Factors When Considering Where to Attend

[thatonegrrl]

---

Members don't see this ad.

For those fortunate enough to have multiple admissions offers - how are you deciding where to attend? And how much weight are you giving your criteria? For any med students or residents reading this - what criteria did you consider? Was there anything you did not consider that you wish you had? What are you pursuing for specialty/residency? And did you feel your school adequately is preparing/prepared you for that specialty?


I am a non-traditional student 4 As so far, 2 declined, 2 I'm seriously considering, and an additional 2 IIs with pending decisions. (I suppose it is possible that I might yet get an invite to interview with one of the other schools where I applied, I haven't been rejected anywhere yet, but at this point I would assume that most of those would be for waitlist positions).

My factors (so far): tuition/financial aid/scholarships, cost of living, curriculum format (lecture/PBL/in-person/recorded, etc.), pass/fail, reputation, student health plan, proximity to support system (friends and/or family), proximity to residency program of interest (for auditions later on), diversity of clinical settings, diversity of student body, diversity of patient population, environment/culture (of school and surrounding community), weather (I didn't apply anywhere I flat out would refuse to live, but definitely prefer some climates over others), previous match record (percentage, for what specialties and where)

 

[Shunsui]

Insight into Pre-Medical Decisions from a Resident (factors in choosing a school, life outlook, etc)

Hey SDN Pre-Med Community, I'm now a resident physician and would like to type up a bit about some things I wished I'd known when applying. Forgive me if some of this stuff is now obvious. I know the stakes get higher every year and as a result, pre-meds are becoming more and more knowledgeable...

forums.studentdoctor.net

One of my favorite threads from @Redpancreas (resident) on this topic. It's from 2018 but it still hits every point.

 

[voxveritatisetlucis]

If you want to match a competitive speciality, it’s all about ranking. At a T20 school, you pretty much control your own destiny.

Non competitive specialty: all about finances

 

[Med Ed]

If you want to match a competitive speciality, it’s all about ranking.

Why don't you read the 2020 Program Director Survey and then come back and we'll talk about it.

 

[Browns99]

If you want to match a competitive speciality, it’s all about ranking. At a T20 school, you pretty much control your own destiny.

Non competitive specialty: all about finances

I disagree. While school rank can certainly help, it is not all "about ranking." Sure, will a t20 give you an edge, yes, if you are a good student, however, for anyone out there at a lower ranked school, if you put together a great app ( boards scores, clinical, grades, AOA, strong letters, etc.), you will make yourself as competitive as anyone else.

 

[efle]

Why don't you read the 2020 Program Director Survey and then come back and we'll talk about it.

Haha, you mean the survey where only 50% of programs in ortho said they care about research? I hope you're not out here giving similar advice in that regard

For those curious this is what the All-Specialty survey looks like:

Comparing the scoring for pedigree vs research shows you how different the game is played for the most competitive fields/programs compared to the norm

 

[Browns99]

Haha, you mean the survey where only 50% of programs in ortho said they care about research? I hope you're not out here giving similar advice in that regard

I think he was referring to what the poster said regarding a T20 basically guaranteeing you any speciality you want. The survey seems to suggest it is on the lower side of what they use when ranking.

Graduate of highly‐regarded medical (MD/DO) school

Percent citing factor- 46%
Average Rating-3.6

 

[efle]

I think he was referring to what the poster said regarding a T20 basically guaranteeing you any speciality you want. The survey seems to suggest it is on the lower side of what they use when ranking.

Graduate of highly‐regarded medical (MD/DO) school

Percent citing factor- 46%
Average Rating-3.6

Like I said, do you also believe you can ignore research and still be fine in ortho? Survey would seem reassuring...reality not so much, I would never tell a preclinical student interested in ortho that.

 

[Browns99]

Like I said, do you also believe you can ignore research and still be fine in ortho? Survey would seem reassuring...reality not so much, I would never tell a preclinical student interested in ortho that.

What are you talking about, who said anything about research in ortho...stick to the post.

 

[efle]

What are you talking about, who said anything about research in ortho...stick to the post.

I'm making the point that while prestige scores low, so too does research, even in fields notorious for demanding student research (average 15+ ERAS research entries for surgical subs these days).

