How to gauge rankings

[studygirl06]

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With the whole step 1 p/f I'm having a hard time thinking about rankings and which lists to be looking at (US World News??). Of course ranking isn't the only variable I will be taking into consideration but I am having a hard time when looking at schools like OHSU vs. U Miami Miller vs. Wake Forest. Does anyone have a list they're looking at or factors that I should be considering more heavily (ie early clinical experiences)?

 

[Physician.EXE]

I would imagine that the medical school ranking list based on residency director scores would be more resourceful than the list from the US World News report. You should also consider schools that have a 1 or 1.5 year pre-clinical curriculum. This will give you more time to get clinical experience and to do more rotations in the specialty that you are most interested in. Having a home department that is also active in research in your specialty will help a lot too.

 

[Goro]

With the whole step 1 p/f I'm having a hard time thinking about rankings and which lists to be looking at (US World News??). Of course ranking isn't the only variable I will be taking into consideration but I am having a hard time when looking at schools like OHSU vs. U Miami Miller vs. Wake Forest. Does anyone have a list they're looking at or factors that I should be considering more heavily (ie early clinical experiences)?

The only people who take US Snooze and Worst Report seriously are starry-eyed pre-meds, and med school Deans.

And for the zillionth time, our own residents and attendings here on SDN have told us that they'll use Step 2 in lieu of Step I to stratify candidates. They scoff at the notion of using school prestige as a filter.

 

[studygirl06]

1

I would imagine that the medical school ranking list based on residency director scores would be more resourceful than the list from the US World News report. You should also consider schools that have a 1 or 1.5 year pre-clinical curriculum. This will give you more time to get clinical experience and to do more rotations in the specialty that you are most interested in. Having a home department that is also active in research in your specialty will help a lot too.

Thank you!

 

[studygirl06]

The only people who take US Snooze and Worst Report seriously are starry-eyed pre-meds, and med school Deans.

And for the zillionth time, our own residents and attendings here on SDN have told us that they'll use Step 2 in lieu of Step I to stratify candidates. They scoff at the notion of using school prestige as a filter.

Hahah got it, yes. So you would advise choosing a school based on early clinical experience or step 2?

 

[Angus Avagadro]

Hahah got it, yes. So you would advise choosing a school based on early clinical experience or step 2?

I would base choosing a school where my scores and app would be competetive. If you are on par for the Ivys, why would you apply to u of Toledo? No disrespect for Toledo, but you get my point. Many so called mid tier schools have a very good match list. It's mostly up to you where you match for residency, very little credit comes from where you graduated. Pedigree can help to a degree, but it's mostly on you to out together a competetive app to match at ranked programs.

 

[A Ryan Seacrest Type]

Where you match comes down to your performance in med school, no matter where you go, and while prestige filter is not necessarily a thing, don’t think for a second that better name med schools wont help your chances at landing competitive residencies or top programs in a specific residency (if that’s what you want of course). Point is, go to the best med school you can possibly get into, why not give yourself every advantage possible. Also picking schools based on step 2 scores is as faulty as trying to pick schools based on step 1 scores

 

[Ole_Toe]

Point is, go to the best med school you can possibly get into, why not give yourself every advantage possible. Also picking schools based on step 2 scores is as faulty as trying to pick schools based on step 1 scores

But if the difference in COA is over 100k+ across 4 years to go to the best school you get into, is it worth the pricetag for the marginal bump in your residency application?

 

[seeinghowitgoes]

I would imagine that the medical school ranking list based on residency director scores would be more resourceful than the list from the US World News report. You should also consider schools that have a 1 or 1.5 year pre-clinical curriculum. This will give you more time to get clinical experience and to do more rotations in the specialty that you are most interested in. Having a home department that is also active in research in your specialty will help a lot too.

This is definitely logical but still flawed - some schools ranked in the 30s there (Case and Sinai for example) have far more matches in competitive specialties and to top academic institutions than “higher ranked” programs.

That is just to reiterate any rankings of med schools, even these, correlate only weakly yo moderately with opportunities after medical school and very poorly with how well you will be setup to achieve your specific personal goals in life.

