How important is top tier IM program?

Started by nickster
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nickster

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Lets say someone 1st in his class, great scores, the whole package but doesn't care to go to a top tier program. He's happy going to a lower second tier program and staying in his comfort zone. How much will this effect his career? I'm sure he will still get a good education but not recognized as the best available. Would it be best to just gut up and go to Hopkins or some other NE program?
 
nickster said:
Lets say someone 1st in his class, great scores, the whole package but doesn't care to go to a top tier program. He's happy going to a lower second tier program and staying in his comfort zone. How much will this effect his career? I'm sure he will still get a good education but not recognized as the best available. Would it be best to just gut up and go to Hopkins or some other NE program?
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No.
 
OK, odd question. If he wants a fellowship or a job at Hopkins in the long run, I would recommend sticking with the big names for residency. East coast academic centers are a bit snobby like that. If he prefers something more humble in the long run, no reason to flog himself now. If he's really interested in the quality of the education, some "top" programs also provide this, but there are also plenty of more relaxed programs with a near similar level of training. The main difference would be exposure to some really amazing physician-scientists at places like Hopkins/BWH/UCSF/etc, but there are probably excellent, if less famous, mentors elsewhere.
 
greenthing said:
OK, odd question. If he wants a fellowship or a job at Hopkins in the long run, I would recommend sticking with the big names for residency. East coast academic centers are a bit snobby like that. If he prefers something more humble in the long run, no reason to flog himself now. If he's really interested in the quality of the education, some "top" programs also provide this, but there are also plenty of more relaxed programs with a near similar level of training. The main difference would be exposure to some really amazing physician-scientists at places like Hopkins/BWH/UCSF/etc, but there are probably excellent, if less famous, mentors elsewhere.
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For JHU fellowship it is not a must, but would not say so for the other "big names" on the east coast.
 
if you want to go to BWH/MGH for competitive fellowships you will have a much better chance.
 
Agree with greenthing.
If you do not want to do a fellowship, but just want to do primary care or be a hospitalist, then going to a high powered U. program does not matter. You will still get a lot of job offers. In fact, sometimes the community programs might be a better place to make connections to get a job locally (or at least might be as good in this regard as some famous-name place).

If you want to do, or think you might want to do, something like GI, allergy/immuno, or cardiology, or even hem/onc, then going to a better ranked program can help you get in to the place(s) you like for fellowship. Also, some of the community programs or smaller university programs IMHO do not have as many sick patients in their ICU's, which leads to less training doing things like central lines and ventilator management, or just with taking care of sicker patients in general. This can be important later during fellowship, and/or if you get a hospitalist job where you happen to need these skills. The OP may also want to consider that the OP may not "fit in" at some of those smaller community programs as much as the OP thinks, if he/she trained at a high powered type medical school. People may do things differently than he/she is used to, and in some cases in a suboptimal manner, depending on which residency he/she picks. This does not mean the OP will necessarily be unhappy in all community programs, but he/she might want to reserve judgment about where he/she "wants" to go until after going on some IM residency interviews.

If you are unsure what type of place you want to do residency, I think the safest thing is to apply to a variety of places and go on several interviews and then let things percolate and make a decision.

There is also a lot of ground between the Hopkins type places and "lower middle tier" type places. There are some very well respected IM programs, or ones with at least very good regional reputations and fellowship connections, that might not be so intense as Hopkins, Duke, UCSF, etc. but still would make getting a fellowship very likely if he/she ends up wanting to do that.
 
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gutonc said:
S/he could. But the list would be different from mine which would be different from the list of anybody else on the planet. Please don't get hung up in the Top X.
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My question was intended to ask which top 20 programs were top for him/her. Now that that is clear can anyone comment on this? Thank you.
 
Whats_up_doc said:
My question was intended to ask which top 20 programs were top for him/her. Now that that is clear can anyone comment on this? Thank you.
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Here's an intuitive, off the top of my head list, NOT in strict order, so don't get on my case about #3 vs #4, but generally moving in a descending order from top to bottom . . .

