Is a more prestigious medical school worth it?

[MedScholar18]

Is it worth paying 120k extra for a med school ranked around 30 over just going to an in state med school ranked around 100?

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[Lawpy]

It depends on many non-financial factors. Like fit, resources, closeness to family/SO/friends etc., school environment vibes, P/F vs grades etc.

 

[MaxPlancker]

Agree with above, but assuming the two schools fit you similarly, I wouldn't say a school around ~30 is worth 120K over a school around 100.

 

[Gabbey]

I was having the same discussion with my parents yesterday. They were talking about yale, emory, John Hopkins and the rest. And I am thinking about the cost . I don't see how that might make a difference. For me now it about which school will I be accepted to.

 

[MaxPlancker]

Well Hopkins and Yale are on a different field than Emory and some other top 30 school.

 

[WingedOx]

120k...? probably not.

 

[piii]

http://forums.studentdoctor.net/thr...ram-from-a-non-top-25-medical-school.1073026/

 

[caffeinemia]

Rank 30? At that point - you're tossed in with the rest of em. Save your 120k. Plenty of state school grads go on to kill it in life.

 

[operaman]

Seriously, as often as this question comes up, I can't believe nobody has done a decent study on it. There are similar studies looking at undergraduate schools; why not medical schools? As it stands now, the reality is we just don't know. We can speculate, but it hasn't been studied.

Students at more prestigious schools, on the whole, match at more prestigious residencies, have higher step scores, etc. This much is pretty easy to verify. The thing we don't know is whether an individual student with the chops to get accepted to a top 30 school (or top 5 or whatever) will have a better or worse outcome depending on whether she chooses to matriculate to the higher or lower ranked school. You see some stellar matches from lower ranked schools all the time; would our hypothetical student be more likely to be one of these? Again, we just don't know.

In light of not knowing, I think the best advice is to attend the best school you can. There are some rare exceptions where lower ranked schools can, in certain instances, provide the same or even better opportunities than much more prestigious ones for certain students pursuing certain fields, but this would get to a level of nitpicking that doesn't really benefit anyone. Broadly speaking, take the best opportunity you can get now and sort the rest out later.

 

[atomi]

In my opinion, probably. But I need more information. What school is it? Because that matters. Rank does not. Unless we are talking about top 10, then yes, it's worth the extra money, hands down.

 

[MedScholar18]

FAU and BU are the schools in question. @atomi

 

[Mansamusa]

No.

I was talking ortho surgeon who went to Yale and he said, "Ignore prestige. It doesn't matter. With the current state of medicine and the outrageous tuitions, go to the cheapest school you possibly can." Then the endocrinologist from Columbia I spoke to said, "I love my job, but I wish I went to my state school instead because my state school colleagues are debt free now, unlike me, and we both have the same exact job."

I have never met a physician who didn't agree that the prestige does not outweigh cost. For undergrad I say 100% choose the top 20 school over state school, but for med school that kind of money in high interest loans is not worth it.

 

[Imperius]

No.

I was talking ortho surgeon who went to Yale and he said, "Ignore prestige. It doesn't matter. With the current state of medicine and the outrageous tuitions, go to the cheapest school you possibly can." Then the endocrinologist from Columbia I spoke to said, "I love my job, but I wish I went to my state school instead because my state school colleagues are debt free now, unlike me, and we both have the same exact job."

I have never met a physician who didn't agree that the prestige does not outweigh cost. For undergrad I say 100% choose the top 20 school over state school, but for med school that kind of money in high interest loans is not worth it.

I had the exact same response from many doctors I've known. The response I get is: "Go to a med school, kill your boards, become whatever kind of physician you want. Board scores are more important than school."

 

[Goro]

I recommend the state school. You'll get a fine education no matter where you go.

Is it worth paying 120k extra for a med school ranked around 30 over just going to an in state med school ranked around 100?

 

[Mansamusa]

I had the exact same response from many doctors I've known. The response I get is: "Go to a med school, kill your boards, become whatever kind of physician you want. Board scores are more important than school."