You can see how the research value being wildly misleading casts doubt upon other responses too, no? For someone who thinks they want that kind of match, youd be giving terrible advice if you told them to just go to their local cheap state school and only do research if they wanted to.

 

[Moko]

Haha, you mean the survey where only 50% of programs in ortho said they care about research? I hope you're not out here giving similar advice in that regard

For those curious this is what the All-Specialty survey looks like:

View attachment 348700
Comparing the scoring for pedigree vs research shows you how different the game is played for the most competitive fields/programs compared to the norm

One other problem with interpreting these surveys is that they only tell you about the averages, which may not necessarily be generalizable to a specific specialty, program, or type of programs (e.g. top X vs non-top X, university/academic vs community, etc.). Certain programs may care tremendously about a certain factor, but this signal may be lost by looking only at the average score from all programs.

As an example, "interest in an academic career" is cited as a factor by only 20% of programs, with a mean importance score of 3.8. It would seem that these programs value "interest in an academic career" as much as most programs value Step 1/2 scores (>78% - 4.0), clerkship grades (69% - 4.0), prestige (46% - 3.6), and research (36% - 3.7). A student interested in matching to the most competitive academic programs may be misled into thinking that "interest in an academic career" does not matter if looking only at the averages (20% - 3.8).

This is one reason why results from research studies are often stratified, and even then, need to be interpreted with great care. Just my thoughts.

 

[CyrilFiggis]

OP, location and match were top for me. And by match, I mean they had applicants match broadly across specialties and geography.

 

[Med Ed]

Haha, you mean the survey where only 50% of programs in ortho said they care about research? I hope you're not out here giving similar advice in that regard

I'm confused, efle. Are you saying the program directors who responded are lying? Or that the sampling is not representative?

 

[efle]

I'm confused, efle. Are you saying the program directors who responded are lying? Or that the sampling is not representative?

I'm saying the expectations vary widely between specialties, and programs within a specialty, and this survey can mislead people if they dont realize this. At a glance, if I was interested in ortho, this would suggest it's not very important that I do research. From what I've seen in recent match cycles and the climbing ERAS numbers, the truth is that research is VERY important for getting considered at the popular academic residencies, but that's diluted in this data by many places that dont have those priorities. I think its similarly wrong to dismiss prestige brownie points, the match lists of the big names are overwhelmingly skewed towards home matches and other big names. What I'd tell someone deciding between a cheaper local state school or distant, expensive "top 20" is that it completely depends on where and what they think theyll want to train in. And if someone has no idea yet, they ought to know that for the more competitive options in whatever field they choose, it's a lot more advantageous to be at the top research centers than the national PD survey reveals.

 

[Med Ed]

At a glance, if I was interested in ortho, this would suggest it's not very important that I do research.

No one who is interested in ortho bases anything off a glance at the PD survey,

Give me a break.

 

[efle]

No one who is interested in ortho bases anything off a glance at the PD survey,

Give me a break.

And yet your first contribution to this thread was to tell someone to look at the PD survey

I'm interested why you think ortho applicant would be LESS keen on this kind of data. In my experience these surgical subspecialty gunners are MORE obsessed with what they need to score or publish or whatever else to stay competitive with the rest of the pack

 

[Med Ed]

And yet your first contribution to this thread was to tell someone to look at the PD survey

Indeed, followed by this: "and then come back and we'll talk about it."

Note that I was not extolling the virtues of the survey. I simply asked @voxveritatisetlucis to look at the information and return for a discussion.

I'm interested why you think ortho applicant would be LESS keen on this kind of data. In my experience these surgical subspecialty gunners are MORE obsessed with what they need to score or publish or whatever else to stay competitive with the rest of the pack

This underscores my confusion. Again, do you think the PDs were being dishonest, do you think the sampling was not representative, or do you think the question itself did not capture objective reality?

 

[efle]

Indeed, followed by this: "and then come back and we'll talk about it."

Note that I was not extolling the virtues of the survey. I simply asked @voxveritatisetlucis to look at the information and return for a discussion.


This underscores my confusion. Again, do you think the PDs were being dishonest, do you think the sampling was not representative, or do you think the question itself did not capture objective reality?

