahimaz7]

haven't take the step 1 yet, i suppose.

Nope. Luckily I haven't taken that test yet.. But, with a decent score and history on my side I might get lucky and have one of those precious spots that you are talking about.

I guess our state school did "ok" this year.


18 Anesthesiology
17 Emergency Medicine
14 Surgery/preliminary Surgery
9 Orthopedic Surgery
6 Radiology
4 ENT
4 Ophthalmology
4 Neurosurgery
2 Plastic surgery
2 Derm

PS. Did you have any luck figuring out what school you were headed to?
http://forums.studentdoctor.net/showthread.php?t=589733

 

[Handy388]

Nope. Luckily I haven't taken that test yet.. But, with a decent score and history on my side I might get lucky and have one of those precious spots that you are talking about.

I guess our state school did "ok" this year.


18 Anesthesiology
17 Emergency Medicine
14 Surgery/preliminary Surgery
9 Orthopedic Surgery
6 Radiology
4 ENT
4 Ophthalmology
4 Neurosurgery
2 Plastic surgery
2 Derm

PS. Did you have any luck figuring out what school you were headed to?
http://forums.studentdoctor.net/showthread.php?t=589733

I did, actually, thanks for asking.

I ended up becoming accepted into a top 20 school that happened to be CHEAPER than the lower tier first acceptance. The first acceptance was a smaller private college in a COLD COLD COLD location. I would go there in a heartbeat if I didn't have other choices.

But a 80 or so increase in rank/NIH funding and 5k lower tuition per year made the choice pretty obvious.

As of the match, don't get me wrong, as of NOW, it doesn't matter where you go. hell, Rosalind Franklin had 19 radiology matches. But I am really worried about the state of flux in health care spending.

 

[Gut Shot]

I suspect the regional bias of an individual school's match is far more student- than institution-dependent, and if you are interested in another area of the country you could take an elective clerkship there and make some contacts.

If your goal is a certain area, rather than a particular program, you will have a much greater chance of success. Trying to match so specifically is often dicey. You're pitted against quite a few people for a limited number of positions, with internal politics often playing a large role in their rank list.

A huge factor is how competitive your field is. With low competition and plentiful openings, you can match pretty much anywhere. If you're just dying to be in Seattle and do IM, applying to the University of Washington is a no-brainer, but you can hedge your bets by also applying to the smaller Virginia Mason Medical Center program.

Something like derm or neurosurg is an entirely different story, and you will just have to come to terms with having less control over your final destination.