Orthopedics: The earlier you can make a decision about specialties, the easier your life will be. This is more true with competitive specialties, so let's go with ortho for now. Among the choices you listed, WashU has the highest ranked orthopedic surgery residency by reputation as reported by Doximity. It is second only to HSS. There are multiple related advantages. First, one typically has a higher chance of matching to a home program compared to outside students. You have the best chance of getting a WashU ortho residency position if you are a top applicant from WashU compared to someone with similar numbers from another school. Second, your home mentors are more likely to be among the most well-known in the field and will have relatively more influence through their letters of recommendation and calls on your behalf to other programs if you want to get out of St Louis. Third, ortho has such a strong presence at WashU that all students take a four week orthopedics rotation on the third-year surgery core clerkship (some opt out by doing plastic surgery). You will have a well-organized orthopedic surgery experience as a third-year student and can definitively verify early on your intention to apply to orthopedics. Of course there is never a guarantee; you still have to be a good student and lucky to match in something competitive. The match list this year for ortho (out of 91 matched people in the class overall) was HSS, WashU, UCSF, Jefferson, UCLA and Cedars-Sinai (couple), Iowa, Oregon, Rochester, Ohio State.
Public health: The public health program at WashU is very young and the joint MD-MPH program is even younger (approved in the last two years). The MPH is administered through the School of Social Work rather than a standalone School of Public Health. Hopkins has a much more established reputation. You might care about this if your vision of a career primarily revolves around public health rather than academic or private practice in orthopedic surgery. My opinion is that WashU's strengths are on the quantitative side of the public health spectrum rather than the social work side. For that, you can find ortho faculty who do health services research and clinical outcomes research, who have masters degrees in clinical investigation (MSCI) from WashU or in public health from elsewhere. If you end up pursuing a non-ortho surgical specialty, it is common for residents at WashU to get a masters in population health science, which is essentially based in the department of surgery. If your interest in public health leans on the quantitative research aspects of the field rather than the fuzzy policy aspects, there are multiple strong dual-degree options at WashU to prolong your education with in this manner. If instead you think more like a public health commissioner, med-peds physician, primary care, volunteer with MSF, spend years in Uganda and Malawi type person, there is also that option through WashU and I can put you in touch with people like that, but the path is not clear cut and a very different direction from most who go into the competitive specialties.
Money: You said you would be maxing loans at Hopkins/Stanford and this is really the kicker. You have a chance to be in the 15% of medical students graduating without educational debt. Imagine you're a fourth year student with a mountain of debt, but your dream programs are HSS, UCSF, MGH. Do you let the high cost of living in these places and your poor financial situation influence your rank list? Imagine when you're a resident and making decisions about the size of your shoebox studio apartment in Manhattan, or whether you can eat out with your co-residents, or whether you can afford hospital parking in San Francisco, when you have loan payments taking up 15-40% of your take-home income. What about a Roth IRA, disability insurance, emergency funds, health savings account? What if you have a kid? Surgical residency is a long time to be living ascetically even in your rare off days and vacation time. First, I'd recommend calculating roughly how much debt you would have coming out of med school (is it 100k or 250k?) and chew on that figure a bit. Second, I'd recommend asking some residents about how their debt affects their life.
Find me giving a tour at second look weekend or PM if you want to talk to people at WashU who matched ortho (plenty of this), or are doing MD-MPH program, or have a full ride (plenty of this).
! Awesome choices, you can't really go wrong here.