Most would probably agree these top five are pretty much THE top five, you may argue specifics within there if you like

1. Hopkins
2. UCSF
3. B&W
4. MGH
5. BID

I think the next six break down into the next group nicely

6. WashU
7. Cornell
8. Penn
9. Duke
10. UCLA
11. Mayo - Rochester (this one is unique for various reasons)

And the rest of a top 20 . . . well I'll list them but I see them as being fairly even

12. UAB
13. Michigan
14. Wahington Uof
15. OHSU
16. Emory
17. TexasSW
18. Baylor
19. Yale
20. Chicago Uof
*Columbia
*Stanford
*Vanderbilt

I'll throw in 5 more for good measure and round out a nice nice top 25 academic programs by reputation . . .

21. North Carolina
22. Wisconsin
23. Iowa
24. NWern
25. Colorado

Ask me tomorrow and my list might be different 😀

*Addded later - please remember the numbers are not specific. You can see criticism of this list below, mostly in regards to programs I'd missed, or palced "too high" (again please remember numbers here are not specific, and I would take them all away, but am leaving because they were there originally). As DF will say below the programs above are generally considered the top programs in the country as a overall gestalt.
 
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jdh71 said:
Here's an intuitive, off the top of my head list, NOT in strict order, so don't get on my case about #3 vs #4, but generally moving in a descending order from top to bottom . . .

Most would probably agree these top five are pretty much THE top five, you may argue specifics within there if you like

1. Hopkins
2. UCSF
3. B&W
4. MGH
5. BID

I think the next six break down into the next group nicely

6. WashU
7. Cornell
8. Penn
9. Duke
10. UCLA
11. Mayo - Rochester (this one is unique for various reasons)

And the rest of a top 20 . . . well I'll list them but I see them as being fairly even

12. UAB
13. Michigan
14. Wahington Uof
15. OHSU
16. Emory
17. TexasSW
18. Baylor
19. Yale
20. Chicago Uof

I'll throw in 5 more for good measure and round out a nice nice top 25 academic programs by reputation . . .

21. North Carolina
22. Wisconsin
23. Iowa
24. NWern
25. Colorado

Ask me tomorrow and my list might be different 😀
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Sorry to hijack the thread...but I just loved it when the so-called snooty Columbia wasnt in your top 25 😉.. that apart, does Yale really rank down so low? (Again, not challenging your rankings, just wondering why it was so low)
 
ResidentMD said:
Sorry to hijack the thread...but I just loved it when the so-called snooty Columbia wasnt in your top 25 😉.. that apart, does Yale really rank down so low? (Again, not challenging your rankings, just wondering why it was so low)
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Like I said the order is more how they popped into my head, not an actual specific order, so Yale is up there too, it's lumped into the third group, which I kind of see as equal . . . in my mind the "top tier" or "top 25" break down into three categories, the elite, the semi-elite, and everyone else, which was evident with my groupings. And I forgot about columbia, so pretend I added them and make my list a top 26 list 😀

But, honestly I think we generally get too caught up on some of this. I am not at any of the programs I listed and I love my program, am getting amazing training, and will likely find fellowship placement during the match in june, so don't get fixated.

PLUS, remember the ranking for IM are not always the same for the sub-specialties. For instance, take Pittsburgh for, the gods of critical care live there and is probably considered an elite place for pulm/critical care, but I wouldn't put their IM into the top 25 necessarily . . .
 
It looks like my comment above about there being a lot of ground between the so-called Top 20 and a mid-lower tier program was misinterpreted. What I meant was that the OP can likely get into his/her desired field without going to one of the so-called Top 10 programs like Hopkins or UCSF. There are a ton of other places, such as Mayo (known for being cushy), Emory, Baylor or Vanderbilt (warm weather/good climate, probably a bit less intense that places like Duke and Hopkinds) that have plenty enough "name" reputation that the OP likely would get into a decent fellowship by going there.

I also disagree with the top 25 list above. 1st of all, making such lists is kind of silly on its face, because there is always going to be a lot of disagreement. I disagree with the above list because I would not rank Mayo as high as this person did. I also would put Vanderbilt on that list around where Emory and UAB were...and probably put Baylor lower given the recent problems there. I also wouldn't have U of N Carolina and Wisconsin on there, although they are definitely solid.
 
Oh yeah, and I also would not have put Oregon as high on that list, although I'm sure it's a fine program. Columbia definitely should be on that list, too, although I agree they have a reputation for being snooty...LOL!

I think that one's "list" is going to be heavily influenced by personal biases, where one trained, and geography (i.e. northeasterners would tend to heavily weight the list w/elite NE programs, West coast people might be more likely to have UCLA and Stanford and U of Washington higher on their list, etc.). These lists are only helpful to get a general gestalt (?sp) sense of the places that a lot of people think are good....
 