I think "what do PDs think about X" and "what do PDs at competitive programs think about X" have different answers for things like research and alma mater, which you would never know from browsing the survey. I completely misunderstood your initial post - I read it as dismissive of the idea that school ranking should be front and center in the decision.

So let me ask this - if OP specifically told you he dreams of being an academic surgeon in San Francisco, what would you say the PD survey ought to inform him of when he looks at it?

 

[Med Ed]

So let me ask this - if OP specifically told you he dreams of being an academic surgeon in San Francisco, what would you say the PD survey ought to inform him of when he looks at it?

The people who dream of being academics at top flight institutions don't ask these questions. They will go to the most prestigious school possible, regardless of cost or location.

What's important for the rest of us mere mortals to remember is that school reputation is one of many factors that can influence a residency application.

 

[thatonegrrl]

I think "what do PDs think about X" and "what do PDs at competitive programs think about X" have different answers for things like research and alma mater, which you would never know from browsing the survey. I completely misunderstood your initial post - I read it as dismissive of the idea that school ranking should be front and center in the decision.

So let me ask this - if OP specifically told you he dreams of being an academic surgeon in San Francisco, what would you say the PD survey ought to inform him of when he looks at it?

Well OP is a she to start with.

I'm actually most interested in primary care, peds, FM and psych. So for me, so far, this has been the most useful advice:

If you want to match a competitive speciality, it’s all about ranking. At a T20 school, you pretty much control your own destiny.

Non competitive specialty: all about finances

But I was/am also curious how others are making their decisions on where to attend, and what advice residents (because of their closer proximity to the match) and program directors (because of their direct involvement in the residency selection process) would give based on their experience.

I realize that would be anecdotal, but also probably more useful than aggregate stats that don't differentiate between specialties at all, much less type of program (community v academic).

Especially with Step 1 pass-fail, would even a well-regarded state school produce a competitive applicant for their goal program (say academic pediatrics at well-regarded program like UW, Harvard/BCH, CU, etc.)? Or should big name always be prioritized, over other factors, even for lower-paying specialties? And does age at start make a difference at all? (Given less time to payoff loan debt on the other side)...

 

[Med Ed]

Well OP is a she to start with.

I'm actually most interested in primary care, peds, FM and psych. So for me, so far, this has been the most useful advice:

Nothing against vox, but he recently started a thread asking if certain IM fellowships are "off limits" to low tier MD students. I appreciate his willingness to be helpful, just take it with a cup of salt.

Especially with Step 1 pass-fail, would even a well-regarded state school produce a competitive applicant for their goal program (say academic pediatrics at well-regarded program like UW, Harvard/BCH, CU, etc.)? Or should big name always be prioritized, over other factors, even for lower-paying specialties? And does age at start make a difference at all? (Given less time to payoff loan debt on the other side)...

Not sure if you are aware, but Cincinnati Childrens has one of the best peds programs in the country. Even US News ranks it #3. Here is where their PGY-1 residents came from:

Alabama x2
Baylor x3
Brown
Dartmouth
Dell
Drexel
Emory x3
EVMS
GWU x2
Loma Linda
MCW
Mercer x2
Miami
Michigan State University - Flint x2
NEOMED x2
North Dakota
Oakland
Ohio State
Penn State
Temple
U of Cincinnati x4
U of Illinois
UTRGV
UTSA x2
UVA
Vanderbilt x2
FMG x2

As I'm sure you can appreciate, there is a broad spectrum of schools represented here. No once can say that school reputation won't ever help you, but not attending a T20 isn't some sort of professional death sentence. Cream, as they say, has a tendency to rise.

 

[efle]

^ This can be a little misleading though since the top 20 are less than 15% of the applicant pool (effectively even less than that because so many choose to home match). I prefer looking at the inverse: where people go on the match list from the more expensive/distant schools one is considering.

For example in 2017, Hopkins had the following IM match despite class average board scores of ~235

Hopkins (Bayview program)
Hopkins
Hopkins
Hopkins
Hopkins
MGH
MGH
NYP/Columbia
NYU
NYU
Penn
Penn
UCLA
UCSF
U Chicago
U Illinois

That is an INSANE internal medicine list for having such typical board scores, and I'd submit that it's a lot easier to be average at JH than to be AOA at U of State, though of course one could go for either route. This does only matter if you think you might aim high in the match. If you're from Nebraska and dream of practicing family medicine in your home town, take the money and run every time.

