Honestly, I'm more than a little burned out on all of this (maybe part of it is that I've had to do too much intellectual heavy lifting for a few unnamed services in my hospital that should ****ing think about the problem a bit before knee jerk consult to pulm and bailing for the afternoon). **** me if I don't want to be helpful, and I do. And I remember this time of year. While, I wasn't as neurotic as some, it was kind of anxiety provoking but putting together a list was fairly straight forward for me. I went with how I liked places. We spend all of this time going over these lists and giving "ranks" but it's largely BULL****. You will get good training at almost any program - truth. Some programs are more structured to formal teaching or to autonomy or to research. You gotta find your niche, your feel. Find the right program for you and tell all this ranking nonsense to eat jelly out of your ass!
A word about fellowship: the bottom line is this about fellowship. If you are a good resident, you're going to find a fellowship somewhere, doing what you want. If your goal is to do basic science research with the world's experts, and find a publish or die kind of a job, then you'll want to match as high up the generally agreed upon academic food chain as possible, because the big name academic types are ****ing snobbish like that. If your goal is simply to get great clinical training, then it doesn't matter as much, not really, where you do your residency, provided it's an academic institution. I'm at, arguably, a top 10 place for pulmonary medicine and I can tell you that outside of the exposure I get to transplant, and probably adult CF (which you largely won't see in private practice anyway) the clinical side of the training is largely not much different than the guys working at my old shop where I did residency (a "mid tier" university program, nothing "fancy" by "SDN ranking") - everyone from my old shop who didn't have a visa issue got their FIRST choice spot for fellowship. You all need to stop agonizing over this and just put together a rank list for YOU. I love you all, and wish you the best, and the best for you probably isn't the ranking we throw around on here - at least I know that was my experience. We can't make these decisions for you, but we're still definitely here to help - at least I know I am.
I may come back to ranking when I'm feeling less cranky, but the above . . . is the ****ing straight sheet. Remember it the next time I or anyone else throws out a rank list.