If you want my take on how to evaluate medical schools having now gone through the match, I genuinely believe the best way to gauge if a school can get you where you want to be (what you’re really looking for in a ranking) is to look at match lists. Specifically see if the schools place people in the regions of the country you want to be in and in specialties you want to be in and in the types of hospitals you want to be in. If they do, you know there are mentors, peers to reach out to for advice, and the school will have a reputation at some residency programs you may be interested in already (because they’ve taken students from your school before). If a school never sends people to your preferred area of the country (Cali, for example), rarely matches in the the specialties you’d like (surgical specialties, for example), and never matches to the types of places you could see yourself at (big academic centers for example), it doesn’t mean you can’t break the mold and walk you own path but it should suggest you may need to be a bit more proactive. Being anymore specific than that when looking at a rank list (ie I want to do urology specifically at Hopkins let’s see who has matched there in the past two years) isn’t worth it before starting medical school. Only caveat I’ll add is if you do know you want to be at a specific place for residency (you’re non-trad and have a family or whatever), usually throw rankings out the window and try to med school that’s associated with that hospital or in that city.

When you evaluate schools this way, you’ll also realize that most AMGs are going to be whatever kind of doctor they want and practice wherever they want regardless of their school, that if you’re going to any medical school you’ll be able to accomplish your personal goals.

 

[EdgeTrimmer]

It's worth if you are not taking loans

But if the difference in COA is over 100k+ across 4 years to go to the best school you get into, is it worth the price tag for the marginal bump in your residency application?

yes, if you (or your parents) have 100K to spare (i.e. no loans).

 

[A Ryan Seacrest Type]

But if the difference in COA is over 100k+ across 4 years to go to the best school you get into, is it worth the pricetag for the marginal bump in your residency application?

I would hardly hardly say it’s marginal for the tipy top class of residency programs. And even if it’s not the tipy top, I have seen very mediocre students from top schools match competitive residencies and top programs and a lot of it comes from the school name or the research opportunities that a top school brings. Ultimately it’s up to you if 100k across 4 years is worth it depending on what your goals are. If you’re trying for plastics at NYU for example, or some other uber competitive program it’s 100% worth it in my opinion. Just look at the medical schools from the first and second year residents in plastics at NYU (NYU, Columbia, Yale). However, if you’re a strong student and aren’t too focused on brand name programs, you’ll match into a competitive specialty, and maybe the 100k ain’t worth it. Just recognize, some mediocre kid at a top 20 might get picked over you. It comes down to knowing yourself and what you want and what you’re willing to pay.

 

[KnightDoc]

It's worth if you are not taking loans

yes, if you (or your parents) have 100K to spare (i.e. no loans).

Why are loans the deciding factor? While nobody WANTS to carry more debt than necessary, what doctor cannot pay off $100K plus interest over time, and why (or how) is $100K plus interest over time more valuable than $100K right now??? In fact, the availability of loans is the great equalizer that allows folks who don't have $100K to spare to have the same opportunities as those who do!! 🙂

 

[Chromium Surfer]

I would hardly hardly say it’s marginal for the tipy top class of residency programs. And even if it’s not the tipy top, I have seen very mediocre students from top schools match competitive residencies and top programs and a lot of it comes from the school name or the research opportunities that a top school brings. Ultimately it’s up to you if 100k across 4 years is worth it depending on what your goals are. If you’re trying for plastics at NYU for example, or some other uber competitive program it’s 100% worth it in my opinion. Just look at the medical schools from the first and second year residents in plastics at NYU (NYU, Columbia, Yale). However, if you’re a strong student and aren’t too focused on brand name programs, you’ll match into a competitive specialty, and maybe the 100k ain’t worth it. Just recognize, some mediocre kid at a top 20 might get picked over you. It comes down to knowing yourself and what you want and what you’re willing to pay.

So going off this logic the implication is that it is better to be average at a top 20 vs being average at a state school. Assuming someone gets into a top 20 and their state school, you would recommend that they go to the top 20 to cover their bases?

 

[Saturday’s Child]

Just recognize, some mediocre kid at a top 20 might get picked over you. It comes down to knowing yourself and what you want and what you’re willing to pay.