 

[thatonegrrl]

That is an INSANE internal medicine list for having such typical board scores, and I'd submit that it's a lot easier to be average at JH than to be AOA at U of State, though of course one could go for either route. This does only matter if you think you might aim high in the match. If you're from Nebraska and dream of practicing family medicine in your home town, take the money and run every time.

This is honestly my biggest internal debate, personally. I have a choice between 2 schools at present (awaiting decision from a third, waitlist for a fourth), both are state schools but one is T50 and one is T100 (eg - the T50 school is on that match list, the T100 isn't)... and I feel like I'm deciding which kind of doctor I want to be. The rural family medicine doctor (or maybe gen peds), or an urban academic (med-peds or peds/psych probably) ... both appeal to me for different reasons, and I'd go for primary care and working with underserved populations either way. Maybe hearing from the other school will help make the decision for me.

 

[KnightDoc]

This is honestly my biggest internal debate, personally. I have a choice between 2 schools at present (awaiting decision from a third, waitlist for a fourth), both are state schools but one is T50 and one is T100 (eg - the T50 school is on that match list, the T100 isn't)... and I feel like I'm deciding which kind of doctor I want to be. The rural family medicine doctor (or maybe gen peds), or an urban academic (med-peds or peds/psych probably) ... both appeal to me for different reasons, and I'd go for primary care and working with underserved populations either way. Maybe hearing from the other school will help make the decision for me.

But you're not. There is no reason you cannot go to a top school and then be a rural family doctor, if that's what you want.

Higher tier schools just leave more doors open. All things equal, no reason not to choose T50 over T100.

Of course, money, location, etc., etc. mean all things are rarely equal. In that case, you need to do you, and not be concerned about whether or not the brain trust on SDN would make the same choice. Good luck!! 🙂

 

[Med Ed]

^ This can be a little misleading though since the top 20 are less than 15% of the applicant pool (effectively even less than that because so many choose to home match). I prefer looking at the inverse: where people go on the match list from the more expensive/distant schools one is considering.

Looking at the inverse is misleading in its own way.

Rare is the candidate who is sweating a decision between Hopkins and Cornhole Medical College. More common is the applicant who is debating spending a ton of money to attend a top 30 over a top 50. But since you opened this can of worms, let's see where the interns at JHU IM came from:

Alabama
Arizona
BU
Cornell
Duke
Emory
Georgetown
Harvard
Hofstra/Northwell
Howard x2
Iowa
JHU x10
LSU
Maryland
Meharry
Miami
Michigan
Michigan State
OHSU
Penn
Penn State
Pitt
Rutgers
Sinai
Texas A&M
Texas Tech El Paso
UNC
UT San Antonio
UT Southwestern
UTHSC (McGovern)
UVA
Vanderbilt
Wash U
Wisconsin x2
FMG x3

Let us keep a couple of things in mind here. One, name carries weight, but it is invariably confounded by the fact that the most ambitious and academically gifted students tend to aggregate at more prestigious medical schools. Thus it can be impossible to really tease out the effect of the name versus the accomplishments and desires of the individual. Two, the landscape for medical school admissions is very different than the one for residency. There are ~150 medical schools and a 40% overall acceptance rate. There are ~5,000 residency programs and a >90% US MD match rate (albeit with a lot of self-selection). There are also thousands more residency positions than US MD applicants.

 

[Med Ed]

This is honestly my biggest internal debate, personally. I have a choice between 2 schools at present (awaiting decision from a third, waitlist for a fourth), both are state schools but one is T50 and one is T100 (eg - the T50 school is on that match list, the T100 isn't)... and I feel like I'm deciding which kind of doctor I want to be. The rural family medicine doctor (or maybe gen peds), or an urban academic (med-peds or peds/psych probably) ... both appeal to me for different reasons, and I'd go for primary care and working with underserved populations either way. Maybe hearing from the other school will help make the decision for me.

You are world-class overthinking this right now. About four out of five medical students change their specialty interest during medical school, sometimes quite unexpectedly. Just ask @Matthew9Thirtyfive Your focus should be on getting the best foundation and having the most opportunities.

