It's insanely difficult to get into a Top IM Program from a non-top 25 medical school

[ABatOutofHeck]

I wanted to post this because it directly contradicts the information I got throughout medical school, the residency application process, and even when choosing a med school. It is an uphill battle getting to top programs from outside the top tier of medical schools. A quick look at the BWH and UCSF website housestaff listing is all it takes to see this. Out of BWH's current intern class, 62 came from top 25 US News schools vs. 13 from other schools. UCSF's incoming class consists of 42 from top 25 med schools vs. 20 from other programs.

Having talked to MS4s from my school (which is just outside the top 25) post match, they had an experience in line with this. The AOA/250+ students got interviews at the tip top programs but most fell quite a bit down their rank lists. I think we underplay just how much where you're coming from matters.

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[gutonc]

Yeah...while this is news to the trolls over in Pre-Allo, it's something many of us have been saying essentially forever.

Also, it may surprise you to know that many undergrad pre-med advisors are living in a different world than the rest of us and the same is sometimes true of many med school deans/advisors.

 

[GTV]

I wanted to post this because it directly contradicts the information I got throughout medical school, the residency application process, and even when choosing a med school. It is an uphill battle getting to top programs from outside the top tier of medical schools. A quick look at the BWH and UCSF website housestaff listing is all it takes to see this. Out of BWH's current intern class, 62 came from top 25 US News schools vs. 13 from other schools. UCSF's incoming class consists of 42 from top 25 med schools vs. 20 from other programs.

Having talked to MS4s from my school (which is just outside the top 25) post match, they had an experience in line with this. The AOA/250+ students got interviews at the tip top programs but most fell quite a bit down their rank lists. I think we underplay just how much where you're coming from matters.

If you haven't, take a look at our past couple years' threads on IM match results which, by and large, illustrate your lament. Indeed, there are exceptions, but you are correct-- it is quite difficult and not at all commonplace for those in lower-tier US MD schools to secure residencies among the most competitive institutions (even among the 250+/AOA crowd). Having substantial research or something else on your application that is truly unique can help significantly, but still does not make up for the lack of pedigree. It sucks, but it's the way it is.

 

[IMPD]

I am still early in my advising career, and I think it is a travesty that this is not made common knowledge all the way down the ladder.

Perhaps it is too inflammatory to say "If you to Upstairs Medical School, you will be significantly disadvantaged in applying to Standford residency". It is left to me at my institution to tell the MS3s this. They appreciate the honesty, even if some of them leave the meeting kicking themselves.

Overall, those of us on the long-done side know that life goes on and that residency at Stanford/UTSW/whatever is no key to happiness, but medical students and pre-meds are being done a diservice.

The important thing to remember with all Bayesian statements is that there are EXCEPTIONS. Unfortunately, the human brain seems to love exceptions more than rules.

 

[visari]

This is the sad truth. and i know how it comes as a shocking fact to MS3s. But seriously who cares. is MGH or UCLA a great place to train for IM? I'm sure they are, but there're tons of solid IM programs out there. some of them might not have the same rigorous academic background but they'll do the job and get you where you want to be.

 

[LoudBark]

I wanted to post this because it directly contradicts the information I got throughout medical school, the residency application process, and even when choosing a med school. It is an uphill battle getting to top programs from outside the top tier of medical schools. A quick look at the BWH and UCSF website housestaff listing is all it takes to see this. Out of BWH's current intern class, 62 came from top 25 US News schools vs. 13 from other schools. UCSF's incoming class consists of 42 from top 25 med schools vs. 20 from other programs.

Having talked to MS4s from my school (which is just outside the top 25) post match, they had an experience in line with this. The AOA/250+ students got interviews at the tip top programs but most fell quite a bit down their rank lists. I think we underplay just how much where you're coming from matters.

Life is not always fair. The earlier you realize this........well you get the point.......

 

[jdh71]

I wanted to post this because it directly contradicts the information I got throughout medical school, the residency application process, and even when choosing a med school. It is an uphill battle getting to top programs from outside the top tier of medical schools. A quick look at the BWH and UCSF website housestaff listing is all it takes to see this. Out of BWH's current intern class, 62 came from top 25 US News schools vs. 13 from other schools. UCSF's incoming class consists of 42 from top 25 med schools vs. 20 from other programs.

Having talked to MS4s from my school (which is just outside the top 25) post match, they had an experience in line with this. The AOA/250+ students got interviews at the tip top programs but most fell quite a bit down their rank lists. I think we underplay just how much where you're coming from matters.

Lerk Moar

 

[Deferoxamine]

Yeah...while this is news to the trolls over in Pre-Allo, it's something many of us have been saying essentially forever.

Also, it may surprise you to know that many undergrad pre-med advisors are living in a different world than the rest of us and the same is sometimes true of many med school deans/advisors.

I do agree that many of my mid-tier med school advisors were CLUELESS about what a bloodbath IM has become (likely overblown because I think we all apply and interview at more places than we need to). I think they also severely underestimated just how gifted and smart (and achieving) my peers at so many other medical schools were (as I have discovered during residency). There are a lot of things about a person that can make them a great resident.

