How the world works (or why you should attend an elite university/med school)

[flatearth22]

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http://infoproc.blogspot.com/2010/10/how-world-works.html

Go to the web sites of venture capital, private equity or hedge funds, or of Goldman Sachs, and you’ll find that HYPS alums, plus a few Ivies, plus MIT and Caltech, are grossly overrepresented. (Equivalently, look at the founding teams of venture funded startups.)

Most top firms only recruit at a few schools. A kid from a non-elite UG school has very little chance of finding a job at one of these places unless they first go to grad school at, e.g., HBS, HLS, or get a PhD from a top place. (By top place I don’t mean “gee US News says Ohio State’s Aero E program is top 5!” — I mean, e.g., a math PhD from Berkeley or a PhD in computer science from MIT — the traditional top dogs in academia.)

This is just how the world works. I won’t go into detail, but it’s actually somewhat rational for elite firms to operate this way — a Harvard guy knows how the filtering works at his alma mater and at similar places so he trusts it. Plus, at the far tail of ability I would guess the top 10-20 UG schools grab almost 50 percent of the pool.

I teach at U Oregon and out of curiosity I once surveyed the students at our Honors College, which has SAT-HSGPA characteristics similar to Cornell or Berkeley. Very few of the kids knew what a venture capitalist or derivatives trader was. Very few had the kinds of life and career aspirations that are *typical* of HYPS or techer kids. At the time I took the survey almost 50 percent of the graduating class at Harvard was heading into finance. You can bet that the average senior at Harvard knows what Goldman Sachs is (and even what it means to make partner there), that McKinsey is so over (relative to careers in finance), what the difference is between a Rhodes, Marshall and Churchill scholarship, etc. etc. Very few state school kids do … Last year a physics student at Oregon won a Marshall to go to Cambridge. The administrators were happy about the PR. I had a conversation with a vice-provost about how to ensure a steady pipeline of such candidates — but there are not the resources, institutional understanding of the process, etc. (let alone pool of able kids) to turn UO into a Rhodes/Marshall/… machine like Harvard.

Now tell me that peer or network effects don’t matter. Controlling for SAT may account for much of the variance in well-established careers like medicine or even law, but for the very top jobs (which contribute disproportionately toward income inequality), kids at elite schools have huge advantages. Guess where I will send my kids (assuming they can get in)?

To see the elite / non-elite divide most starkly, look at the probability of (earned) net worth, say, $5-10M by age 40. This cuts out almost all doctors and lawyers and leaves finance, startups and entertainment (i.e., movies or television; let’s ignore sports). Even after controlling for SAT, I would guess elite grads are 3 or maybe even 10 times more likely to achieve this milestone.

Controlling for IQ doesn't account for differences in drive or life expectations or naked ambition, let alone social networks, signaling or information flow among elites.

This guy talks mostly about elite undergrads and finance but I think it applies for med schools as well. Not only for residency placement and having higher chances of getting into competitive specialties....but that the elite med schools give you the connections and platforms necessary to find fame and money in areas tangentially related to medicine like media, publishing, activism, and entrepreneurship. For example, most of the big name docs like Sajnay Gupta, Dr. Oz, Ben Carson etc. attended big name places where they had the connections and infrastructure needed to launch them into stardom and $$$.

Let's face it - medicine in and of itself is a career with a high basement but also a low ceiling (see the bolded part in the quote). In order to make a big impact on the world as a physician and acquire megabucks and uberprestige one needs to have a sort of secondary career because just practicing medicine isn't going to cut it. So is the SDN paradigm of attending the cheapest school (UG or med) wrong? Should the school you choose to attend be looked on as a long-term investment whose outcome varies based on the quality of school as opposed to a uniform debt?

 

[Double Trouble]

But shouldn't prestige be less relevant and less important to a person in a field like medicine??

 

[235788]

But shouldn't prestige be less relevant and less important to a person in a field like medicine??

unless you want to do academic medicine

 

[armybound]

I don't think this applies to medicine like you think it does.

Sure, some of the top programs want to select from the Ivies almost exclusively, but talking about finance jobs that pay in the millions and being able to say you went to HMS are not quite on the same scale, nor equally exclusive.

