I was offered an out of the match position last year at Hopkins and turned it down because for me, it was worth the risk to go after one of the better programs. I could be wrong about this but, this is my feeling on the topic. Hopkins is a good program but they have been having many issues over the last two years that I will not go into detail on here. I recognized this last year and saw how aggresive they were to get highly qualified applicants outside the match. Many of these applicants were in the match (I actually spoke to several of them who were offered positions at Hopkins) awaiting to go to "stronger" programs but when you are offered a spot at Hopkins, (outside the match) it is hard to turn down because the match is not a certain thing. I think they do this because I believe they are not as competative as some of other programs at this time. This enables them the opportunity to compete with some of the programs that are more difficult to get into and try and pull attractive applicants away from them. The applicants they are going after are people who are going to be boarded in other specialties. Hopkins is still a very good place.