Yeah, and I think we've already reached the point where people will be graduating with so much debt that they have to take the full 25 yrs to pay it off and will have to delay retiring, so I do not recommend taking out more than you need to

 

[MedScholar18]

Thanks for everyones input. However, it seems there is a very mixed opinion. Just for clarification by worth it I mean better residency placement.

 

[Acoustica]

finish med school with as little debt as possible, rock boards and honor your rotations...i feel like it doesn't matter in the long run

 

[Psai]

If you want to go to Harvard, it will be easier from bu. I think that name matters more than I thought it did before the match. I'm from a school without a big name and I didn't get interviews from some places that invited similar applicants. I did interview at the majority of academic programs I applied to in my region. But is school name worth 120k? I'm trying to figure out how I'm going to pay my loans and I think I would be despondent if I had 120k more.

My friend goes to a very highly ranked school and told me about multiple people that didn't match. Individual effort matters. You have to set yourself up for success and things like step 1, letters of rec from big names, 3rd year grades, research, aoa count. There are a decent number of 240+ and even 250+ people with solid apps who don't match to ent, derm, ortho, ophtho, etc. because of the limited number of spots and stiff competition

 

[operaman]

The question is worth it how? define worth here? Better residency (whatever that may mean)? How about correlation with residency match preference? Since 78% of US seniors match into one of their 3 top rankings that may not give us much useful data. Income? but that varies widely and mostly by specialty. I am not sure what you would define this as. It would seem to be a complex study looking at survey of doctors some 10-20 years down the career path to really make sense of it



http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf
Some idea can be gleamed from the yearly Residency Program Director's Survey, which includes "Graduate of highly regarded U.S. medical school" as a factor in both selection for residency interview and ranking for program. For example, in 59 Derm programs responding, 46% used this as a factor in granting interviews but only 22% used in a factor in ranking. It is about 150 pages covering 22 specialties.

Yeah the PD survey really is the only shred of data we have at the moment, though even this is painfully inadequate and doesn't even begin to answer the question. The PD survey always irks me because it's a 5 point Likert scale in which nothing ever gets scored less than a 3, so everything is super clustered together and nearly impossible to distinguish. Graduate of highly regarded US school is cited but seems on par or less important than volunteer/ECs and preclinical grades. Intuitively this just doesn't seem right, but then again the PD survey was never meant to be used this way. It's certainly a factor, but just how important it is in isolation and what, if any, effect it has on outcomes remains an unanswered question.

Given the cost of medical education, I'm surprised the AAMC hasn't studied this more robustly - the cohort of students accepted to top schools who matriculate elsewhere compared to those at the top schools themselves. They have the data of which students were accepted where and where they each ultimately matriculated. They could easily add some questions to the giant survey we all do at the end of med school - possibly even link with ERAS and NRMP since those are all linked with your AAMC number. You could even layer on academic promotion and NIH funding data using publicly available databases. All the most important data is sitting there. Seems like a disservice to the thousands of pre-meds who face this dilemma each year and have to make a big career and financial decision with terribly limited information.

 

[osckey]

Compare their match lists.

 

[atomi]

FAU and BU are the schools in question. @atomi

BU is not a big enough name to justify the extra cost over FAU in my opinion. And suppose you did have a harvard acceptance, this would really only matter for certain specialties and/or you were set on an academic career.

 

[pageantry]

Watching friends go through the match and experience disappointment makes me think what makes a prestigious medical school worth it are:

1) If it's in a region you want to be in (or risk being in) for ~10 years (given that it is usually easier to match closer to your school, especially if it has a good name in the region). Matching in a specialty you want is important. Matching in a region you like is important too.

2) If you think you'd click with your cohort better there (networking is everything in life. Plus, feeling sour and lonely the whole way through can only hurt your third year grades/letters of rec).

3) If their research opportunities and connections would inspire you (why go to all the trouble to become a doctor if you're going to be bored? Then again, some people don't care at all about research or academia).