What about Case Western and UPMC somewhere in the 20-25 range? Would that be accurate, or you think these programs are slightly lower than the programs listed?
 
dragonfly99 said:
It looks like my comment above about there being a lot of ground between the so-called Top 20 and a mid-lower tier program was misinterpreted. What I meant was that the OP can likely get into his/her desired field without going to one of the so-called Top 10 programs like Hopkins or UCSF. There are a ton of other places, such as Mayo (known for being cushy), Emory, Baylor or Vanderbilt (warm weather/good climate, probably a bit less intense that places like Duke and Hopkinds) that have plenty enough "name" reputation that the OP likely would get into a decent fellowship by going there.

I also disagree with the top 25 list above. 1st of all, making such lists is kind of silly on its face, because there is always going to be a lot of disagreement. I disagree with the above list because I would not rank Mayo as high as this person did. I also would put Vanderbilt on that list around where Emory and UAB were...and probably put Baylor lower given the recent problems there. I also wouldn't have U of N Carolina and Wisconsin on there, although they are definitely solid.
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Why don't people READ what I write 🙄

THE ORDER OF MY LIST WAS NOT SPECIFIC TO NUMBERS

This was a free-association type of list
 
What's UPMC?

Case Western...not sure where to rank it...definitely solid but I'm not sure it quite makes my personal top 25. Would definitely make the top 50.
'
 
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nickster said:
Lets say someone 1st in his class, great scores, the whole package but doesn't care to go to a top tier program. He's happy going to a lower second tier program and staying in his comfort zone. How much will this effect his career? I'm sure he will still get a good education but not recognized as the best available. Would it be best to just gut up and go to Hopkins or some other NE program?
Click to expand...

No... not necessarily.

Top tier programs do not necessarily produce great doctors. I have met someone from a top 5 IM program (per US World News and Report), and they were incredibly pompous, arrogant, and did not connect well with patients (or as they were probably thinking... the "plebeians" that inconvenience them from research)... other people I have met from the same program have been wonderful. Then you meet someone from a middle tier program, and they seem great as well.

Bottom line --> if you have skills, truly care about your patients, and are a good person, then it does not matter what program you end up... you are going to do good in the world and for your patients.

When you make your rank list,
- rank the programs you liked the best if you consider that the most important variable.
- keep in mind people like to rank things (even though ranking is an artificial process and may not be a true indicator of how great the program might be to the individual... some great places do rest on their laurels).

Caveat --> I do think that if you are at the top of the class, then going to a crap program is "wasted capital" so to speak... you need to be amongst those who will challenge you (a program where people at least have the same mental capacity as you). At every program, there is always someone that isn't "the sharpest tool in the shed," but in reality... that person is getting the best bargain being surrounded by constant challenge. That will vary for everyone... but going to a lower ranked program may cause some intellectual inertia in a bright student.


Best wishes in the match. :luck:

Take care,

Frugal Traveler
 
jdh71 said:
Here's an intuitive, off the top of my head list, NOT in strict order, so don't get on my case about #3 vs #4, but generally moving in a descending order from top to bottom . . .

Most would probably agree these top five are pretty much THE top five, you may argue specifics within there if you like

1. Hopkins
2. UCSF
3. B&W
4. MGH
5. BID

I think the next six break down into the next group nicely

6. WashU
7. Cornell
8. Penn
9. Duke
10. UCLA
11. Mayo - Rochester (this one is unique for various reasons)

And the rest of a top 20 . . . well I'll list them but I see them as being fairly even

12. UAB
13. Michigan
14. Wahington Uof
15. OHSU
16. Emory
17. TexasSW
18. Baylor
19. Yale
20. Chicago Uof

I'll throw in 5 more for good measure and round out a nice nice top 25 academic programs by reputation . . .

