Okay, here we go...
A school's match list on face value should be the single most important thing when figuring out which medical school to go to. While we can quibble about medical education and where/when you 'learn' medicine, the end result of medical school is the ability to enter the NRMP and match at a program. For the vast majority of students, ie. those that are pursuing a career in clinical medicine of some flavor, this becomes the single most important aspect of medical school: attaining a residency position. Where a student ultimately matches is the sum of many components which I will try to explain as objectively and broadly as I can. A school's match list therefore is the sum of that sum. In my personal opinion because of the sheer number of variables that goes into each match, their non-linearity and the many personal factors that go into it, trying to analyze the sum of the sum is foolhardy.
#1 How successful an individual match is determined by how far down on your rank list you had to go. At the end of the day, it is the ONLY measure of success, it is the sum of all the hard to figure out variables. This is not publicly available information. It is also far from a perfect variable since it is of course confounded by the fact that you can only rank a program that you interview at. It isn't fair to talk about pre-interview rank lists because people learn a ton about programs as they interview and their rankings will obviously shift as the interview trail goes on.
#2 You can only match somewhere if, a) You apply to their program, b) The program invites you for an interview, c) You decide to rank the program and d) The program decides to rank you. Unlike medical school admissions, where there are 141 MD-granting medical schools currently accredited by the LCME, there are 4,200+ residency programs administered by the ACGME. The largest specialty (Family Medicine) has 514 programs. While in smaller specialties, there are some applicants that apply to all the programs in the discipline, the reality is that the majority will not even come close. The 'top' students or the best students, regardless of what school they go to do not apply to programs based on a well publicized list provided by US News. The application process is far more personal and focused. It is easy to appreciate parts b, c and d as a pre-med, but understanding part (a) is non-trivial.
#3 How people decide on their rank list is personal. Everyone has their own priorities and what you need to understand is that those priorities are incredibly varied. It is something that is incredibly difficult to appreciate as a traditional applicant to medical school. I certainly did not understand it until I was well into residency. A big factor is AGE. You aren't talking about people in their early/mid 20s. You are talking about people in their mid-late 20s. The number who are married is significantly higher. The number with kids is significantly higher. The number who were, "academics all the way!" is much lower. The jadedness is much higher. You get my point. Simply put, it is a fundamentally different population that values things on average differently. There are plenty that haven't changed, but my point is that the population is much more heterogeneous. There are many more "real world" factors that come into play. For example, there is a thread by
@cbrons in allo that highlights the importance of healthcare benefits to him when looking for a residency. Never in a million years would I have ever guessed that that was a variable. But, it is for him. One can debate how important it should be (you can see the thread), but at the end of the day, it matters to some applicants. You can find dozens, if not hundreds of these reasons. One of the biggest of which...
#4 Geography. Do not underestimate the power of geography. Whatever you imagine it's influence on medical school admissions, multiply this by 100. Whether it be from family issues (see #3), ease of away rotations, school connections, faculty mentor cross appointments, geography influences how people apply to and rank residencies. Which brings me back to #1. Just because someone from the Midwest didn't apply to or rank programs at big name medical schools, doesn't mean that their match didn't go perfectly. This affects a very large number of graduating medical students. A couple years back, I knew a student at a non-ranked school in the Midwest applying to pediatrics, she was the only one that applied to CHOP of the 20+ that went into pediatrics, she ended up matching there. Very strong academically, likely the strongest of those going into pediatrics, but certainly didn't have something special that made her an obvious, gotta have. She was the ONLY one who applied.
#5 Program quality. As a pre-med, you can not possibly assess a program's quality from the outside. Applicants as MS4s can barely do it. Name of an associated medical school means very little. Do you know which Harvard/Yale associated programs were on ACGME probation in the last 5 years? I know of 2. I guarantee that there are more. I haven't seen a correlation with probation and name of medical school and doubt there is one. Matching into one of those programs, never mind the programs not on probation that should be (because the residents are coached on how to answer the ACGME survey, see thread in surgery sub-forum) or not on probation but because they aren't bad enough yet, is bad news. Having several world class faculty doesn't fix a dysfunctional training program. Typically, people only get wind of this on the trail and it simply drops the program to the bottom of their rank list, which brings me back to #1, the only thing that really matters.
#6 Program desirability. There is a correlation between strong residencies and big name medical schools. Some of this is funding, some of it is faculty recruitment. But, it is far from perfect. I interviewed at all 3 Harvard programs, JHU and Yale. Only one of those 5 were in my top 8. Above them were many programs which unless you are in vascular surgery would fly completely under your "competitive" radar, yet for me and for many of my colleagues is perfectly rational. Further, many people rank community, non-big name programs higher or don't even apply to the big academic programs, regardless of specialty (unless that specialty doesn't really have non-academic programs).
In summary, match lists reflect the school. Yes, schools that traditionally have stronger pre-meds are going to have MS4s with more options. People stay local. There is tremendous home institution bias, but also geographic clustering. Can school name matter? Of course it can. But, for the vast majority (95%+) of applicants, it means little to nothing. If you are a strong student with good credentials and a desire to end up at a powerhouse program in whatever specialty, you can get there and no, you don't have to stick out in some amazing way. At the tip-tip top of academic programs and in the super competitive specialties, you may get crowded out, but again, we are talking about a very small number of total students affected.