And then--this is just my process but I'll recommend it--I suggest making a chart and filling in things like: What's your lowest possible future wage (if you match in a poorly paid specialty)? What would be your takehome after taxes (and really pretend you're an idiot who would take no deductions and make no active choices about managing your money)? And then make a final line for how much you'd have left over each month/year if you were paying PAYE rates on your loans with the more expensive school vs the less expensive school. Use the AAMC loan repayment calculator and the ADP after tax calculator.

For most schools, your repayment will be very similar on PAYE, despite difference in costs.

(Granted, forgiveageddon lurks, and could strongly affect things down the line, but I say let's not worry about that just now. 25 years is a long time to make wise investments and for regulations to change.)

For me, with my financial aspirations, this exercise lets me make a much calmer decision based on the quality of life I desire in the future, location, fit, career goals, etc. I think it really helps to see it in black and white.

 

[piii]

I'd only go to BU if you really want to do residency in Boston and the partners system. BUs name carries a lot more regional weight than national.

 

[Mansamusa]

And then--this is just my process but I'll recommend it--I suggest making a chart and filling in things like: What's your lowest possible future wage (if you match in a poorly paid specialty)? What would be your takehome after taxes (and really pretend you're an idiot who would take no deductions and make no active choices about managing your money)? And then make a final line for how much you'd have left over each month/year if you were paying PAYE rates on your loans with the more expensive school vs the less expensive school. Use the AAMC loan repayment calculator and the ADP after tax calculator.
.

The only thing with this though, is that it's really hard to predict. The first insurance company declared that in April they will start cutting physician reimbursement to make up for the profit they lost from ACA. Other insurance companies will follow. Salaries are going to drop, we know that much, but we are only just now starting to see the effects of the ACA. Less than 35% of physicians are independent practice owners (vs 62% 8 yrs ago), what will happen to salaries once everyone is employed?

We are moving towards more socialized programs and in the 2-3 presidential elections that will occur during our training, I think we will start to see a rise in federal taxes. Even Bernie's proposals, which call for the highest tax increases, do not make accommodations for people balancing a half a million dollar loan while also losing half their income to taxes. And there aren't an incredible amount of deductions available for a single person making over $150K.

The general trend strongly suggests lower salaries and more taxes taken, which is why I very much think that anyone going to med school should focus on limiting their debt. There is a reason only 10% of physicians are optimistic about the future of medicine, and it is in everyone's interest to put themselves in the best position they can by reducing their debt load.

It is one thing if the difference was $20K, but $120K will likely mean an extra $200K after residency, which will end up being a lot more over the lifetime of the loan

 

[pageantry]

The only thing with this though, is that it's really hard to predict. The first insurance company declared that in April they will start cutting physician reimbursement to make up for the profit they lost from ACA. Other insurance companies will follow. Salaries are going to drop, we know that much, but we are only just now starting to see the effects of the ACA. Less than 35% of physicians are independent practice owners (vs 62% 8 yrs ago), what will happen to salaries once everyone is employed?

We are moving towards more socialized programs and in the 2-3 presidential elections that will occur during our training, I think we will start to see a rise in federal taxes. Even Bernie's proposals, which call for the highest tax increases, do not make accommodations for people balancing a half a million dollar loan while also losing half their income to taxes. And there aren't an incredible amount of deductions available for a single person making over $150K.

The general trend strongly suggests lower salaries and more taxes taken, which is why I very much think that anyone going to med school should focus on limiting their debt. There is a reason only 10% of physicians are optimistic about the future of medicine, and it is in everyone's interest to put themselves in the best position they can by reducing the debt

Eh. This is my cynicism talking, but money will control politics the way it has always done. And that means corporations will not go out of style.

Thus, smart money forms an S-corporation and writes student loan repayment into the terms of hiring its principle employees (yourself). This makes student loan repayment a tax deductible expense per corporate tax code. This is what big money does and this what physicians should do. Incorporating can turn your whole life into a completely legal tax deduction/CEO benefit.

If you're not in a field that reasonably allows for self-employment, PSLF is a strong choice. If that doesn't work, if nothing works, if we're all screwed. Well. Then we're all screwed. But I would suggest the reason PSLF exists is because the continued possibility of much more lucrative private practice is not going anywhere anytime soon.

