How to Match to Low vs. Mid vs. High Tier Residencies?

[AspiringMD2018]

I'm a rising MS1 and I'm trying to set goals and expectations for med school. I have found the differences in difficulty and expectations pretty clear for getting into different specialties (e.g. avg. step scores for a specialties, specialty specific research for competitive specialties, AOA, etc.) but I'm confused about how to go about setting goals and expectations for getting into programs within a specialty.

Within a given specialty, what might a successful applicant at a top tier residency (MGH, Stanford, Hopkins, etc.) look like, vs. a successful applicant to a mid tier vs. a successful applicant to a low tier?

Thanks!

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[Redpancreas]

First you need to see if tier even matters.

#1. What’s your end goal? Private practice/Community setting like 90%+ of physicians? If yes, proceed to #2.

#2. Is residency your anticipated terminal training and do you not plan on doing fellowships? (FM, EM, Surgical Subspecialties, etc.) . If yes, tiers don’t matter, but that doesn’t mean your field itself isn’t competitive. If it’s not your terminal training, proceed to #3.

#3. For fields like Internal Medicine (best example of this) as well as probably General Surgery, Pediatrics, Radiology, etc., your residency strength directly determines your fellowship chances so tier absolutely matters. Proceed to #5.

#4. If you want to go into academics, every tiny tier/name matters and you need to just churn out publications, do well on exams, etc. Things they look for are dedication to academics as demonstrated by gap years to do research, high volumes of publications with a track record of getting published, etc. Keep in mind salary is typically lower although you’ll be at the forefront of medicine and will be teaching the next generation.

#5. This is only a guide

High tier: AOA/Near top of class, minimum 240 Step 1, Top School (usually works by itself even if others are average). 1+ serious publication.

Midtier: Top half of class, 230+ Step 1, US MD school. Some research experiences.

Low Tier: Less than above.

 

[AspiringMD2018]

First you need to see if tier even matters.

#1. What’s your end goal? Private practice/Community setting like 90%+ of physicians? If yes, proceed to #2.

#2. Is residency your anticipated terminal training and do you not plan on doing fellowships? (FM, EM, Surgical Subspecialties, etc.) . If yes, tiers don’t matter, but that doesn’t mean your field itself isn’t competitive. If it’s not your terminal training, proceed to #3.

#3. For fields like Internal Medicine (best example of this) as well as probably General Surgery, Pediatrics, Radiology, etc., your residency strength directly determines your fellowship chances so tier absolutely matters. Proceed to #5.

#4. If you want to go into academics, every tiny tier/name matters and you need to just churn out publications, do well on exams, etc. Things they look for are dedication to academics as demonstrated by gap years to do research, high volumes of publications with a track record of getting published, etc. Keep in mind salary is typically lower although you’ll be at the forefront of medicine and will be teaching the next generation.

#5. This is only a guide

High tier: AOA/Near top of class, minimum 240 Step 1, Top School (usually works by itself even if others are average). 1+ serious publication.

Midtier: Top half of class, 230+ Step 1, US MD school. Some research experiences.

Low Tier: Less than above.

I'll won't be attending a top medical school, but it will be more upper middle tier (think top 30-40). Is this a nail in the coffin for getting those top-tier residencies or can it be made up for in other ways?

 

[DubbiDoctor]

I'll won't be attending a top medical school, but it will be more upper middle tier (think top 30-40). Is this a nail in the coffin for getting those top-tier residencies or can it be made up for in other ways?

Go on the meet the residents page of top residencies, and find out for yourself. Spoiler alert: plenty of top-tier residents graduate from US MD schools that are not top tier.

 

[AnatomyGrey12]

Within a given specialty, what might a successful applicant at a top tier residency (MGH, Stanford, Hopkins, etc.) look like, vs. a successful applicant to a mid tier vs. a successful applicant to a low tier?

Completely depends on the specialty. Something like IM is going to have great stratification, whereas something like integrated plastics where the people who match to the “low tier” programs will be superstars.

You also need to ask yourself why you want a top tier program. Depending on your career goals a top program might be more detrimental than helpful.

 

[Lexdiamondz]

I'll won't be attending a top medical school, but it will be more upper middle tier (think top 30-40). Is this a nail in the coffin for getting those top-tier residencies or can it be made up for in other ways?

Top students at USMD schools regardless of tier generally have their pick of residencies, while the effect of school ranking and perceived prestige matters the most among average students.

Compare the match lists of say, Columbia (top tier) and Einstein (mid tier). The average Columbia student matches into a top-tier research instution whereas the good Einstein students do well, and the average ones match at average university programs despite each school's respective average board scores not being terribly different.

 

[FlowRate]

I'll won't be attending a top medical school, but it will be more upper middle tier (think top 30-40). Is this a nail in the coffin for getting those top-tier residencies or can it be made up for in other ways?

Depends on the field and exactly how far up the top-tier. Literal top-3 residencies in any specialty tend to be Ivy / Public Ivy heavy. Top tier but not top-3 in lower competitiveness specialties still require a solid record but much less picky on med school.