I keep seeing this statement thrown around as if it’s a common assumption. Just how many “mediocre students” do you think there are at top 20 schools? Pre-med success is not perfectly correlated with med school success, but I find it hard to believe there is a surplus of individuals who just decided to become incredibly lazy and unmotivated once they gained acceptance and started school at a t-20 program. I also find it hard to believe that there will be tons of students at “lower tier” schools who all of a sudden become Harvard-caliber in med school, yet will be punished because they don’t go to Harvard.

An accomplished student will always be an accomplished student. “Name recognition” aside, a top program will almost always make it easier to become “accomplished” if it has an abundance of research opportunities, great clinical training, etc. compared to a lower ranked state school. This does not mean it’s impossible to become accomplished at the state school, it just means there will be more barriers in place.

 

[PreMedStudent55555]

You can arguably do well on STEP 2 wherever you go. I’d say go with the highest ranked school or the one with the best reputation. A big factor moving forward will be LOR’s and who you know. Schools with better reputations will have faculty who have great connections to program directors who can help you succeed.

Other major factors like STEP 2, clerkship grades and etc will arguably be the similar where you go. It’s not like if you go to an unranked you’ll get a 250 whereas if you got a T50 you’ll get a 220 on STEP 2. You would’ve most likely gotten similar scores based on your abilities so I say go to the best school you can get into as they will likely have the best connections for you.

Best of luck and congrats on the acceptances!!

 

[EdgeTrimmer]

Why are loans the deciding factor? While nobody WANTS to carry more debt than necessary, what doctor cannot pay off $100K plus interest over time, and why (or how) is $100K plus interest over time more valuable than $100K right now??? In fact, the availability of loans is the great equalizer that allows folks who don't have $100K to spare to have the same opportunities as those who do!! 🙂

100K more in loan not 100K only. A primarycare salaried doctor living in SF who wants to spend like his dotcom friends may not be able to pay it off quickly

 

[KnightDoc]

100K more in loan not 100K only. A primarycare salaried doctor living in SF who wants to spend like his dotcom friends may not be able to pay it off quickly

So what? My point is simply that $100K is $100K, whether it's paid in a lump sum up front or over time with interest. It doesn't matter or not you live in SF and want to keep up with the Joneses, or whether or not you want to pay it off quickly or slowly. You say $100K in loans is not only $100K due to interest. The same could be said about a $100K lump sum, due to the money it could make over time if it were invested instead of spent.

 

[licensed to ill]

So what? My point is simply that $100K is $100K, whether it's paid in a lump sum up front or over time with interest. It doesn't matter or not you live in SF and want to keep up with the Joneses, or whether or not you want to pay it off quickly or slowly. You say $100K in loans is not only $100K due to interest. The same could be said about a $100K lump sum, due to the money it could make over time if it were invested instead of spent.

if you can manage an investment portfolio that grows at a consistent rate as high as student loans then you should just go work on wallstreet and forget about medical school

 

[A Ryan Seacrest Type]

I keep seeing this statement thrown around as if it’s a common assumption. Just how many “mediocre students” do you think there are at top 20 schools? Pre-med success is not perfectly correlated with med school success, but I find it hard to believe there is a surplus of individuals who just decided to become incredibly lazy and unmotivated once they gained acceptance and started school at a t-20 program. I also find it hard to believe that there will be tons of students at “lower tier” schools who all of a sudden become Harvard-caliber in med school, yet will be punished because they don’t go to Harvard.

An accomplished student will always be an accomplished student. “Name recognition” aside, a top program will almost always make it easier to become “accomplished” if it has an abundance of research opportunities, great clinical training, etc. compared to a lower ranked state school. This does not mean it’s impossible to become accomplished at the state school, it just means there will be more barriers in place.