Service to the poor can be built into your corporate tax deduction strategy. Corporations don't match charitable contributions because they're sweethearts.

I agree there are risks, but I personally think fear of risk shouldn't override choosing a school with a location and fit you like, given that PAYE levels the playing field so much over the next 25 years. However, as you point out, risk aversion should be factored into this decision.

That said, (not that this is you), physicians who complain about compensation compared to being in finance or business are the ones who should be most willing to face some risk. Unfortunately, "risk taker" is not the typical medical student profile.

I think smart people with real skills and the capacity to hire smart accountants and lawyers will be okay. Someone's always going to be on top. Medicine is a reasonable leg up.

 

[osckey]

FAU and BU are the schools in question. @atomi

FAU has INCREDIBLY LOW tuition for in-state. If I recall correctly, it's somewhere around 28,000/year. That's leaves you in a position to be a considerably lower amount of debt after school.

 

[MedScholar18]

http://www.med.fau.edu/newsandevents/March_2015_FYN_Newsletter.pdf

This is FAU's 2015 match list. Is it any good?

 

[christmasindr]

There is much more to life and medicine than prestige. If you find a school that is lower ranked and fit your needs (e.g. financially, regionally, student body), then by all means go for it. I gave up a top 10 school for a much lower ranked state school, and I never regretted it. Not that US News Ranking is a good objective ranking system.

 

[osckey]

No

Ok

 

[SooDeeO]

I've come from a mid-tier state school in the south without much national prestige/recognition.

1) Prestige may not seem to have mattered to those who already came from a good pedigree. The prestige bias is more palpably felt against a person with no supposed elite academic background. So when an "ortho surgeon from Yale" gives you his/her two-cents about the "prestige doesn't matter" speech, take it with a grain of salt.

2) It is also equally wrong to say that individual effort doesn't count--when you crush your med school class rank and Step I/II scores, become an AOA member, display strong work ethic throughout your clerkship rotations, and gain research experiences, you will most likely receive interview invites from premier residency programs across the nation. I as well as many of my classmates did.

3) One of the benefits of attending a more nationally-recognized medical school is that it is a lot easier to locate mentors with national connections. Big name institutions tend to successfully recruit big name faculty. This also influences the variety/quality of available research projects. I cannot overemphasize this point. After gaining entry to medical school, every successive application cycle becomes iteratively smaller, making networking that much more important.

4) The general career goals/aspirations set by your fellow classmates could easily influence your motivation/drive. Your classmates and you together grow in maturity and change in career objectives over the years. It is easier to be motivated if you surround yourself with brighter people. I'd personally rather be the dumbest person in the room than the smartest.

5) The widely-accepted notion that Hopkins/Yale graduates match frequently to Brigham & Women's and MGH while a regional program like FAH may not be able to provide a similar trend from year to year should be considered as you make your decisions. While it is obviously true that personal priorities, such as regional preference, family ties, etc heavily influence match list, a conspicuous absence of "top-tier" programs should still be a red flag. While I understand and appreciate that not everyone is shooting for top academic residency programs, it's difficult to predict your career goals as a pre-med; therefore, it's best to keep doors open.

 

[MedSkoolz]

In a similar situation as OP and going with prestige. My choice was Michigan vs Wayne with 50k-75k difference. Some people told me prestige doesn't matter, but after talking to med students, I think it does (but I am no expert of course).

When you can tell your mentor that you want to move back to XYZ for residency and they can make a "call" or you are interested in XYZ specialty and your mentor is nationally renowned in that field, I would consider that an advantage.


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[pageantry]

To glom onto some things @SooDeeO wrote in that great post, one thing I've done is ask friends of mine why they chose their oncologist when they were diagnosed with cancer.

Every single time they cite a big name school they noticed on their doctor's residency.

Sometimes prestige/reputation isn't for you as much as it is for them.

 

[Psai]

In a similar situation as OP and going with prestige. My choice was Michigan vs Wayne with 50k-75k difference. Some people told me prestige doesn't matter, but after talking to med students, I think it does (but I am no expert of course).