 

[music2doc]

http://infoproc.blogspot.com/2010/10/how-world-works.html



This guy talks mostly about elite undergrads and finance but I think it applies for med schools as well. Not only for residency placement and having higher chances of getting into competitive specialties....but that the elite med schools give you the connections and platforms necessary to find fame and money in areas tangentially related to medicine like media, publishing, activism, and entrepreneurship. For example, most of the big name docs like Sajnay Gupta, Dr. Oz, Ben Carson etc. attended big name places where they had the connections and infrastructure needed to launch them into stardom and $$$.

Let's face it - medicine in and of itself is a career with a high basement but also a low ceiling (see the bolded part in the quote). In order to make a big impact on the world as a physician and acquire megabucks and uberprestige one needs to have a sort of secondary career because just practicing medicine isn't going to cut it. So is the SDN paradigm of attending the cheapest school (UG or med) wrong? Should the school you choose to attend be looked on as a long-term investment whose outcome varies based on the quality of school as opposed to a uniform debt?

So why are YOU going to medical school?

 

[Shakespeare37]

It totally and completely depends on what you want to do. If you want to go into academic medicine, plastics, optho, derm, rad-onc (or any competitive to extremely competitive) residencies, then yes it matters. But if you want to practice in a traditionally less competitive field, in private practice, than I don't really think it matters. School prestige is only relevant for certain things. That said, I don't know what type of medicine I want to practice, and going to the 'best' school I get into keeps the most doors open. Ironically, the big name schools also have a lot of money, and are probably cheaper than any other private institution.

 

[Barcu]

I don't think anyone would deny that going to a top school will help you quite a bit.

The question becomes is it worth it to reapply again or to turn down a much cheaper option? The answer depends on the person.

I think this forum does tend to say "it doesn't matter where you go to school" a bit too strongly. Still, for many folks, it actually does not matter due to their personal professional goals.

 

[aluminumleaflet]

.

 

[235788]

Even seeing this, I still stand by the belief that what you do in medical school matters more than the name. My uncle went to WVU SOM and made contacts during an away rotation at Gtown. He wound up going there for his residency in anesthesiology. GHSU sent a graduate off to a diagnostic radiology residency at Brigham and Women's fairly recently. How many of you have heard of GHSU?

And wright state sent someone to yale for general surg or something (heard about it at interview). There are always exceptions.

Don't count on being that exception.

 

[Narmerguy]

Graduate schools in the sciences typically don't hold the same "fever" for name-brand that businesses and other corporations do.

However, I think people on this forum kid themselves into thinking that prestige does not matter in this world. In most areas of the world, it unambiguously matters A LOT. In medicine, it doesn't matter as much because so many people are joining private or group practices where pay is generally "set" and based on external formulae and we aren't expected to be that responsible for bringing in "customers". However, beyond this rather unconventional realm (which admittedly encompasses the majority of medical graduates right now), prestige matters.

 

[Dharma]

Let's face it - medicine in and of itself is a career with a high basement but also a low ceiling (see the bolded part in the quote). In order to make a big impact on the world as a physician and acquire megabucks and uberprestige one needs to have a sort of secondary career because just practicing medicine isn't going to cut it. So is the SDN paradigm of attending the cheapest school (UG or med) wrong? Should the school you choose to attend be looked on as a long-term investment whose outcome varies based on the quality of school as opposed to a uniform debt?

You can make a big impact on the world around you without the megabucks and uberprestige. That said, I don't think many here would say attend the cheapest school. You need to find the best fit and this will certainly be determined by a number of factors, including tuition. IMO uberprestige and megabucks shouldn't be the future physician's motivation. Humbling times await...

 

[KnuxNole]

LIke I said in the other topic, I personally couldn't give a **** about "prestige" at all. It's not like being a doctor in general is prestigious(except for uninformed general public who think all doctors make a million bucks). Same with undergrad too, it only matters if you wanna make an insane amount of money, compared to average joes. Plus a lot of prestige is based on research, and I don't look at research for one second, and I know this is the same for many undergrad/med students too...

 

[Hopetocure2012]

Why is there such thing as "elite" in the first place then?

 

[Lil Mick]

Never really liked the idea of making a lot of money or being in the public eye... Personally, I'd recommend doing the best you can with what you have at the time. I went to a community college, took a scholarship to local university, and was admitted to several schools when I applied (MD/PhD). The name of my university didn't matter as much as how well I did there and my accomplishments with the resources I did have. And I have no desire to know any of the business stuff mentioned in that article...