As I've been at this for awhile now. My short list of things to consider is pretty simple:

1. Cost - your debt will impact a lot of you decisions for many years. Best to have as little as possible.
2. Clinical education - does the school have a big hospital, or are you roaming around the countryside to different affiliates?
3. GME - more programs is better. Way better.
4. Location - proximity to support system is important for some people (but not all).

 

[efle]

To the contrary I think a very large number of "top tier" admits also have less competitive schools on their list they're weighing against, either solid state schools close to home or schools that offer them lots of recruitment money. It was a very common question/topic for second look visiting students.

I'll add I often see SDN advise against making it a priority over money/location, but I dont really ever see people who did education or training at the research giants say they found the resources/advantages underwhelming or regret the decision. Agree theres probably a big selection bias there though - I think most of my classmates would tolerate a lot of distance/cost to max their chances of ideal match outcomes, which may not be everyone's priority. Similar to how not all premeds have any interest in attending HMS...but their matriculation data shows it's a large majority of those willing to consider/apply that do, given the chance, move to boston from all over the nation and take their need-only aid.

Just have to ask yourself what your goals are

 

[deleted1114112]

I ran some numbers earlier in the cycle and out of ~640 open slots for orthopedic residency the T13 schools (schools in the T20 that I could find full match lists for, essentially was the top 13) filled about 76 slots.

So about 10-13% of ortho is filled by T10 schools, 19-22% by T20 schools. That leaves about 72-78% of slots that are filled by (surprise) non T20 students.

Not going to say it's easy to match from a lower ranked school, but...come on now. Even if you want to argue P/F STEP 1, this has already been disputed and at least personally many interviewers have told me STEP 2 and research will just take over. Not going to a T30 is not a death sentence. I have no idea how the distribution works for lower tier schools without a match list, but it's not like your chances are nill if you go to one. Mid-tiers probably don't hurt at all.

As someone else said, smart people and hard working people usually rise to the top naturally. It's just that more people like that go to top schools. If you go to a full-ride state school ranked 41 instead of Penn, your ability to perform well will not just spontaneously disappear. Maybe you have to put in a bit more work but none of that is quantifiable and the data speaks for itself, over 70% of all these competitive specialties are literally filled by non T20 students.

 

[thatonegrrl]

You are world-class overthinking this right now. About four out of five medical students change their specialty interest during medical school, sometimes quite unexpectedly. Just ask @Matthew9Thirtyfive Your focus should be on getting the best foundation and having the most opportunities.

As I've been at this for awhile now. My short list of things to consider is pretty simple:

1. Cost - your debt will impact a lot of you decisions for many years. Best to have as little as possible.
2. Clinical education - does the school have a big hospital, or are you roaming around the countryside to different affiliates?
3. GME - more programs is better. Way better.
4. Location - proximity to support system is important for some people (but not all).

That's still 20% who don't change their mind. And while I haven't landed on specific specialty yet, I am a nontrad career changer with 10 years of professional experience, so I think my goals are unlikely to change significantly. I know myself, my values and my strengths well enough at this point in my life. FM, Peds, Med-Peds, Psych, FM/Psych and Peds/Psych have been and remain my leading interests all along. I know I can go do community FM or Peds from just about anywhere, but I also know from my past work experience that I'm driven and want to be a leader/innovator/change-maker in whatever I do - hence the appeal of academics and the chance to influence through educating the next generation and through research and advocacy in addition to meaningful clinical work.

Which is why, if I get into my top school with a good scholarship it would be no question to me on where to attend.

But waffling between two fairly close schools is harder. Tuition is basically equivalent, cost of living is slightly lower at one school, the weather is slightly more to my liking at one. The biggest difference is in ranking. (See my "help me decide" thread).

But I don't want to bogart this thread either, I was mostly asking out of curiosity for how others are deciding, what factors are important to them (especially fellow non-trads), and what factors PDs are looking for in their residency candidates.

 

[efle]

I ran some numbers earlier in the cycle and out of ~640 open slots for orthopedic residency the T13 schools (schools in the T20 that I could find full match lists for, essentially was the top 13) filled about 76 slots.