When you can tell your mentor that you want to move back to XYZ for residency and they can make a "call" or you are interested in XYZ specialty and your mentor is nationally renowned in that field, I would consider that an advantage.


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It matters but how much does it matter? Is it worth 200k? Probably not. I think for 50-75k you are making the right decision. Some doors are closed to people from lower ranked schools. You won't be matching mass eye and ear without being from a top school. But you can still get an ophthalmology spot and be a great eye surgeon

 

[Dr. Death]

http://www.med.fau.edu/newsandevents/March_2015_FYN_Newsletter.pdf

This is FAU's 2015 match list. Is it any good?

Doesn't matter. Ignore all match lists when making school vs school decisions.

 

[MedScholar18]

@SooDeeO would you say going to the state medical school that you did hurt your residency prospects?

 

[JonnyMintz]

This conversation was going on at the hospital I volunteer at - a prestigious one in a medium sized city. In the E.R., the doctors educations range from Caribbean schools to Ivy League, with a pretty even distribution (it's easy to find this stuff out on the hospital websites). Their residencies are fairly similar as well.

When I asked one of the physicians about how I can look at this choice, he pretty much to go to a school that doesn't have a "bad" reputation. He mentioned some of the southern state schools as an example - (Mississippi, LSU). He said as long as you're OK working in those areas, it's OK to go to a school hovering around 100, and making an impression on your professors and during your rotations. He also told me all this stuff can be found in MSAR, especially with regard to which field you want to enter, and how much research you want to do.

 

[Perrotfish]

Thoughts:

1) There is insufficient data to say whether going to a top school helps, hurts, or doesn't affect your chances at your choice of residency. The issue is that the more competitive the school, the more competitive the classmates, so you have a better name but a lower class rank. Unless you are planning to be the top student AT the top school, you may actually be costing yourself. Or it may help, but I don't think anyone here knows.

2) I think that, for the same reasons, there is insufficient data to say that a top school helps, hurts, or doesn't affect your chance of finding a mentor for research. Top schools have more top researchers, but they also have more students interested in becoming top researchers. Its easier to get a job when no one else is applying, but its harder when there are fewer jobs, so without knowing the exact ratio we don't know if a prestigious school helps or hurts.

3) The type of residency you match matters for you career, the prestige of the residency you match is almost worthless. I guess it could help you get a job at a better Medical school, if you want to pursue academic medicine, but mostly this is a trade and you're either certified or not. An Ortho can work pretty much anywhere as an Ortho. Salaries/work hours/job satisfaction are (relative to other jobs) incredibly flat within medical specialties

4) Remember, when you're talking about borrowing money, think about it in terms of how much time you are going to need to work to pay it back. If you borrow 100K it compounds to 150K by the end of residency. Over a 10 year plan after residency you will pay back 225K. You pay that with after tax dollars, so you need to actual EARN about 300K. So you're looking at working for a full 1-2 years just to pay back the difference in tuition. Is 4 years at this school worth 1-2 years of your life after school is done? Its not unreasonable to say yes, but that's how you should think about it.

 

[christmasindr]

Doesn't matter. Ignore all match lists when making school vs school decisions.

Yeah I agree. Match lists are very hard to analyze, even for medical students. Just because someone got an interview from a big-name-residency program, it doesn't mean that person will rank it higher than a community program for many reasons.

 

[Azete]

The general feeling I get from associates is that medical students and pre-meds always wish they were at a more prestigious school, while residents & attendings wonder why they ever gave a ****.

 

[Lannister]

So, here's my question. A lot of people are saying that it's easier to get a more prestigious residency when you go to a more prestigious med school. But what is meant by prestigious residency? A residency in a competitive field like derm or ENT, or a residency at a prestigious institution? If I wanted a competitive specialty but didn't care about being "the best in my field" or having an academic career, then does prestige matter or no?