21. North Carolina
22. Wisconsin
23. Iowa
24. NWern
25. Colorado

Ask me tomorrow and my list might be different 😀
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Obviously, a subjective list. I wouldn't put BID in the top 5 or perhaps even in the top 10.
 
nickster said:
Lets say someone 1st in his class, great scores, the whole package but doesn't care to go to a top tier program. He's happy going to a lower second tier program and staying in his comfort zone. How much will this effect his career? I'm sure he will still get a good education but not recognized as the best available. Would it be best to just gut up and go to Hopkins or some other NE program?
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Hi nickster-
Your question will find it's own definition as you progress through medschool(noticed u're ms1?). First you need to ask yourself a variety of questions, such as:
1. Academia vs. Clinical Medicine
2. Rural vs. City
3. Primary care track vs. specialty track
4. Family vs. Career (how do you want to tip this balance)
Think about these listed entities, I think the answer will become quite obvious then...
Also, I agree with Frugal Traveler and jdh in regards to not necessarily having to be at the "top" 25 to gain an excellent education, as you may have already noticed, the defn of top 25 will be somewhat different for many....
 
I'm a she, Internal Medicine.

N=1 for sure, and great doctors can come from every program. But, academic medicine is its own animal and programs want to hire, offer fellowships, and work with perceived equals.

There are always exceptions, and great doctors can write their own tickets (eg. UT-San Antonio has several doctors from Hopkins). But, look at match lists, housestaff rosters, and research dollars... there is a discernable pattern of hires between "equal" programs.
 
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CanIMakeIt said:
I know this is your list 😀 but I wouldn't put BID in leagues of your other top 10. May be 3rd list. But that is just my opinion 😀
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I appreciate that it is the cushiest of the Harvards, but it is still considered an elite program with elite connections. I also think they have one of the lower interviews to spots ratios I have ever heard of - meaning that it's difficult to get in there because most people who apply and get an interveiw rank them. They also have excellent fellowship placement.

It's the gestalt
 
CanIMakeIt said:
I know this is your list 😀 but I wouldn't put BID in leagues of your other top 10. May be 3rd list. But that is just my opinion 😀
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Can someone clarify on this? I have heard this on and off on SDN that BIDMC is not considered by some as a top 10 program. Any particular reasons besides the perceived cushiness of the program? I would think that having the "Harvard" stamp would pretty much open doors for most fellowships, and also the research opportunities at HMS would be above most of the other places.

jdh71 said:
PLUS, remember the ranking for IM are not always the same for the sub-specialties. For instance, take Pittsburgh for, the gods of critical care live there and is probably considered an elite place for pulm/critical care, but I wouldn't put their IM into the top 25 necessarily . . .
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Could you elaborate? I interviewed at UPMC earlier this month and was very impressed with the direction in which the department was headed towards. Also liked the cameraderie between the residents, and opportunities for tailoring training. Plus zero, absolutely zero scut.
 
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Resident MD- my home PD basically told me he does not think BID is an elite program. I think it comes from the reputation as being cushy and just being carried by the harvard name. I think this perception is borne out by the inferior fellowship match (IMHO) compared to other top tier programs.

2009 fellowship match:
Cards: 3 at BIDMC (not MGH level, but pretty good), 1 at UPenn, 3 at less stellar local boston programs
GI: 2 at BIDMC, 1 at emory (mid-high tier?- not really familiar wiht GI), and 4 at lower tier hospitals
Heme-Onc: A-list match
Pulm: 50/50 top tier vs. lower top/mid tier
ID: 50/50


Basically, other than heme onc, the fellowship match for other specialties is not on par with a top 10 program. I would say a perceived lower ranked IM program like wash u, cornell, or northwestern has a comparable match list.

All that being said, I think BIDMC is awesome and I plan to rank it highly. However, I would do so knowing that it is not at the level of MGH, columbia, upenn, etc because of mixed perceptions among PD's and fellowship directors.


All this is for ego anyways. Go to any university program in the country and you will learn internal medicine, and you will have countless research opportunities. I say work hard, live well, and dont worry about reputation. You'll get enough respect just for being a doctor
 
ResidentMD said:
Could you elaborate? I interviewed at UPMC earlier this month and was very impressed with the direction in which the department was headed towards. Also liked the cameraderie between the residents, and opportunities for tailoring training. Plus zero, absolutely zero scut.
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Not really much to elaborate on. Even though Pitt, I'm sure, is a great general IM program, the general consus by reputation is that it is not a top 25 place for general medicine. Basically, IM =/= Subspecialty reputation.
 