But at the end of the day, I don't think I can blame the advisors. I think the reason for their generic advice is 1) not to offend anyone, 2) because they truly just don't know how you'll do. Especially at the mid-tier, why not tell all your AOA's and near-AOA's to shoot for the moon? At the end of the day, they just don't know what will happen. Certainly in other medical school classes at my school (not my class), at least 2 anecdotes of the charismatic and likeable junior AOA falling FAR on their IM list (YES, for IM), while the person who barely squeaked into senior AOA lands at a Top 5/6 institution. And these applicants were very self aware that this happened, and NO, their lives were not over when it didn't work out exactly as planned.

Top 6/8/10 programs all know what they want. Period. Years ago, I interviewed at 6 of them. When you're a mid-tier, when you walk through that door, an element of magic between you and the interviewer you ended up with either happens or it doesn't happen. Period. If it happens, you'll know it because they'll probably tell you. If it doesn't... they probably don't deserve to have you anyways, so enjoy the free food and buy yourself a drink on the plane ride home.

 

[DIce3]

This is the sad truth. and i know how it comes as a shocking fact to MS3s. But seriously who cares. is MGH or UCLA a great place to train for IM? I'm sure they are, but there're tons of solid IM programs out there. some of them might not have the same rigorous academic background but they'll do the job and get you where you want to be.

Agreed. I really don't understand the interest in the pecking order unless the medical student desires an academic career. I suspect, but surely could not prove, that most state university programs are clinically fully equal to the "top 4." Furthermore, state university programs would afford entrance to a competitive fellowship placement in a similar state university system. Pedigree becomes 100% irrelevant out in clinical practice.

 

[visari]

Agreed. I really don't understand the interest in the pecking order unless the medical student desires an academic career. I suspect, but surely could not prove, that most state university programs are clinically fully equal to the "top 4." Furthermore, state university programs would afford entrance to a competitive fellowship placement in a similar state university system. Pedigree becomes 100% irrelevant out in clinical practice.

most medical students dont see it that way. pretty much the majority "think" they want an academic career. Though I can't blame medical students because a lot of fellows went into fellowship thinking they wanted an academic career. eventually ~10% actually did it.

At the end of the day these top places are very tempting to go to and their academic reputation is hard to match, but top medical students at non-top medical schools should be told early by their mentors that they might not get a lot of love from these places and life isn't over if that happens. They can still be good doctors and/or scientists.

 

[235009]

I'm very glad to (finally) hear a consensus on this. Now someone needs to tell this to the gaggle of premeds who keep "advising" their peers to go to the cheapest school and that everyone is on equal footing no matter which school you attend.

 

[qxrt]

Agreed. I really don't understand the interest in the pecking order unless the medical student desires an academic career. I suspect, but surely could not prove, that most state university programs are clinically fully equal to the "top 4." Furthermore, state university programs would afford entrance to a competitive fellowship placement in a similar state university system. Pedigree becomes 100% irrelevant out in clinical practice.

It's funny that in a thread about stopping the perpetuation of the myth of "every med student is equal when applying to all residencies," you then perpetuate yet another similar myth that affects medical professions even further down the line, namely "pedigree is not important at all unless you plan to go into academics." Pedigree definitely gives a wow-factor when it comes to the layperson, and I have personally seen many people choose a physician and judge how good or bad of a doctor he or she is based on the context of his or her pedigree. Believe it or not, it is human psychology to be just as, if not more forgiving, of a Harvard-trained doctor with a few eccentricities than a no-name-trained doctor with good bedside manners. And I would be surprised if you have never seen a person choose to go to a certain doctor over another because that doctor went to Harvard or another famous name.

Of course, in the end, your ability as a doctor is all that should matter, but that's no reason to be oblivious to the fact that your pedigree will have effects on your career, whether in private practice or academics. And I prefer to deal with how the world is rather than how it should be.

 

[jdh71]

Eh. I think out in the "real world" the only person who cares you went to Mass Gen is someone who went Mass Gen. Sorry. Are there groups that might be snobs about this stuff? Sure. Most groups are only going to care that you are BE/BC, will potentially get along with the group (which usually means not being an elitist and pretentious a-hole), and had solid recommendations by peers as a good doc.

 

[DoctwoB]

I'm very glad to (finally) hear a consensus on this. Now someone needs to tell this to the gaggle of premeds who keep "advising" their peers to go to the cheapest school and that everyone is on equal footing no matter which school you attend.

While people may not be on equal footing at different med schools, price definitely still matters. If you could go to a halfway decent state medschool X for 100k instead of top 10 U for 250k (which will be a ~250 to 300k difference after interest), I'd still take the state school. Sure that top student/AOA at state U may end up at Emory or UPMC or UTSW or Michigan instead of UCSF or Brigham, but I'd take great training +300k over a slight pedigree difference and be a happy man.

 

[GTV]

While people may not be on equal footing at different med schools, price definitely still matters. If you could go to a halfway decent state medschool X for 100k instead of top 10 U for 250k (which will be a ~250 to 300k difference after interest), I'd still take the state school. Sure that top student/AOA at state U may end up at Emory or UPMC or UTSW or Michigan instead of UCSF or Brigham, but I'd take great training +300k over a slight pedigree difference and be a happy man.