Mediocre is an exaggeration, and I agree that in general a student that can get into a top20 will continue to be a high caliber student into residency, and that someone who struggled with undergrad and the mcat is likely to keep struggling in med school and step. However, my point is that the margin for imperfection in students from top20 or brand name schools is higher when competing for top residency programs. Such a margin gives you the freedom to score less on step, be lower class rank have less research etc. And even in terms of research, You yourself make the point that being accomplished is easier at top schools, go to Harvard and want World class level research just ask any of the faculty at your school or , go to UCLA? Same thing. Go to Cornell? cross the street to Rockefeller, sloan Kettering or HSS or stay at Cornell. Overl tho The reality is that coming from a tipy top school (like top10) you can probably sit on your butt (not that a student would) get a 230 on step, have like 2 publications, get no AOA and still have a decent chance at matching into a top or very good program which is not the case at the low tier schools. I would also argue that someone from Harvard or Stanford with a 240 and no AOA could still possibly get a seat over someone from a low tier school with a 250 and AOA at the tipy top.

 

[KnightDoc]

if you can manage an investment portfolio that grows at a consistent rate as high as student loans then you should just go work on wallstreet and forget about medical school

Not necessary -- anyone who understands this can do both. What do you think doctors (and anyone else with funds to invest) do with their money??

While past performance never guarantees future returns, the Vanguard S&P 500 Index Fund (an UNMANAGED stock fund that replicates the S&P 500 stock index, and only has $543.1 billion in net assets) returned 13.94% annually over the past 10 years as of 1/31/20, so unless your student loan interest rate is above 14%, (and before taking taxes into account) you'd have been better off borrowing $100,000 on 1/31/10 to pay for med school and investing $100,000 in the Vanguard S&P 500 Index Fund than writing a $100,000 check to a school.

The equivalent number is 21.66% over the past year, and 12.34% per year over the past 5 years. How much more consistent do the returns need to be to make the point? No need to get a MBA, know how to pick stocks or work on Wall Street. Not saying one way or the other whether it's worth paying more to go to a high ranked school. Just saying that money is money, whether it's burning a hole in your pocket or you have to borrow it.

 

[A Ryan Seacrest Type]

So going off this logic the implication is that it is better to be average at a top 20 vs being average at a state school. Assuming someone gets into a top 20 and their state school, you would recommend that they go to the top 20 to cover their bases?

Oh for sure, better to be average at a top 20 then average at a low tier state school lol but again is better worth it for you? That’s the million dollar question. If I wanted to have a better shot at a crazy competitive specialty or have a shot at a world class program then to me,I would dish out 100k more, 200k? Idk, 300k? Probably not. Can I still get into a top program from a low tier school, idk maybe? Would I have to absolutely kill it? Yea, would I be ok with maybe not matching at said program instead of dishing out 300k? Yep. But for 100k, I’ll pay it go to a top20 and expand my margin of imperfection for a shot at a top program. Might I regret the extra loan, well maybe not if I’m doing derm. Might I regret it if I’m doing family medicine, possibly lol

 

[Chromium Surfer]

Oh for sure, better to be average at a top 20 then average at a low tier state school lol but again is better worth it for you? That’s the million dollar question. If I wanted to have a better shot at a crazy competitive specialty or have a shot at a world class program then to me,I would dish out 100k more, 200k? Idk, 300k? Probably not. Can I still get into a top program from a low tier school, idk maybe? Would I have to absolutely kill it? Yea, would I be ok with maybe not matching at said program instead of dishing out 300k? Yep. But for 100k, I’ll pay it go to a top20 and expand my margin of imperfection for a shot at a top program. Might I regret the extra loan, well maybe not if I’m doing derm. Might I regret it if I’m doing family medicine, possibly lol

Thanks for your response. Just to clarify you’re saying you would prob not be cool with dishing out 300k “more” to go to a top 20 over a low tier state school which makes sense. However later on it sounds Kinda like you’re saying 300k would be too much for a top 20. But then again it’s rare to go to a top 20 for just a 100k, while paying 100k more to go there seems to be a common factor to consider.

So to get more specific, assuming 250k full COA for a low tier vs 350 full coa for a top 20 and for someone not interested in family med you would pick the top 20 in that case? I feel like that’s about an average difference in cost for state schools vs top 20 privates assuming no aid.

 

[Moko]

But if the difference in COA is over 100k+ across 4 years to go to the best school you get into, is it worth the pricetag for the marginal bump in your residency application?