I have a friend who is a high school drop out (didn't finish 9th grade) who started his own tech company and is now quite wealthy. Another has two years of college and has worked several well-paying jobs since dropping out. It really is what you make of it, not what schools or pedigree you come from.

 

[phltz]

This guy talks mostly about elite undergrads and finance but I think it applies for med schools as well. Not only for residency placement and having higher chances of getting into competitive specialties....but that the elite med schools give you the connections and platforms necessary to find fame and money in areas tangentially related to medicine like media, publishing, activism, and entrepreneurship. For example, most of the big name docs like Sajnay Gupta, Dr. Oz, Ben Carson etc. attended big name places where they had the connections and infrastructure needed to launch them into stardom and $$$.

Let's face it - medicine in and of itself is a career with a high basement but also a low ceiling (see the bolded part in the quote). In order to make a big impact on the world as a physician and acquire megabucks and uberprestige one needs to have a sort of secondary career because just practicing medicine isn't going to cut it. So is the SDN paradigm of attending the cheapest school (UG or med) wrong? Should the school you choose to attend be looked on as a long-term investment whose outcome varies based on the quality of school as opposed to a uniform debt?

Do you want to be a good physician, or do you want to be a celebrity? Dr Oz gets rich from pushing scams and quackery. Is that where you want to take your career? If you just want lots of attention and bucks, try to get onto the cast of "Jersey Shore" and leave medicine to the rest of us.

If you want to change the world (and maybe make some megabucks) through medicine, your best bet is to go into research. Find a better way to treat cancer or diabetes, and you'll be there. You can certainly start a successful career in medical research at a great many medical schools, although it'll be a bit easier at a well respected one. That said, I'm not sure that there's an appreciable value in being at a top 5 schools as compared to a top 25.

The one area where prestige is likely to make a big difference is if you're going into policy debates, where having a good name behind you will get you heard a bit better. However, you sound like enough of a douche, I'm going to go ahead and politely request that you not try to go into medical policy. Please just don't.

 

[1TB4RKSB4CK]

Do you want to be a good physician, or do you want to be a celebrity? Dr Oz gets rich from pushing scams and quackery. Is that where you want to take your career? If you just want lots of attention and bucks, try to get onto the cast of "Jersey Shore" and leave medicine to the rest of us.

If you want to change the world (and maybe make some megabucks) through medicine, your best bet is to go into research. Find a better way to treat cancer or diabetes, and you'll be there. You can certainly start a successful career in medical research at a great many medical schools, although it'll be a bit easier at a well respected one. That said, I'm not sure that there's an appreciable value in being at a top 5 schools as compared to a top 25.

The one area where prestige is likely to make a big difference is if you're going into policy debates, where having a good name behind you will get you heard a bit better. However, you sound like enough of a douche, I'm going to go ahead and politely request that you not try to go into medical policy. Please just don't.

👍

 

[ronaldo23]

Do you want to be a good physician, or do you want to be a celebrity? Dr Oz gets rich from pushing scams and quackery. Is that where you want to take your career? If you just want lots of attention and bucks, try to get onto the cast of "Jersey Shore" and leave medicine to the rest of us.

If you want to change the world (and maybe make some megabucks) through medicine, your best bet is to go into research. Find a better way to treat cancer or diabetes, and you'll be there. You can certainly start a successful career in medical research at a great many medical schools, although it'll be a bit easier at a well respected one. That said, I'm not sure that there's an appreciable value in being at a top 5 schools as compared to a top 25.

The one area where prestige is likely to make a big difference is if you're going into policy debates, where having a good name behind you will get you heard a bit better. However, you sound like enough of a douche, I'm going to go ahead and politely request that you not try to go into medical policy. Please just don't.

 

[Stumpyman]

Most people going into medicine aren't really aiming to become one of the few (what is it, maybe 20, 25?) famous, ultra-rich doctors, similar to Gupta, Ben Carson, Dr. Oz, etc.

If that is your aim, sure maybe a top school will help get you there (though it's FAR from a guarantee).

 

[kpcrew]

Graduate schools in the sciences typically don't hold the same "fever" for name-brand that businesses and other corporations do.

well school name is marginally important but your pi is massively important. it seems that if you work for a giant in your field, people respect that in the way people in other fields respect those that come from the name brand schools.