As many have alluded to above, I think it totally depends on the career aspirations of the student. Your point would be well-taken if the student was absolutely sure he/she wanted to go into private practice. However, if the individual has any inkling whatsoever that he/she may want a career in academics, it would likely behoove that individual to eat the extra $300k and take the better name.

 

[235009]

As many have alluded to above, I think it totally depends on the career aspirations of the student. Your point would be well-taken if the student was absolutely sure he/she wanted to go into private practice. However, if the individual has any inkling whatsoever that he/she may want a career in academics, it would likely behoove that individual to eat the extra $300k and take the better name.

Exactly. You have people in the pre-allo forum who make it sound so cut and dry. They make it sound like even with a $15k per year difference you'd be a fool not to go with the cheaper school no matter what. They're truly doing people a disservice. It stems from the "undergrad school doesn't matter" myth that's also sdn dogma.

 

[GTV]

Exactly. You have people in the pre-allo forum who make it sound so cut and dry. They make it sound like even with a $15k per year difference you'd be a fool not to go with the cheaper school no matter what. They're truly doing people a disservice. It stems from the "undergrad school doesn't matter" myth that's also sdn dogma.

Yup. These people really need to be educated as soon as possible that as unfortunate and seemingly unfair it is, pedigree matters. A lot. And not only does it matter, but the degree to which it matters (at least in the academic world, from what I've seen) seems to exponentially increase as you move to the "next level." Maybe others have some hard data on this (which may or may not support what I am saying), but top med schools will almost always take the applicant from Harvard/Stanford with the 3.7 GPA & 32 MCAT over the state school applicant with a 3.9 GPA & 36 MCAT. When two applicants apply to or interview at the same elite residency spot, you can put money on the fact that the guy from UCLA with the 235 step 1 will get the spot over the University of Wherever guy with 255/AOA/research. When applying to fellowship, the average-performing resident with minimal research who did his residency at UCSF will almost certainly get the spot at Brigham over the mid-tier residency superstar chief resident with multiple publications. Are there exceptions? Yes, but as someone else mentioned, they are just that: exceptions.

Are the higher-pedigree applicants inherently better physicians (or even better researchers) than the generics? I doubt it. But it is what it is, and I for one severely underestimated these aspects of academia when I was a medical school applicant (and a college applicant). In the future, if my children or the children of my friends have any interest in wanting to go into medicine from a young age (i.e. high school) and are otherwise bright, the number 1 piece of advice I would give them (besides considering other fields in addition to medicine) is to try to build pedigree in the earliest stages of education (starting with making oneself as competitive as possible for elite colleges) in order to maximize the number of academic opportunities available down the road. There is this notion these days that even speaking of pedigree makes one an elitist, classist, etc, that in our new, progressive world assertions as simple as "pedigree matters" are antiquated and crass, and that instead "you can do anything as long as you set your mind to it." This mindset and the unwillingness to engage in such discussions with young people truly does them a disservice and needs to change.

 

[DIce3]

Pedigree definitely gives a wow-factor when it comes to the layperson, and I have personally seen many people choose a physician and judge how good or bad of a doctor he or she is based on the context of his or her pedigree. Believe it or not, it is human psychology to be just as, if not more forgiving, of a Harvard-trained doctor with a few eccentricities than a no-name-trained doctor with good bedside manners. And I would be surprised if you have never seen a person choose to go to a certain doctor over another because that doctor went to Harvard or another famous name. Of course, in the end, your ability as a doctor is all that should matter, but that's no reason to be oblivious to the fact that your pedigree will have effects on your career, whether in private practice or academics. And I prefer to deal with how the world is rather than how it should be.

Reputation of the provider is everything..... Everything. Your ability to become an electromagnet in the community is what the ER nurse says about you behind your back. It is what a neighbor says to another neighbor about the doctor he/she saw. It is about what one doctor offhandedly says about another doctor.

99% of patients will be completely unaware of a doctor's pedigree even though there are diplomas all over the walls.
Most patients can't tell me the difference between an MD, ARNP, and PA.

Pedigree does not give a wow factor to the layperson. It does not. If one friend tells another friend that Dr. X is amazing... it makes no difference that Dr. X went to a crappy community program and Dr. Y went to UCSF/BW. None. Zero. Not even on the radar.
This is true for all clinical specialties.

All the nonsense about "top school/residency" is an absolute waste of time. Unless a medical student wants to compete in the ultra-competitive grant writing arena years down the road, pedigree is totally irrelevant. Makes no difference. Acceptance to a competitive internal medicine fellowship is doable from any state program. In the current NIH system, wanting to be a grant writer means by definition that clinical work is going to be dropped. This removes any relevance to ranking for people who want to be practicing clinicians. For this last paragraph, I am speaking solely about internal medicine and internal medicine sub specialties (as I am a practicing internist and sub specialist).

 

[jdh71]

In the current NIH system, wanting to be a grant writer means by definition that clinical work is going to be dropped. This removes any relevance to ranking for people who want to be practicing clinicians. For this last paragraph, I am speaking solely about internal medicine and internal medicine sub specialties (as I am a practicing internist and sub specialist).

qft

 

[DoctwoB]

As many have alluded to above, I think it totally depends on the career aspirations of the student. Your point would be well-taken if the student was absolutely sure he/she wanted to go into private practice. However, if the individual has any inkling whatsoever that he/she may want a career in academics, it would likely behoove that individual to eat the extra $300k and take the better name.