So going off this logic the implication is that it is better to be average at a top 20 vs being average at a state school. Assuming someone gets into a top 20 and their state school, you would recommend that they go to the top 20 to cover their bases? ... Just to clarify you’re saying you would prob not be cool with dishing out 300k “more” to go to a top 20 over a low tier state school which makes sense. However later on it sounds Kinda like you’re saying 300k would be too much for a top 20. But then again it’s rare to go to a top 20 for just a 100k, while paying 100k more to go there seems to be a common factor to consider. So to get more specific, assuming 250k full COA for a low tier vs 350 full coa for a top 20 and for someone not interested in family med you would pick the top 20 in that case? I feel like that’s about an average difference in cost for state schools vs top 20 privates assuming no aid.

There's no right answer to these questions. It all depends on how much value one places on avoiding debt (and by proxy, ability to afford other things and/or achieve financial independence sooner), ego/prestige, other opportunities associated with better funded schools, and potential differences in competitiveness for a desired specialty and program. Many people are willing to give up a full tuition scholarship at a state school to attend Harvard, Hopkins, Stanford, Penn, etc. And even more extreme, some people have given up these scholarships at top 20's to attend a top 5. While I personally do not advise someone to go into debt over incremental increases in school ranking, people have different means and place different values on these things. So reaching a different conclusion from me and others does not necessarily mean it's the wrong choice. The most important thing is to make sure that any decision is informed, well thought out, and based in reality as to avoid 'buyer's regret'.

Very broadly, when I was thinking about debt and ranking, I had assigned my personal preference and probabilities to the four following scenarios, and my goal was simply to maximize my personal happiness through my school choice:
i) Pay more to attend higher-ranked school, remain satisfied with decision as attending
ii) Pay more to attend higher-ranked school, regret decision as attending
iii) Pay less to attend lower-ranked school, remain satisfied with decision as attending
iv) Pay less to attend lower-ranked school, regret decision as attending

I am very fortunate to have ended up in scenario i, but even had I ended up in scenario ii, I would still be okay with my original decision as I had already considered all outcomes when making my school choice. Just my thoughts.

 

[Moko]

Why are loans the deciding factor? While nobody WANTS to carry more debt than necessary, what doctor cannot pay off $100K plus interest over time, and why (or how) is $100K plus interest over time more valuable than $100K right now??? In fact, the availability of loans is the great equalizer that allows folks who don't have $100K to spare to have the same opportunities as those who do!! 🙂 ... My point is simply that $100K is $100K, whether it's paid in a lump sum up front or over time with interest. It doesn't matter or not you live in SF and want to keep up with the Joneses, or whether or not you want to pay it off quickly or slowly. You say $100K in loans is not only $100K due to interest. The same could be said about a $100K lump sum, due to the money it could make over time if it were invested instead of spent.

I agree that a dollar is a dollar, but the utility assigned to that dollar is different depending on one's financial circumstances. Someone going $100k into debt (whether it be for education or a financial investment, e.g a home or stocks) may need to go through potentially years of extra frugality and/or hardship (sustenance on off brand cup noodles, living with people they dislike, or in an area they'd rather not be in, etc). They cannot afford for their investment not to pay off. It's easy for us to say (with the benefit of hindsight) that someone 10 years ago would have been better off taking out loans and investing in index funds, but as you mentioned, the past does not always predict the future, and things could easily have gone the other way (think Enron before it bellied up).

In contrast, someone with a net worth of >$1 million can easily afford to pay (and lose) the $100k and still have no meaningful change in their quality of life. To take this to the extreme, for billionaires such as Bloomberg and Bezos, they "rationally" (from their perspectives) spent >$500,000,000 on ads, and >150,000,000 on a new vacation home, respectively, and would be completely fine even if their entire investment was lost.

Edit: Just realized I may have dated myself with the Enron reference. 😛

 

[KnightDoc]

I agree that a dollar is a dollar, but the utility assigned to that dollar is different depending on one's financial circumstances. Someone going $100k into debt (whether it be for education or a financial investment, e.g a home or stocks) may need to go through potentially years of extra frugality and/or hardship (sustenance on off brand cup noodles, living with people they dislike, or in an area they'd rather not be in, etc). They cannot afford for their investment not to pay off. It's easy for us to say (with the benefit of hindsight) that someone 10 years ago would have been better off taking out loans and investing in index funds, but as you mentioned, the past does not always predict the future, and things could easily have gone the other way (think Enron before it bellied up).

