Medical How do I decide between a T20 and low-ranked state medical school?


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lord999

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Hey guys- I hope this is an ok place to post this. So I’ve been accepted at my state school with a really solid scholarship, so I’d be paying little enough to where my folks can help out and I’ll graduate debt-free. This school is ranked in the 60's and 70's for research and primary care
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I also got accepted to a T20 school fairly recently where it seems unlikely I’ll get much (if any) moola since it's so late in the cycle. I’ll likely graduate with a tonnn of debt- perhaps around $260,000 after potential parental help.

The insane difference in price the two is completely mind-boggling to me and with STEP 1 going P/F and a lot of people guessing that school prestige is going to matter more, I’m at a total loss as to what to do. I’d love to go to the T20 and it’s my top choice also in a city I enjoy, but I can’t even begin to think how I’ll pay all of that off. Some simple calculations with projected average residency salaries makes it seem I'll be paying off debt for at least 8 years after graduating (if I continue to live super frugally). It doesn't seem worth it at all although, again, I'd love to attend the T20.

Anyone have any advice?
Congratulations on having a good problem! I think this is more predicated on what sort of career post-school. If you are going into the relatively non-competitive residencies: IM, FM, etc., then you would of course pick the low debt school. For ultracompetitive residencies: Derm, Interventional Radiology, etc, then it becomes a larger consideration. Step II is still scored though.
 

lord999

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Hi! I’m way more interested in competitive specialties- I like ophthalmology, cardiology, and interventional radiologist (although I want to actually try those things before dedicating myself to them). I’ve head Step II has a more subjective grading scale and isn’t as important?
Do you think that level of debt is justifiable? I can’t imagine living so frugally until I’m 34 and paid off all debt and only then starting to relax and live

That's subjective, and most spend far longer in debt (the last staffing analysis for government the Interventional Cardiology and the Interventional Radiology specialties had the vast majority counting on PSLF for their loans). But, it is quite lucrative as well, so the debt risk is yours. There's quite a bit of AAMC debate on the issue, but the choice of medical school is not anywhere near as deterministic as your performance within it. If you can ace the exams and graduate highly, the competitive specialties are still quite open.
 

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A lot of IGNORANT pre-meds and preclinical med students are speculating ceaselessly that Program Directors are either too lazy or too stupid to not use other measures of candidate quality, like Step 2.

In the end, it doesn't matter where you go to school, because your attending salary will be the same if you got to ACOM or Yale, JAB or Harvard, U WA or U Miami.

The T20 route is only beneficial if you wish to go into academic medicine, which actually pays less.

Hence, go for the free ride. You can still get into the uber-specialties even if you go to No Name U
 
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Hi! I’m way more interested in competitive specialties- I like ophthalmology, cardiology, and interventional radiologist (although I want to actually try those things before dedicating myself to them). I’ve head Step II has a more subjective grading scale and isn’t as important?
Do you think that level of debt is justifiable? I can’t imagine living so frugally until I’m 34 and paid off all debt and only then starting to relax and live

The decision here is extremely personal. If the debt is worth it to you to reach your goals, then the amount of debt is justifiable. My personal take is that if you do well, all specialties are open to you, so for me, the debt is not worth it. However, your decision does not have to be based entirely on your debt burden. most physicians live well and aren't suffering financially once residency (and fellowship) ends.
 
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MusicDOc124

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Step 2 is still scored, and it's not a subjective exam. It's a standardized board exam just as Step 1 is. You will have pre-clinical grades, clinical grades, shelf exam scores, rankings potentially depending on location, hobbies, research, volunteering, etc to still be measured by.

FWIW I know a derm resident who initially had to SOAP into a prelim year. That person attended harvard, scored well (250+ step 1 and 2), had all the checks in the boxes, was personable, and still didn't match. After SOAPing, reapplied for match and matched on the 2nd go-around. Despite scores and the Harvard name, they didnt match. On the other hand, I know multiple DOs who matched ACGME without issue first go-around. Who are you and EVERYTHING combined matters. Not just step 1 or name.

Do names open doors, sure, but they sure as hell don't get you through them. So don't think because you end up going to a T20 school that it ensures you're going where you want in what you want.

Keep all that in mind before making a decision.
 
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MusicDOc124

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Thanks a tonnn this was super helpful advice. Sorry I’m pretty ignorant about some things- what is SOAPing and what’s the prelim year?

SOAPis when someone doesn’t match and they may contact programs that haven’t filled to try to get something that is left over. Sometimes this doesn’t work out either and graduates are left without a residency position unless they find something outside the match.

Prelim years and transition years are single-year positions. Usually they are taken by people applying for advanced positions that start PGY2 like anesthesiology, radiology, derm, PMR, etc. the rest tend to go to those who didn’t match and they have to reapply that very next year again.
 

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So to clarify- even if I go to such a significantly lower ranked school, I’m not putting myself at a huge disadvantage if I want to go into a competitive specialty? (Which, at this time, I do)

Nope.

Do a little searching on [school name] match list 2020 or 2019 and see what their grads are going into.
 
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