'
Yes, because only MGH and UCSF internists become academicians . . . except wait, that's completely untrue.

Pedigree does matter, but the difference between a top 5 program and a top 20 program is tiny relative to the impact of individual skills/research/affability, etc.

 

[ABatOutofHeck]

I think people who talk about how this discussion is pointless because pedigree doesn't matter miss the fact that although pedigree may not matter for them, their situation is not representative of all people. For example, I want to do GI, am interested in an academic career, and have a wife who has career prospects in 2 very desirable cities. I wasn't willing to do community programs in those cities, and the academic programs there were all highly competitive. I didn't match at them and instead am headed to a program in the top 20 that will not hamper my career, but I will now spend either 3 years away from my wife or she will greatly sub-optimize her career trajectory (we're still deciding). Is it the end of the world? No, but it still sucks.

My lack of pedigree closed doors that I had no idea I'd end up needing open. I think this is why many people want to go to the best place they can. Can the Hopkins trained internist become a private practitioner whose practice is built on his patients recommending him to friends? Sure. But can the no name state U internist become chair of some institute at fancy pants medical center? The answer to this is also yes, but we all know that road will be much, much harder and require a lot of sacrifice and luck along the way.

 

[IMPD]

I think people who talk about how this discussion is pointless because pedigree doesn't matter miss the fact that although pedigree may not matter for them, their situation is not representative of all people. For example, I want to do GI, am interested in an academic career, and have a wife who has career prospects in 2 very desirable cities. I wasn't willing to do community programs in those cities, and the academic programs there were all highly competitive. I didn't match at them and instead am headed to a program in the top 20 that will not hamper my career, but I will now spend either 3 years away from my wife or she will greatly sub-optimize her career trajectory (we're still deciding). Is it the end of the world? No, but it still sucks.

My lack of pedigree closed doors that I had no idea I'd end up needing open. I think this is why many people want to go to the best place they can. Can the Hopkins trained internist become a private practitioner whose practice is built on his patients recommending him to friends? Sure. But can the no name state U internist become chair of some institute at fancy pants medical center? The answer to this is also yes, but we all know that road will be much, much harder and require a lot of sacrifice and luck along the way.

Your situation is a true representation about how doors get shut and the natural desire to "keep our options open". Honestly though, there aren't enough spots in the top 20 medical schools to enable everyone who wants to keep things open to actually do so.

If 80% of medical students are outside the top 20% med schools, lots of kids are getting MDs with built-in restrictions.

I don't do any pre-allo counseling, so I don't know how many kids are making bad career choices. My guess is that ultimately, many people regret not having a choice at some point in their life, and that 20 years afterwards it becomes like a lot of life, something that just happened. Everyone bails out of the "keeping options open" plan eventually...and not usually with any happiness.

 

[235009]

I don't do any pre-allo counseling, so I don't know how many kids are making bad career choices.

If we're talking about SDN pre-allo it has gotten really bad with the current seemingly universally accepted dogma being that attending a DO school is similar to attending a "low tier" US MD school. But of course when you actually look at match lists the matches look way more similar to caribbean schools than any US MD school's match list. Basically a whole slew of FM/IM community programs in the middle of nowhere but of course each one is deemed "excellent" and "fantastic" because of the 1 person out of 300 who matched into an ACGME ophto program.

....i need to stop going to the pre-allo and osteo forums

 

[circulus vitios]

It's funny that in a thread about stopping the perpetuation of the myth of "every med student is equal when applying to all residencies," you then perpetuate yet another similar myth that affects medical professions even further down the line, namely "pedigree is not important at all unless you plan to go into academics." Pedigree definitely gives a wow-factor when it comes to the layperson, and I have personally seen many people choose a physician and judge how good or bad of a doctor he or she is based on the context of his or her pedigree. Believe it or not, it is human psychology to be just as, if not more forgiving, of a Harvard-trained doctor with a few eccentricities than a no-name-trained doctor with good bedside manners. And I would be surprised if you have never seen a person choose to go to a certain doctor over another because that doctor went to Harvard or another famous name.

You really think the average layperson knows how schools outside of Harvard, Stanford, and Yale rank?

 

[AlmostAnMD]

I go to a top 100 medical school and there was a huge uproar over someone matching derm at UCSF.

Starting to see why

 

[IlDestriero]

It's true for the best fellowships as well. The majority of our fellows come from the same handful of highly regarded anesthesia programs.

 

[qxrt]

Reputation of the provider is everything..... Everything. Your ability to become an electromagnet in the community is what the ER nurse says about you behind your back. It is what a neighbor says to another neighbor about the doctor he/she saw. It is about what one doctor offhandedly says about another doctor.

99% of patients will be completely unaware of a doctor's pedigree even though there are diplomas all over the walls.
Most patients can't tell me the difference between an MD, ARNP, and PA.

