Thank you droliver for your wonderfully detailed response; I knew I could count on you.
I should have perhaps clarified some elements of my earlier post. To wit:
I should have been more clear that when I was naming places known for subspecialties; it is TRUE that gen surg residents will not likely be doing those cases, hence my comment about unopposed programs or places without fellowships. I just wanted to point out that most ranking systems focus on subspecialties rather than General Surgery. If it makes you feel better droliver, even the Plastics residents at Louisville only spend 3 months on Hand at Kleinert and Kutz. The place is a mad-house, fellows swarming around everywhere, but I enjoyed spending a few days there.
The rankings I gave were based on NIH funding - a dubious distinction as I mentioned. However, using that ranking system Mass Gen and B&W do not rank in the top 10. Doesn't mean they aren't well recognized, just don't get the funding that others do.
I mentioned Duke because it was always mentioned to me as the program to avoid because of its malignancy. However, I am aware that some of the others I've listed have the same reputation. As a matter of fact, I go to Pitt for Transplant and from what I've heard from my senior residents, its not a friendly few weeks. As for judging which ones are malignant, certainly the impression of the current residents helps but also in talking to students at those programs. I was sort of out of the loop coming from Australia, but was repeatedly told about Duke, Pitt and Hopkins. Emory was never raised so I can't comment on that.
As droliver notes, there are many factors to consider when choosing a program. I wanted an academic program, so the lab years weren't an issue for me, but the ability to do what and where I wanted was. I also wanted to be at a place that wasn't necessarily top drawer - I wanted a more collegial feel, more bread and butter surgery without extensive fellowship competition. There is no BEST program that fits everyone's needs. Louisville is a great program - the Chair there is highly regarded, they produce the Amer J of Surgery there, and do lots of good research. Plus Louisville is a great town. It just wasn't the right program for me.
Your department Chair can often give you some insight into programs he thinks are good, which will fit your needs, etc. When you are doing electives or meet visiting students at your school, ask them about what programs they've been to, what their school is like, etc. Read on-line reviews of programs (http://www.scutwork.com) and pick the brains of any resident who will give you his email!
And don't discount community programs - there are some great ones out there. I was particularly impressed with Wilmington DE. Think about what you want in a program - if its to be Chief of an Ivy Surgery Service, then go high powered academic program; if its to be a good community surgeon then there are many programs (both university and community) which will make you into one.
Hope this helps clarify things.