 

[JonnyMintz]

Thoughts:
3) The type of residency you match matters for you career, the prestige of the residency you match is almost worthless. I guess it could help you get a job at a better Medical school, if you want to pursue academic medicine, but mostly this is a trade and you're either certified or not. An Ortho can work pretty much anywhere as an Ortho. Salaries/work hours/job satisfaction are (relative to other jobs) incredibly flat within medical specialties

I think this is the best advice so far. Someone in my family is a surgeon had residency at a very undesirable hospital. She finished just well enough in med school to match into the specialty. Once her residency was up, she left and has a majorly successful career. Maybe those years weren't as glamourous as she liked, but she'll have a decades-long career because of it.

 

[Perrotfish]

I think this is the best advice so far. Someone in my family is a surgeon had residency at a very undesirable hospital. She finished just well enough in med school to match into the specialty. Once her residency was up, she left and has a majorly successful career. Maybe those years weren't as glamourous as she liked, but she'll have a decades-long career because of it.

To understand the glamour of a prestigious residency I would like you to imagine two bars. The first is in an exclusively Los Angeles area club. It is filled with all of your favorite A list celebrities. The other is in a middle class neighborhood in a small Midwestern city. It is a hangout for off duty police officers and postal workers.

Now imagine that in each bar there is a bathroom

Next imagine that each bathroom is connected to a septic tank

Finally imagine that there are two people, one is assigned to clean out the first septic tank, and one is assigned to clean out the second.

Which of those two people has the more glamorous job?

 

[7331poas]

To understand the glamour of a prestigious residency I would like you to imagine two bars. The first is in an exclusively Los Angeles area club. It is filled with all of your favorite A list celebrities. The other is in a middle class neighborhood in a small Midwestern city. It is a hangout for off duty police officers and postal workers.

Now imagine that in each bar there is a bathroom

And imagine that each bathroom is connected to a septic tank

Now imagine that there are two people, one is assigned to clean out the first septic tank, and one is assigned to clean out the second.

Which of those two people has the more glamorous job?

Not sure I see that comparison. Those septic tank cleaners are generally aware of their environment. I would rather be the septic tank cleaner who lives in San Diego rather than some rural poophole.

 

[Germanicus89]

Not sure I see that comparison. Those septic tank cleaners are generally aware of their environment. I would rather be the septic tank cleaner who lives in San Diego rather than some rural poophole.

I think perhaps your comment unwittingly exposes the substance of the comparison.

 

[Moko]

I would rather be the septic tank cleaner who lives in San Diego rather than some rural poophole.

Pun intended?

 

[JonnyMintz]

I think perhaps your comment unwittingly exposes the substance of the comparison.

Haha - I get it!!

 

[Cyberdyne 101]

Not sure I see that comparison. Those septic tank cleaners are generally aware of their environment. I would rather be the septic tank cleaner who lives in San Diego rather than some rural poophole.

He's referring to the "glamour"'of the residency itself, not the location.

 

[christmasindr]

It matters but how much does it matter? Is it worth 200k? Probably not. I think for 50-75k you are making the right decision. Some doors are closed to people from lower ranked schools. You won't be matching mass eye and ear without being from a top school. But you can still get an ophthalmology spot and be a great eye surgeon

Hahaha if that person's sole goal of going to med school is to match into Mass General ENT program, then I feel incredibly bad for his/her life.

That being side, I think this thread discussion is going nowhere. Yes, prestige helps and matters...to some degree. But at some point, it is not worth pursuing it (e.g. high cost).

 

[Mansamusa]

http://www.med.fau.edu/newsandevents/March_2015_FYN_Newsletter.pdf

This is FAU's 2015 match list. Is it any good?

Yes, I say this is good enough.

You have an ENT and neuro match. That means there is some infrastructure for students to gets the research and networking they need to match in a competitive specialty. Especially with neurosurg. The average person who matches there has a lot of pubs. All you need to know is that they have the resources available to you to go in any direction you want, and it's just up to use make good use of them

And, remember, the majority of students do not apply to competitive specialties, so even if you think you want to do one now you may change your mind.

 

[AlfonsTheGuru]

Well Hopkins and Yale are on a different field than Emory and some other top 30 school.

Yale medical center is especially on a completely different field since their recent lawsuit.