Pedigree does not give a wow factor to the layperson. It does not. If one friend tells another friend that Dr. X is amazing... it makes no difference that Dr. X went to a crappy community program and Dr. Y went to UCSF/BW. None. Zero. Not even on the radar.
This is true for all clinical specialties.

All the nonsense about "top school/residency" is an absolute waste of time. Unless a medical student wants to compete in the ultra-competitive grant writing arena years down the road, pedigree is totally irrelevant. Makes no difference. Acceptance to a competitive internal medicine fellowship is doable from any state program. In the current NIH system, wanting to be a grant writer means by definition that clinical work is going to be dropped. This removes any relevance to ranking for people who want to be practicing clinicians. For this last paragraph, I am speaking solely about internal medicine and internal medicine sub specialties (as I am a practicing internist and sub specialist).

I agree with you that reputation is the most important thing by far, but pedigree does give a wow factor to certain, not all, laypeople. I myself know people who chose their doctors based on their pedigree. Are you telling me that I'm just hallucinating these people choosing doctors this way? It may not matter to you and maybe even to most people, but it will matter to some people. To say it is totally irrelevant is just false.

Of course, in practice, every competent doctor is going to have a sufficient patient base anyway, so this argument about the significance of pedigree is just academic in nature.

 

[sluggs]

I have some good (or bad) news for you guys:
1.You do not have to go to a top medical school to get a top IM residency. It may help, sure, but the top IM programs screen with: board scores, grades, clinical grades, top LORs (these are given out like water, mostly) and Academic Extracurriculars (publications, MPH, Masters in Biostats, PhD). Then you have to sell the bull**** at your interview.
2. You do not have to go to a top IM residency to get a top academic-bound fellowship: you need to be a top clinician AND really rock Academic Extracurriculars (see above). Having an academic mentor who is connected is certainly a help, but you can find Hopkins, MGH, UCSF alums who produce in academia, in a number of IM residencies.
3. You do not have to go to a top fellowship to land a great/high level academic job. See Academic Extracurriculars, above. Top academic positions are getting less competitive as people are seeing that "academic prestige" (working very hard, producing papers [whether or not they are meaningful], fighting for grant money, and making less $) isn't all it was billed to be.
4. You do not have to be in academics to be a great (even outstanding) physician and contribute to the medical community.
If academic prestige is your passion, by all means, go for it! Just be careful what you wish for...

 

[235009]

I have some good (or bad) news for you guys:
1.You do not have to go to a top medical school to get a top IM residency. It may help, sure, but the top IM programs screen with: board scores, grades, clinical grades, top LORs (these are given out like water, mostly) and Academic Extracurriculars (publications, MPH, Masters in Biostats, PhD). Then you have to sell the bullcrap at your interview.
2. You do not have to go to a top IM residency to get a top academic-bound fellowship: you need to be a top clinician AND really rock Academic Extracurriculars (see above). Having an academic mentor who is connected is certainly a help, but you can find Hopkins, MGH, UCSF alums who produce in academia, in a number of IM residencies.
3. You do not have to go to a top fellowship to land a great/high level academic job. See Academic Extracurriculars, above. Top academic positions are getting less competitive as people are seeing that "academic prestige" (working very hard, producing papers [whether or not they are meaningful], fighting for grant money, and making less $) isn't all it was billed to be.
4. You do not have to be in academics to be a great (even outstanding) physician and contribute to the medical community.
If academic prestige is your passion, by all means, go for it! Just be careful what you wish for...

you are the first person in this thread to use the phrase "have to" .....no one said or implied any of the things you're arguing against. Sorry you wasted your time writing that post. We all know you don't HAVE TO anything.

 

[jdh71]

you are the first person in this thread to use the phrase "have to" .....no one said or implied any of the things you're arguing against. Sorry you wasted your time writing that post. We all know you don't HAVE TO anything.

Of course you elitist types didn't say "have to" you simply stated that no one will probably love you otherwise.

 

[jdh71]

Man. If I had a dollar for every isolated anecdote being used to recommend anything in this thread, I'd be eating steak tonight.

The real bottom line is sometimes you get dealt a couple of aces and sometimes you're holding a 7 and a 2, off suit. Play YOUR cards accordingly. Everyone. Quit obessessing. The neuroticism of a handful of posters on SDN is THE CANCER that is killing this place very slowly.

What would be funny though is a system that forced every program to take a few of the dirty state school peasants every year in the elite programs. A sort of "affirmative action" for those who were simply not cool enough or well connected enough to land all these tops spots. This would be a great way for us all to be involved in social justice. I know everyone wants a chance to "check" their privilege.

Gig'em.

 

[ABatOutofHeck]

Man. If I had a dollar for every isolated anecdote being used to recommend anything in this thread, I'd be eating steak tonight.

The real bottom line is sometimes you get dealt a couple of aces and sometimes you're holding a 7 and a 2, off suit. Play YOUR cards accordingly. Everyone. Quit obessessing. The neuroticism of a handful of posters on SDN is THE CANCER that is killing this place very slowly.

What would be funny though is a system that forced every program to take a few of the dirty state school peasants every year in the elite programs. A sort of "affirmative action" for those who were simply not cool enough or well connected enough to land all these tops spots. This would be a great way for us all to be involved in social justice. I know everyone wants a chance to "check" their privilege.

