People don't change whether they go to top or bottom tier. Those who are dinguses will always be dinguses, those who are laid back will always be that way, those who are lazy will get lazier, those who whine will cry louder, those who are miserable will stay that way til death, and those who can find happiness every day will always be happy regardless of where they go.
In medicine nowadays, happiness or just plain good/well enough is the elusive and rare unicorn.
And as mentioned above, don't underestimate the influence an attending can have who you've only worked with for 5 days in three years, or your senior residents or co-residents. It just takes a single sentence recommendation from them to open doors and secure you a job. That's how I got my job and how I have buddies asking to be notified when there's an opening. It's also how I have a backup plan and other options from other buddies if something were to happen out of the blue.