In contrast, someone with a net worth of >$1 million can easily afford to pay (and lose) the $100k and still have no meaningful change in their quality of life. To take this to the extreme, for billionaires such as Bloomberg and Bezos, they "rationally" (from their perspectives) spent >$500,000,000 on ads, and >150,000,000 on a new vacation home, respectively, and would be completely fine even if their entire investment was lost.

Edit: Just realized I may have dated myself with the Enron reference. 😛

I 1,000% agree with you, and love your step by step analysis of how you came to your decision.

I was simply responding to a post that basically said that $100K out of pocket was less expensive than borrowing. As I'm sure you know, interest is merely the price of paying current dollars back in the future, when they will be less valuable (other than computers and flat screen TVs, what costs less now than 10 years ago? -- certainly not health care, Big Macs or California real estate!), and does not make the investment more costly, unless, of course, it entails borrowing at usurious credit card interest rates in order to fund a lifestyle beyond one's means. My other post was just to prove the point using a widely followed stock index, to prove that one does not have to be an investment guru in order to earn at least as much from current funds as the interest on student loans.

Utility is something else entirely, there is no right or wrong answer, it is different for everyone, and, as you note, everyone has a different tolerance for risk. I would note, however, that the S&P 500 is a basket of 500 stocks, not one stock like Enron was. And even thought the market crashed during the financial crisis, it did come back, while, of course, a single company like Enron, or the Wall Street banks that failed, cannot. My post pointed out consistent returns over 1, 5 and 10 years.

Of course, things could change in the future, but that's not the point. The fact is, once you arrive at the decision that the extra $100K is worth the expense, it is not "more expensive" to borrow it than to write the check, due to the time value of money and the opportunity to earn a rate of return on funds not spent, even if that return is not absolutely guaranteed.

If one has available funds and is risk averse, paying cash is absolutely the way to go. But that does not mean borrowing is inherently more expensive. It's also more expensive to keep your money in a bank account than to invest in the S&P while it is going up 10% or 20%. And, of course, the availability of student loans means the opportunity to attend a more expensive, more prestigious school is not limited to those with a big pile of cash.

 

[Moko]

They scoff at the notion of using school prestige as a filter.

I agree that school prestige will not (nor ever) serve as an absolute filter for matching into competitive specialties and programs. School prestige is but one of many factors considered. However, for many programs, school prestige is already given considerable weight in deciding who to interview and rank. Per the 2018 NRMP PD Survey , 50% of programs (among all specialties) cited 'being a graduate of a highly-regarded US medical school' as a factor in deciding who to interview, with a mean importance score (MIS) of 3.8.

Select comparisons:
Step I: 94% programs, MIS of 4.1
MSPE / letters from same specialty: ~80-85%, MIS of 4.0-4.2
Clerkship grades: 76%, MIS of 4.1
AOA membership: 60%, MIS of 3.9
Research: 41%, MIS of 3.7

Similar findings and trends are seen when considering who to rank highly, and also across competitive specialties. I suspect that the most competitive programs within each specialty (typically big name university academic programs) are the ones citing research and medical school reputation as being factors, with mean importance scores being quite comparable to Step I, LORs, clerkship grades, AOA, etc. This isn't to imply that medical school rank/reputation is the most important factor considered (nb: it's definitely not), but school reputation is a consideration for many program directors per this survey, and in many ways, it does act as a partial filter. For me, this would explain why "top" schools tend to have more impressive match lists, and why residents at the most competitive programs by and large disproportionately come from their peer institutions (with some notable exceptions against this trend). Access to better-known faculty and other opportunities would not fully explain these observations.

If for whatever reason a student deems it important to end up in one of these programs, then considering medical school reputation (as one of many considerations, including debt, fit, proximity to family, etc) would not be an unreasonable one. Just my thoughts.