Gig'em.

Honestly, I think it's the dismissive attitudes from a few posters about everything they don't think is important that's killing this place. As an infrequent poster, I never felt comfortable posting in the "WAMC" thread because I knew the responses were going to be "Oh, only AOA and 250+? You're clearly going to match in Timbuktu." Same thing in the "Help Me Rank" thread. Go read what kind of super helpful responses people with solely competitive schools on their ROL got. We get it. We're being unnecessarily neurotic and from your perch of infinite wisdom, you can see how insignificant all these queries are. If the topic is one you consider irrelevant and uninteresting but others find meaningful, how about letting them have their conversation instead of stifling it for everyone with caustic replies?

Regardless, I, for one, was not advocating for any course of action. I just wanted to provide a counterpoint for the pervasive advice that the playing field was somewhat level coming out of allopathic US medical schools. It's not; it's ridiculously steep. I don't see anyone advocating that this is an unfair situation that needs to be fixed. We're just arguing that premeds should be aware of it, so they know how they're limiting their future selves.

 

[jdh71]

Honestly, I think it's the dismissive attitudes from a few posters about everything they don't think is important that's killing this place. As an infrequent poster, I never felt comfortable posting in the "WAMC" thread because I knew the responses were going to be "Oh, only AOA and 250+? You're clearly going to match in Timbuktu." Same thing in the "Help Me Rank" thread. Go read what kind of super helpful responses people with solely competitive schools on their ROL got. We get it. We're being unnecessarily neurotic and from your perch of infinite wisdom, you can see how insignificant all these queries are. If the topic is one you consider irrelevant and uninteresting but others find meaningful, how about letting them have their conversation instead of stifling it for everyone with caustic replies?

Regardless, I, for one, was not advocating for any course of action. I just wanted to provide a counterpoint for the pervasive advice that the playing field was somewhat level coming out of allopathic US medical schools. It's not; it's ridiculously steep. I don't see anyone advocating that this is an unfair situation that needs to be fixed. We're just arguing that premeds should be aware of it, so they know how they're limiting their future selves.

That sound? It's the world smallest violin playing. Sad songs. The oh so repressed excellent student from a top school. Life is so hard for you brah. I never realized. Until. Now. Consider me appropriately clued in on the plight of those who are so very concerned about their chances at only top programs.

No one is stopping your conversation. Not me. Have it. If you don't like my commentary, ignore it. A free country is a burden sometimes.

 

[ABatOutofHeck]

Wow, I was afraid my criticism was going to come across as unjust, but thanks for amply demonstrating exactly what I was talking about.

Do you go into travel forums where people ask for vacation tips and post things like "Quit worrying, dude. You can afford a vacation! Tell me more about how your diamond shoes are too tight?" Please tell: what is the achievement ceiling at which people can ask questions and get advice here with a modicum of courtesy and not just belittlement?

 

[DIce3]

To redirect here because I think this thread may be a useful one in the future:

I opened up our county medical society directory. It is really a nice one with beautiful color pictures of each doctor with status of board certification. I went down the list as I do pay attention to where people trained because I am a snob. I really do think that university trained internists are better adult primary care doctors long term compared to community trained internists and family doctors, in general. (let us not get into this discussion on this thread)

Here are my observations:

1.) Doctors considered to be the best in their specialty are real standouts. There are the couple of ID doctors that are amazingly sharp. The CV surgeon with crazy good stats. The neurosurgeon that seems to always get the right call. The couple of handfuls of really solid general internists... etc etc...

2.) Quite a few of these doctor's doctors are actually FMGs who trained at mostly Indian or African medical schools and then almost always at a "non-top 20" state university program. Don't get me wrong, there is a much much larger group of FMGs that are just horrid. Really awful. (hope nobody can figure out who I really am)

3.) The observation in #2 is not a new one for me with respect to African doctors. The number of African trained doctors who train in the United States is relatively low percentage wise but nearly every one I have ever come across has been truly amazing clinically and wonderful in personality. I have no explanation for this.

4.) And as I stated before, pedigree appears to have no statistical significance to standing in the community

5.) How busy a doctor is seems to have an inverse correlation with pedigree. The doctors from Harvard tended to be less busy than those who trained at a community program in the Bronx.

 

[IlDestriero]

Ultimately, for many specialties, it is not really pedigree that matters to your training, but regular access to high acuity cases. I think it's critical to anesthesia. Large University referral centers give you that kind of exposure. Any dunce can do a VP shunt revision or a hernia, sailing smoothly through the ruptured AVM or major trauma at 2 AM is your goal as an attending.
Residency pedigree does come into play for fellowships and academic faculty gigs at the premiere programs. HOWEVER, you still have to walk the walk and have superior LORs. You can be a marginal guy in your IM program at MGH and not get your fancy GI fellowship because your "adequate" LORs will tell the whole story.

 

[LovelyBRass]

So I, too, am really happy to see there is a consensus that pedigree really does matter when it comes to matching at top IM programs. And going to a good med school definitely opens up choices for you.