 

[chronicidal]

most of the big name docs like Sajnay Gupta, Dr. Oz, Ben Carson etc. attended big name places where they had the connections and infrastructure needed to launch them into stardom and $$$.

Just so everyone knows what level of elite we're talking about,

Gupta went to UMich for undergrad, med school, and residency.
Oz went to Harvard for undergrad, Penn for med school, Wharton for his MBA, and residency at Columbia-Presbyterian.
Carson went to Yale undergrad, UMich for med school, and Hopkins for residency.

 

[KnuxNole]

yawn

😛

 

[MT Headed]

Just so everyone knows what level of elite we're talking about,

Gupta went to UMich for undergrad, med school, and residency.
Oz went to Harvard for undergrad, Penn for med school, Wharton for his MBA, and residency at Columbia-Presbyterian.
Carson went to Yale undergrad, UMich for med school, and Hopkins for residency.

UMich FTW!!!1!

 

[Stumpyman]

Just so everyone knows what level of elite we're talking about,

Gupta went to UMich for undergrad, med school, and residency.
Oz went to Harvard for undergrad, Penn for med school, Wharton for his MBA, and residency at Columbia-Presbyterian.
Carson went to Yale undergrad, UMich for med school, and Hopkins for residency.

Dr. Phil went to the University of North Texas.

Connections help, but luck doesn't hurt. Going to UMich won't make you the next Gupta, same as moving to Hollywood won't make you the next movie star.

 

[circulus vitios]

or get a PhD from a top place. (By top place I don't mean "gee US News says Ohio State's Aero E program is top 5!" — I mean, e.g., a math PhD from Berkeley or a PhD in computer science from MIT — the traditional top dogs in academia.)

The author of that article is a complete ******.

"I don't mean top 5 in the field that you want to do research in, which is really the most important thing to consider when you're getting a PhD"

I'm not even sure what the point of the article is. Kids from non-elite schools aren't interested in finance. Most people don't want to work in finance because it's boring, soulless work. There is more to life than being a prestige ***** and living an 80 hour a week New York City hell courtesy of Goldman Sachs.

 

[music2doc]

Your ignorance is showing.

You sure about that? I'd actually suggest the faculty author's ignorance is showing. For some of us, there are options available to go that direction if we desire it (i.e., I have those kinds of connections), but, at least to me, it seems quite undesirable. That kind of work lacks meaning or significance. There is a lot more to life than money and power.

 

[Dave89]

So why are YOU going to medical school?

👍

 

[Dave89]

"Uberpestige" and "megabucks" should have directed anyone on this thread to a Finance or Business major, LOL.

 

[CoolWhipp]

"Uberpestige" and "megabucks" should have directed anyone on this thread to a Finance or Business major, LOL.

What can be more uber of a prestige than curing cancer or aids? That's the ultimate prestige in my eyes. 200K a year is good enough in terms of the money category in my life, but real reward is the chance to discover something monumental that will improve humanity and to do it before any one else. Gotta love stomping out the competition. 😀

 

[Dave89]

What can be more uber of a prestige than curing cancer or aids? That's the ultimate prestige in my eyes. 200K a year is good enough in terms of the money category in my life, but real reward is the chance to discover something monumental that will improve humanity and to do it before any one else. Gotta love stomping out the competition. 😀

From what I've seen, doctors who practice relatively full-time aren't going to have the time to make those discoveries. But good luck to you! (and us all, I suppose)

 

[drizzt3117]

You sure about that? I'd actually suggest the faculty author's ignorance is showing. For some of us, there are options available to go that direction if we desire it (i.e., I have those kinds of connections), but, at least to me, it seems quite undesirable. That kind of work lacks meaning or significance. There is a lot more to life than money and power.

His point is that many top firms don't even recruit from non-elite institutions. When I worked in consulting McKinsey and a lot of the boutique firms recruited from about 10 schools. When I did hiring, you got so many apps pretty much looking at a resume you'd spend 10 seconds looking at where they did ug/MBA, look at GMAT, then 10 sec browsing where they worked and the people who were mediocre after that quick scan got their app thrown in the trash.

I'd respectfully disagree about the downturn of consulting. Sure things aren't what they once were, but it's much less up/out than IB and talented people still regularly go BA to partner in 8-10 years; you aren't making Goldman Sachs money as a partner but low 7 figure salaries and mid 6 figure bonuses when much of your job is wining and dining isn't a terrible way to live. The travel is the downside but that's minimized a bit at the EM and above levels.