So about 10-13% of ortho is filled by T10 schools, 19-22% by T20 schools. That leaves about 72-78% of slots that are filled by (surprise) non T20 students.

Not going to say it's easy to match from a lower ranked school, but...come on now. Even if you want to argue P/F STEP 1, this has already been disputed and at least personally many interviewers have told me STEP 2 and research will just take over. Not going to a T30 is not a death sentence. I have no idea how the distribution works for lower tier schools without a match list, but it's not like your chances are nill if you go to one. Mid-tiers probably don't hurt at all.

As someone else said, smart people and hard working people usually rise to the top naturally. It's just that more people like that go to top schools. If you go to a full-ride state school ranked 41 instead of Penn, your ability to perform well will not just spontaneously disappear. Maybe you have to put in a bit more work but none of that is quantifiable and the data speaks for itself, over 70% of all these competitive specialties are literally filled by non T20 students.

Agree you can definitely match any field from any school. The Charting Outcomes has data on percent of spots filled by NIH Top 40 and it's surprisingly not very skewed at all (as in, the overall percent of applicants from T40 and percent of derm/surgical matches from T40 are very close numbers). The only caveat is where people are matching, with the folks applying from the giant academic centers much more likely to train at another giant academic center

 

[deleted1114112]

Agree you can definitely match any field from any school. The Charting Outcomes has data on percent of spots filled by NIH Top 40 and it's surprisingly not very skewed at all (as in, the overall percent of applicants from T40 and percent of derm/surgical matches from T40 are very close numbers). The only caveat is where people are matching, with the folks applying from the giant academic centers much more likely to train at another giant academic center

I mean, true, but data does not support any financial advantage to attending such institutions. In fact data actually supports the notion that you're paid less working at these large academic centers as an attending. There also isn't any disparity in fellowships attained when looking at the T50 schools by ortho (don't know about the other residencies or schools), but obviously fellowship location is indeed following similar trends. In any case all of these people still get their jobs and seem to be able to get a fellowship of choice, or even private practice. I have a massive excel that I probably spent way too much time collecting data (manually) and other stuff, but at the end of the day if you just crunch the numbers and look at reality a lot of things people say is simply just not backed by data in any way or form.

Unless you want research to be a large part of your career then I have no idea why you would be a proponent of the idea that you have to be t20 or bust for any specialty. I won't argue that it doesn't matter in that realm because it most definitely does.

 

[Med Ed]

But waffling between two fairly close schools is harder. Tuition is basically equivalent, cost of living is slightly lower at one school, the weather is slightly more to my liking at one. The biggest difference is in ranking. (See my "help me decide" thread).

Pffftttt.... UT Long all day every day, sister.

 

[efle]

I mean, true, but data does not support any financial advantage to attending such institutions. In fact data actually supports the notion that you're paid less working at these large academic centers as an attending. There also isn't any disparity in fellowships attained when looking at the T50 schools by ortho (don't know about the other residencies or schools), but obviously fellowship location is indeed following similar trends. In any case all of these people still get their jobs and seem to be able to get a fellowship of choice, or even private practice. I have a massive excel that I probably spent way too much time collecting data (manually) and other stuff, but at the end of the day if you just crunch the numbers and look at reality a lot of things people say is simply just not backed by data in any way or form.

Unless you want research to be a large part of your career then I have no idea why you would be a proponent of the idea that you have to be t20 or bust for any specialty. I won't argue that it doesn't matter in that realm because it most definitely does.

True that Procedure X will bill the same regardless of where you trained, but that does not mean all jobs are equally accessible from everywhere. Sometimes there are very desirable private practice groups filled with alums from particular top programs (e.g. Mallinkrodt radiology groups) that like to recruit their own and will never be a posting on the job boards. More generally speaking, the strongest applicants get more control over exactly where they train, especially valuable for folks from places like SF or Manhattan or who want to work there after. And theres also the actual training itself, which gets pretty different for a resident at Hopkins vs Baltimore Community Hospital #3. And theres no way those two programs would have similar fellowship matches each year for things like cardiology/GI/hemeonc, Ortho must be pretty unique in that regard of all their fellowships are equally accessible to everyone everywhere.

All this to say there are in fact reasons other than research to aim for a competitive match