But before we start running to pre-allo telling them to pick the best med school EVA, remember: all anyone on the pre-allo forum cares about is just becoming a doctor. And hey, if you want to do IM (or anything really), there's still no financial argument to be made for choosing the expensive private school as opposed to the cheaper state school. It doesn't matter which USMD school you pick, you'll match into a residency and become a doctor, and isn't that what we all wanted?

 

[jdh71]

Wow, I was afraid my criticism was going to come across as unjust, but thanks for amply demonstrating exactly what I was talking about.

Do you go into travel forums where people ask for vacation tips and post things like "Quit worrying, dude. You can afford a vacation! Tell me more about how your diamond shoes are too tight?" Please tell: what is the achievement ceiling at which people can ask questions and get advice here with a modicum of courtesy and not just belittlement?

You are still acting like a victim. You are not.

You can have your conversation about your need to make sure you get into one of the places you think are the tippy-top. There are plenty of people to have that conversation with. If you take umbrage that find your consternation here cute, that's your business, not mine. And based on what your talking about you really need to star caring about what people think about you, just not us dirty peasants. My opinion of you here us really none of your business. ;-)

 

[anonperson]

I wanted to post this because it directly contradicts the information I got throughout medical school, the residency application process, and even when choosing a med school. It is an uphill battle getting to top programs from outside the top tier of medical schools. A quick look at the BWH and UCSF website housestaff listing is all it takes to see this. Out of BWH's current intern class, 62 came from top 25 US News schools vs. 13 from other schools. UCSF's incoming class consists of 42 from top 25 med schools vs. 20 from other programs.

Having talked to MS4s from my school (which is just outside the top 25) post match, they had an experience in line with this. The AOA/250+ students got interviews at the tip top programs but most fell quite a bit down their rank lists. I think we underplay just how much where you're coming from matters.

This isn't surprising to be honest.

Programs like Hopkins, UCSF, BWH etc want known commodities to put it crudely. Medical students from top 20 etc medical schools generally have a track record for being strong residents because of their perceived educational quality. Is a medical student from a no name allopathic med school with a 250 step 1/AOA status etc going to be a good resident. The vast majority of times yes, but if you have a med student from Yale with a 230 step 1 and is in the top 30% of their class, I would be surprised if they didn't pick the latter most of the time. The pedigree helps. The letters of rec from big name clinicians/researchers these students usually have help. And don't underestimate a phone call from one attending to another especially if they know each other, even if in passing.

This is magnified even more for fellowship when the community is even smaller. There are a lot of back door dealings/phone calls. I'm in OB and applied for fellowship coming from a no name community residency program. I had publications, high in service scores, and good letters of rec-one from a well known clinician during an away rotation. I had to have this type of a resume to compete with other residents from Brown, Stanford, UTSW who had weaker applications on paper but their programs have fantastic reputations for training good clinicians/fellows. It goes back to programs wanting people they feel will succeed/handle the training. And on my interviews, the one constant thing that was mentioned was the letter of rec from my away rotation who I spent a month with (and got along great with) because he essentially knew the vast majority of people within the field. Not the glowing letter from my PD who I have worked with for 4 years (but is not well known). Not my research. Not my in service exams.

But I think it comes down to the fact that the vast majority of residents/fellows go on to to do similar things in regards of their career. Most will go on to private practice. Some will stay in academics. Very very few will be game changers in the field and programs realize this. They don't want or need to take chances finding these game changers, PDs/programs want someone who will do well in residency/fellowship and this goes back to finding applicants who come from places they are familiar with-For BWH, they have more experience with students from Harvard, UCSF etc.

Pedigree will only help but not having that name is not the end of the world or one's career.

 

[trep14]

It's funny that in a thread about stopping the perpetuation of the myth of "every med student is equal when applying to all residencies," you then perpetuate yet another similar myth that affects medical professions even further down the line, namely "pedigree is not important at all unless you plan to go into academics." Pedigree definitely gives a wow-factor when it comes to the layperson, and I have personally seen many people choose a physician and judge how good or bad of a doctor he or she is based on the context of his or her pedigree. Believe it or not, it is human psychology to be just as, if not more forgiving, of a Harvard-trained doctor with a few eccentricities than a no-name-trained doctor with good bedside manners. And I would be surprised if you have never seen a person choose to go to a certain doctor over another because that doctor went to Harvard or another famous name.

Of course, in the end, your ability as a doctor is all that should matter, but that's no reason to be oblivious to the fact that your pedigree will have effects on your career, whether in private practice or academics. And I prefer to deal with how the world is rather than how it should be.

In my opinion, laypeople get way too much credit in these discussions. Speaking as a former layperson, before I started reading anything on this website, I had no idea that 80-90% of the top 25 schools or programs were actually considered top 25 schools or programs. Like would you have ever guessed that Baylor is considered to have a really good medical school? Baylor was only on my radar because of RG3.

Now that I'm getting ready to start residency, I get asked on a daily basis what a medical residency even is. Yes the name harvard would probably turn heads, but I would put my bets that almost anyone not involved in medical education has no idea that most of the programs that everyone here considers top 25 are any better than <insert average program here>.

 

[IMPD]

Questions of pedigree and it's relative importance are not going to be settled.