 

[Narmerguy]

His point is that many top firms don't even recruit from non-elite institutions. When I worked in consulting McKinsey and a lot of the boutique firms recruited from about 10 schools. When I did hiring, you got so many apps pretty much looking at a resume you'd spend 10 seconds looking at where they did ug/MBA, look at GMAT, then 10 sec browsing where they worked and the people who were mediocre after that quick scan got their app thrown in the trash.

I'd respectfully disagree about the downturn of consulting. Sure things aren't what they once were, but it's much less up/out than IB and talented people still regularly go BA to partner in 8-10 years; you aren't making Goldman Sachs money as a partner but low 7 figure salaries and mid 6 figure bonuses when much of your job is wining and dining isn't a terrible way to live. The travel is the downside but that's minimized a bit at the EM and above levels.

Do many people really make it to that level though? How talented would you have to be to do that?

 

[drizzt3117]

Do many people really make it to that level though? How talented would you have to be to do that?

Consulting is a field with high turnover; the hours aren't great, you have a lot of travel, and lots of opportunities to leave for higher paying jobs (especially immediately after your MBA, but whenever, really) so people that stay in, are good at their jobs and are good with people have a good chance to move up in the ranks. One problem is that getting a partner job in a desirable location is very hard, but getting one abroad or in somewhere like atlanta, Houston/Dallas, phoenix, Seattle, etc would be easier than NYC/sf/Chicago/la/Boston.

 

[Whatyousay]

brb transferring to Harvard.

 

[KnuxNole]

Money isn't a big deal....which is why finance and the like never appealed to me at all. I'd rather be HAPPY than make a million bucks. There's just no benefit at all to having a lot of money vs. a good amount to live comfortably.

 

[Ignatius M.D.]

I really think this only applies for super prestigious residency programs (MGH, UCSF, etc.) and for particular specialties. Even then, I'm not sure it holds too much weight, although I'm sure it matters somewhat to PDs. For undergrad, there are certainly discrepancies between average earned income between universities (sometimes north of 25k/year), and if your not looking to go to med/law school it's pretty silly to ignore that difference if you have the opportunity. That is not exactly relevant to medicine though.

 

[Osteoth]

What do you call the person who's last in his class at the worst med school in the country? A doctor.

What do you call the person who's last in his class at the worst law school/MBA program in the country? Unemployed

It's all about supply and demand, with this country in the need of physicians, no matter where you graduate from, you're likely to find a job. Like other posters have said, if you're trying to get into a ROAD specialty in a big city, it might be a bit more important where you came from, but at the end of the day the risk/reward of going to a better known/less known med school are much less than in fields like law or business where pedigree is more important.

 

[anegron519]

.

 

[ppfizenm]

For the most part, the opportunities are there if you want to take them. I wouldn't listen to people telling you it matters a great deal. By residency directors own admission it matters, but not as much as other things. Some on here make it sound like an average student from a top five will beat out an above average student from a top 50. Not the case.

Also, comparing medical school/residency to business/finance job is not responsible

 

[Danlee07]

Deutsche Bank had a 3-day interview period where there was a Harvard recruiting and non-Harvard recruiting group for 8-10 IB internship positions. The end was an acceptance rate of less than 0.05%, with Harvard graduates having filled about 7 of those slots...

For any degree, more people can recognize Ivy Leagues or Stanford better than Eastern Virginia or Rosalind Franklin. Some people don't even know Baylor College of Medicine or Mayo. In the end, It's circumstantial and situational. You can still overcome the fact that you don't have a degree from a certain school.

 

[phltz]

Deutsche Bank had a 3-day interview period where there was a Harvard recruiting and non-Harvard recruiting group for 8-10 IB internship positions. The end was an acceptance rate of less than 0.05%, with Harvard graduates having filled about 7 of those slots...

For any degree, more people can recognize Ivy Leagues or Stanford better than Eastern Virginia or Rosalind Franklin. Some people don't even know Baylor College of Medicine or Mayo. In the end, It's circumstantial and situational. You can still overcome the fact that you don't have a degree from a certain school.

Finance is very different than medicine, and I'm not sure how much insight you can get from comparing them.