ResidentMD said:
Didnt get this.
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He means that, just because a place has a great reputation for IM, doesn't also mean they have a great reputation for Cards, GI, Hem/Onc, ID, Renal, Pulm/CC, whatever. The converse is true as well and his example was spot on. If you want to do hepatology or Pulm, you would be hard pressed to find a better place to do that training than UPMC (there are others just as good obviously but nothing head and shoulders above them). But for IM training, they are a well respected, good, mid-tier Univ program where the residents seem happy. That's it.
 
gutonc said:
He means that, just because a place has a great reputation for IM, doesn't also mean they have a great reputation for Cards, GI, Hem/Onc, ID, Renal, Pulm/CC, whatever. The converse is true as well and his example was spot on. If you want to do hepatology or Pulm, you would be hard pressed to find a better place to do that training than UPMC (there are others just as good obviously but nothing head and shoulders above them). But for IM training, they are a well respected, good, mid-tier Univ program where the residents seem happy. That's it.
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Okay - thanks. I think thats why in previous posts on this thread, people have said that one may choose a lower tier place depending on one's personal and/or professional interests. Keeping the PCCM concept in mind, Colorado would fall into the same league as UPMC then, wouldnt it (genuine query, no sarcasm)?

Interesting though - I am also seeing many programs developing a GIM focus. So the rankings may be different for different people.

More inputs about BIDMC?
 
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ResidentMD said:
Okay - thanks. I think thats why in previous posts on this thread, people have said that one may choose a lower tier place depending on one's personal and/or professional interests. Keeping the PCCM concept in mind, Colorado would fall into the same league as UPMC then, wouldnt it (genuine query, no sarcasm)?

Interesting though - I am also seeing many programs developing a GIM focus. So the rankings may be different for different people.
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Actually, I started the post writing about Colorado (which pretty much rules pulmonology with UPMC and UW close behind), but changed it to be slightly more inclusive of other specialties.

And congratulations on finally getting it. The best program is the one that fits YOU best, not the one that your dad, advisor, roommate, drinking buddy who's going into Ortho, etc, thinks is the best. And different programs are good at different things. If only every applicant figured this out.
 
gutonc said:
best program is the one that fits YOU best, not the one that your dad, advisor, roommate, drinking buddy who's going into Ortho, etc, thinks is the best. And different programs are good at different things. If only every applicant figured this out.
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AGREED! Absolutely! 👍
 
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nickster said:
but doesn't care to go to a top tier program. He's happy going to a lower second tier program and staying in his comfort zone. How much will this effect his career?
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The fundamental question that must be answered is "why" he/she is happy going to a lower second tier program. If the assumption is that you won't work as hard, that's a bad assumption. By and large, work hour rules have tended to make programs more similar than dissimilar (sure there are differences, but they are less significant than in the past). To realize your potential, you need to push yourself to excel and you need to try to come out of your comfort zone to figure out where the zone really is. If you don't do that, then you'll never know your potential and you run the risk of being mediocre. You can push yourself in a second tier program, but it tends to be easier to push yourself when you are in an environment where colleagues are also trying to push themselves--that seems more likely in a first tier program. Mind you, I'm not talking about competition between residents, rather I'm talking about being in an environment where housestaff are nurtured to try to come out of their comfort zone to see what they're capable of.

I think you owe it to yourself and your future patients to spend the next 3 years in a place that has an environment where you can maximize your potential. If you think you'll be miserable at a "top" program, then you won't realize your potential anyway so a second-tier program would be more desirable. However, you have to ask yourself "why" in the first place you don't want a top program that you'd otherwise qualify for?
 
how about this for a plan:
1. apply broadly
2. go on a bunch of interviews
3. rank the programs in the order in which you think you will be happiest
4. let the match sort it out
5. do as little clinical medicine as possible until intern year starts
 
To be honest, when it comes down to it, I am going to rank programs according to geographic location because of family reasons. But I am just curious, which programs are considered top tier? Is top tier top 10, top 20, or top 25 programs? And how can you find these rankings?
 
barmay said:
To be honest, when it comes down to it, I am going to rank programs according to geographic location because of family reasons. But I am just curious, which programs are considered top tier? Is top tier top 10, top 20, or top 25 programs? And how can you find these rankings?
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You didn't read the thread did you? :nono:

(bad newbie! bad newbie!)

😀

There is a list of a about 30 programs posted above that are considered the "top tier" by general gestalt. You cannot find actually objective rankings for this kind of thing.
 
my god!!! I should've read the thread first!

Thanks for your input. That was exactly what i was looking for actually. Sounds like there is no subjective list like the medical or law school ranking list. Its just that I just had a conversation with my brother in borders about elite internal medicine programs and I couldn't find a rank list on the USNEWS magazine.
 
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