 

[3characterslong]

#1. What’s your end goal? Private practice/Community setting like 90%+ of physicians? If yes, proceed to #2.

#2. Is residency your anticipated terminal training and do you not plan on doing fellowships? (FM, EM, Surgical Subspecialties, etc.) . If yes, tiers don’t matter, but that doesn’t mean your field itself isn’t competitive. If it’s not your terminal training, proceed to #3.

Are you suggesting that one competitiveness doesn't matter for someone interested in terminal training at a non-competitive specialty? Because if tiers don't matter and fellowship isn't your goal, it sounds like you're saying that. And thats something i'd like to hear.

 

[AspiringMD2018]

Go on the meet the residents page of top residencies, and find out for yourself. Spoiler alert: plenty of top-tier residents graduate from US MD schools that are not top tier.

How do you think these students overcome the hurdle of not being from a top tier medical school?

 

[AspiringMD2018]

Completely depends on the specialty. Something like IM is going to have great stratification, whereas something like integrated plastics where the people who match to the “low tier” programs will be superstars.

You also need to ask yourself why you want a top tier program. Depending on your career goals a top program might be more detrimental than helpful.

I am very much interested in academic medicine, as well as the possibility of working and living on either the west or east coast. Plus, if I'm setting goals, I might as well aim as high as is reasonable. My interest in academic medicine might change during medical school, but I want to be on track to achieve those goals to keep the door open at the very least.

 

[DubbiDoctor]

How do you think these students overcome the hurdle of not being from a top tier medical school?

Northwestern actually offers detailed information about the characteristics of their internal medicine residents. 63% come from top 25 medical schools, leaving more than a third that don't. 46% were AOA, and I presume a greater percentage of residents who didn't graduate from top med schools were AOA. I also assume they had higher board scores, 246 and 258 being the average. Lastly, they likely had excellent research. Residency matching is not determined by your medical school. It's a factor, but being above average in step scores, research, clinical grades or interviewing skills and/or being AOA will more than make up for not graduating from a top-tier med school.

Meet the Internal Medicine Residency Class of 2021: Department of Medicine: Feinberg School of Medicine: Northwestern University

 

[Redpancreas]

Are you suggesting that one competitiveness doesn't matter for someone interested in terminal training at a non-competitive specialty? Because if tiers don't matter and fellowship isn't your goal, it sounds like you're saying that. And thats something i'd like to hear.

Yeah, I don’t think it really does. Just go on your interviews, figure out which places give you the best fit, and go there and get your credit. SDN places a high emphasis on tier because it’s engrained in our head from medical school. There will come a point in everyone’s life here (unless you are doing academia) where the name of the hospital no longer makes an impact on your salary potential, quality of life, etc.

 

[Redpancreas]

Northwestern actually offers detailed information about the characteristics of their internal medicine residents. 63% come from top 25 medical schools, leaving more than a third that don't. 46% were AOA, and I presume a greater percentage of residents who didn't graduate from top med schools were AOA. I also assume they had higher board scores, 246 and 258 being the average. Lastly, they likely had excellent research. Residency matching is not determined by your medical school. It's a factor, but being above average in step scores, research, clinical grades or interviewing skills and/or being AOA will more than make up for not graduating from a top-tier med school.

Meet the Internal Medicine Residency Class of 2021: Department of Medicine: Feinberg School of Medicine: Northwestern University

Agreed, if you’re at a mid tier school, an upper tier IM program is very attainable if you have the innate ability and work very hard. People offhandedly list off AOA, multiple publications, 250+ Step scores, but these things take a great deal of dedication to do and people are lying about their stats in real life and on SDN. If everyone had the stats they said, everyone would get into a top residency.

 

[curiousneuro]

I'm a rising MS1 and I'm trying to set goals and expectations for med school. I have found the differences in difficulty and expectations pretty clear for getting into different specialties (e.g. avg. step scores for a specialties, specialty specific research for competitive specialties, AOA, etc.) but I'm confused about how to go about setting goals and expectations for getting into programs within a specialty.

Within a given specialty, what might a successful applicant at a top tier residency (MGH, Stanford, Hopkins, etc.) look like, vs. a successful applicant to a mid tier vs. a successful applicant to a low tier?

Thanks!

Having the "numbers" (Step 1 and 2) and grades are obviously important for getting the "top tier" residences, as well as research. However, as many posters have mentioned already, it really depends on what subspecialty you are going for. Neurology, for example, is much more research-oriented for the top-tier programs, but Step scores probably matter a little less than Ortho. You first need to find out what field you want to go in to, and then you can make decisions about residency options.

Main thing to keep in mind is to try to do well throughout school, and do well on Step 1. However...your priorities may change drastically between now and match season in fourth-year. "Top" residencies are not always the best place for you individually - part of the interview trail is trying to find the place that has the best "fit" - which, in my opinion, is WAY more important than "tier".