And let's be clear --- we're only arguing about the relative importance of pedigree. No one should seriously argue that pedigree is of no importance. That would be like arguing that good looks, a well endowed trust fund and great teeth/hair are of no importance. They all help mediocre people get into good positions and they provide the stamp of "open doors" that helps great people cement their authority.

In a practical way, how much is this pedigree worth paying for? I think that's a much more interesting question. If you have the choice of a 300k medical education vs a 150k, is it worth it?

Since you can't know beforehand how much you're going to value the real but difficult to measure benefit of pedigree, you're left with the discussion we see above. My main advice to people is that pedigree is generally worth the most to folks who are marginally motivated, highly value status or have extremely high ambitions. For everyone else, probably not.

 

[padastra]

I think some laypeople do go by reputation--at least my parents do. It's stupid but it happens. But it doesn't matter because you'll never run out of patients as a decent physician. Also, see layperson perspective below:

Doctor 1: Brown (an Ivy!). Wow!!
Doctor 2: Hmm... went to some state school, oh I don't even remember the name, is there even a UC in San Francisco? Maybe California State University San Francisco or somesuch?

That being said, pedigree is important, but its importance varies depending on your goals in life.

 

[20893528]

I figured I would put in my 0.02c as I just went through this process of trying to match into a top IM program from a mid tier state school in the northeast (stats ect can be found in my other posts).

I'll echo what everyone else has said, its really hard. When I interviewed at top programs I would be 1 of maybe 2-3 state school applicants there, out of 15-25 interviewees. I think a lot of this has to do with familiarity of programs with prior residents. PD's are familiar with friends, faculty, letter writers at some institutions more than others and are willing to take their advice and assessments over unknown faculty at a smaller program.

As everyone else has said, there is no magic formula. I think there are some generalities:

• You need a nearly flawless academic application. Honor IM, honor most of your other clerkships, and get AOA.
• Do well on boards: no you do not need a 260 (despite what others will tell you). I aimed to get a 240 on Step 1 FWIW
• Find something that you are professionally passionate about and own it: This doesn't mean you need 10 first author pubs, get involved in curriculum development, community service, research - but you must have a deep level of commitment over your medical school career.
• Know where your program sends grads. You should try to develop a relationship with residency programs of interest that your school doesn't match well to. I think this cannot be understated, do an away, get faculty/deans to call the PD on your behalf / get LOR's from other top tier institutions.
• When you do get an interview, don't be intimidated by the applicants around you. You are there because you met the rigorous academic requirements needed for an interview, be confident.

 

[20893528]

Doctor 1: Brown (an Ivy!). Wow!!
Doctor 2: Hmm... went to some state school, oh I don't even remember the name, is there even a UC in San Francisco? Maybe California State University San Francisco or somesuch?

Similar anecdote

Layperson #1: Where did you match?
M4: Brigham and Wom......
Layperson #1: Wait, I thought you wanted to stay in the northeast? Did you want to go to Utah?
M4: Brigham and Women's is in Boston and it was my #1 ...
Layperson #1: Oh, why not MGH?

My point , most laypeople don't get residency rankings/prestige, hell I didn't get it before I applied to be honest. I also feel the clinical training is likely similar in most hospitals in the NE. Residency prestige / LOR's play an even larger role in fellowship apps because you do not have as many objective metrics on fellowship applications.

 

[ChessMaster3000]

Similar anecdote

Layperson #1: Where did you match?
M4: Brigham and Wom......
Layperson #1: Wait, I thought you wanted to stay in the northeast? Did you want to go to Utah?
M4: Brigham and Women's is in Boston and it was my #1 ...
Layperson #1: Oh, why not MGH?

My point , most laypeople don't get residency rankings/prestige, hell I didn't get it before I applied to be honest. I also feel the clinical training is likely similar in most hospitals in the NE. Residency prestige / LOR's play an even larger role in fellowship apps because you do not have as many objective metrics on fellowship applications.

Lol at the layperson who would say Why Not MGH

 

[Instatewaiter]

Lol at the layperson who would say Why Not MGH

Yeah, Anyone would be a fool to think MGH is a decent program

 

[notbobtrustme]

Yeah, Anyone would be a fool to think MGH is a decent program

doesn't even have harvard in the name

 

[Greenberg702]

This thread just scared the **** out of me. I turned down Wash U and Penn for a full tuition scholarship to Mt. Sinai, saving 280K. Should I try and see if I can change course this late in the summer?

 

[Jorts]

This thread just scared the **** out of me. I turned down Wash U and Penn for a full tuition scholarship to Mt. Sinai, saving 280K. Should I try and see if I can change course this late in the summer?

Take the free ride and run. You can still get an awesome fellowship from Mt. Sinai and not having debt = amazing.

 

[IMPD]

This thread just scared the **** out of me. I turned down Wash U and Penn for a full tuition scholarship to Mt. Sinai, saving 280K. Should I try and see if I can change course this late in the summer?

Again, it is a matter of degree, not a cliff. So....students from Top 50 schools have a "better" residency match list than the next 90. And...it's a sloping line all the way down to the bottom. If you look at the match list from Ponce in PR, it is going to look very different from Mt Sinai. Likewise, from residency, it's a sloping line, not a binary function.