That said, keep in mind that medical schools are generally much smaller than colleges. The combined undergrad population of HYSPM is close to 32k students. Assume a quarter of them enter each year, and you're looking at almost 8 thousand new HYSPM matriculants per year. Sorting the SDN's MSAR stat knockoff spreadsheet by LizzyM score (which we'll take as a reasonable measure of "elite-ness"), it looks like you'd need to consider a bit over the top hundred med schools to come up with an equivalent number of new students.

Big banks can all find 7 new Harvard undergrads each year for an internship, no sweat. A residency program or hospital (likely barring Harvard's own residency programs and hospitals) simply won't be able to find 7 new Harvard med grads each year. There aren't enough to go around.

 

[45408]

Deutsche Bank had a 3-day interview period where there was a Harvard recruiting and non-Harvard recruiting group for 8-10 IB internship positions. The end was an acceptance rate of less than 0.05%, with Harvard graduates having filled about 7 of those slots...

For any degree, more people can recognize Ivy Leagues or Stanford better than Eastern Virginia or Rosalind Franklin. Some people don't even know Baylor College of Medicine or Mayo. In the end, It's circumstantial and situational. You can still overcome the fact that you don't have a degree from a certain school.

If someone doesn't recognize Mayo, then they are in no position to be judging your medical background.

 

[drizzt3117]

For the most part, the opportunities are there if you want to take them. I wouldn't listen to people telling you it matters a great deal. By residency directors own admission it matters, but not as much as other things. Some on here make it sound like an average student from a top five will beat out an above average student from a top 50. Not the case.

Also, comparing medical school/residency to business/finance job is not responsible

In my experience, it is the case. Ppl with 245 from Harvard were getting interviews over people with 260/AOA from no name schools.

 

[thlaxer]

If someone doesn't recognize Mayo, then they are in no position to be judging your medical background.

That doesn't stop them from judging though 😛. I didn't hear of Mayo until I started reading SDN to be honest.

 

[ppfizenm]

In my experience, it is the case. Ppl with 245 from Harvard were getting interviews over people with 260/AOA from no name schools.

245 is about 20 points above average, a standard deviation above. I also wouldn't say many of the top 50 schools are no name schools.

 

[drizzt3117]

245 is about 20 points above average, a standard deviation above. I also wouldn't say many of the top 50 schools are no name schools.

The same is true for Harvard grads with 225 compared to say, MCW grads with 240.

 

[ppfizenm]

The same is true for Harvard grads with 225 compared to say, MCW grads with 240.

where does this example come from?

 

[bigloley]

Deutsche Bank had a 3-day interview period where there was a Harvard recruiting and non-Harvard recruiting group for 8-10 IB internship positions. The end was an acceptance rate of less than 0.05%, with Harvard graduates having filled about 7 of those slots...

For any degree, more people can recognize Ivy Leagues or Stanford better than Eastern Virginia or Rosalind Franklin. Some people don't even know Baylor College of Medicine or Mayo. In the end, It's circumstantial and situational. You can still overcome the fact that you don't have a degree from a certain school.

Are you certain about your numbers? If there was 10 IB positions with an acceptance rate of 0.05% that would mean they interviewed 20,000 people for 10 positions. Assuming each interview is 1 hour (probably more, especially with 2 or 3rd interviews) that means they used over 20,000 hours interviewing. Valuing each hour at $50 (this is a very low estimate, most IB divisions bill hours for much more and the interviewers are not entry level positions) that means they spent over $1,000,000 in interviewing costs. Not to mention Deutsche bank has had a couple really bad quarters recently and their IB prestige is way down

 

[drizzt3117]

where does this example come from?

People's experiences this cycle.

 

[ChiDO]

People's experiences this cycle.

n=1....very strong. 🙄

Grades, Boards, Audition >>>>>>>>>>>>>>>>>>>>>> school you went to

 

[drizzt3117]

n=1....very strong. 🙄

Grades, Boards, Audition >>>>>>>>>>>>>>>>>>>>>> school you went to

I don't usually think perusal of match lists is that useful, but looking at top tier match lists is instructive; they're usually insanely strong top to bottom whereas mid tier schools have more variability. Part of this is self selection but part of it is simply program prestige. The difference between tiers of MD schools isn't at the top end of the scale so much, the very top people (step 1 > 265/AOA) generally can get into top tier schools regardless of tier if less consistently than their top tier colleagues) but Step 1 averages at Harvard and Penn are 235-240 so obviously a lot of their students are getting step scores around the national average but they're still matching into top programs.