Prestige of Medical School and Residencies

[JZp2]

Hi everyone,

My friend and I have been debating about the point of prestige in terms of medical school attended and residency.

Even if you get into a T20 school for example, why does it matter if you attend a top residency? Schools at that level will get you to match into your specialty right? What difference does it make if you did your residency at Mass Gen versus any other place if you are planning on being a physician who treats patients? I guess the question is: when does the rat race end to be at the best institutions? Is it mainly to get "in the club" with people at the top?

I will admit- I used to think that wherever you went to college didn't matter. Although this is true, I realize now that it was only true to an extent... meaning a better university=better outcomes or at the very least it was easier to get better outcomes. People may argue about confounding variables like "if you were good enough to go to Harvard you were good enough to do well anywhere," but at the end of the day you only can look at the outcomes. Better school=better connections=better chances of going somewhere great for medical school.

I think that made sense of college at least, since getting into medical school is super difficult and particularly the top ones. How much value does that mindset hold for the transition from medical school to residency? Almost 90+% of people match right? If someone decides to do stuff outside of medicine, how difficult is it really for them to do that stuff after becoming a physician? I see plenty of physicians doing research as clinicians even if they haven't been to one of the research power house schools.

You ask people at those schools like Harvard, and they say it makes a difference. You ask people in the T20 spectrum and they say it doesn't make a difference. Then you ask people from mid-tier schools and they say it definitely makes a difference. So who's right?

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[KnightDoc]

Everyone and no one. You are largely confusing correlation and causation. Stars do well anywhere. A disproportionate number of them are attracted to top schools, where they excel. If you needed a top school to excel, Mass Gen wouldn't take anyone who didn't come from a T5 or T10 school, and no one from a lower tier school could possibly become a plastic surgeon or dermatologist.

Yes, top schools have more, "better" research and networking opportunities, but stars find their level anywhere, and even top schools have people who SOAP every year, so they really don't guarantee anything, or make you any better than you already are. Academia is probably the only real exception to this, since prestige and credentials seem to make a difference there, and top schools and top residencies serve as a kind of Good Housekeeping seal of approval. Otherwise, if you just want to be a humble clinician, causation vs. correlation!

 

[MadRadLad]

Matters for residency/fellowship matches to a degree, but less and less as you go up the chain.

In real life, none of this matters if you aren't going into academia (and particularly academia at the places that care about their own names like Harvard, Penn, Hopkins etc). Location is a bigger factor in terms of local hiring.

There's a lot of self selection though. The type of people who grind it out trying to go to the top schools are often interested in research and academia, so more likely to place within those institutions for research/fellows. I knew AOA people in my class who crushed every test (250+ steps) and got their top choice residencies that didn't necessarily have the same "brand" name but were close to their family/community in the specialties of their choice. Profile wise they were up there with any of the top ortho/ENT/derm matches in my class but it doesn't look as fancy on a match list.

 

[SaxWhat]

Just anecdotally, a resident from a brand name IM program told me that when she applied to different private practice jobs, she sent applications to various job postings using either her personal email or her hospital email (which has the name of her program). She had a much more difficult time getting interview offers when she used her personal email compared to her hospital email. Of course, n=1.

 

[ChiDO]

Define "a top residency program?"

99% of posters in the pre-med forums and in life in general do not know the above answer nor does "name recognition hospital" correlate with "top residency" in whatever "specialty."

Furthermore, if my PP group is interested in a candidate, their email address doesn't matter 😂 unless it's like [email protected]. And then, we're definitely bringing them in to find out the back story.

And as others have alluded to above. If you're a top student at prestigious t20 school, you're a top student a local state med school and both can get you interviews at any program is you do well.

90%+ of the hospitals and jobs in this country are non teaching and non academic programs.

One of my partners is trained at two different super duper prestigious named residency and fellowship programs (SDN premeds would be in awe). On paper, he's an absolute stud. In the OR, he does some very weird academic **** during cases that don't make any difference to patient outcomes, take twice as long, and annoy all the hospital staff. He drank too much academic kool-aid....after a couple years now, he's starting to drop some of that stuff. 😂

 

[deleted314957]

Hi everyone,

My friend and I have been debating about the point of prestige in terms of medical school attended and residency.

Even if you get into a T20 school for example, why does it matter if you attend a top residency? Schools at that level will get you to match into your specialty right? What difference does it make if you did your residency at Mass Gen versus any other place if you are planning on being a physician who treats patients? I guess the question is: when does the rat race end to be at the best institutions? Is it mainly to get "in the club" with people at the top?

I will admit- I used to think that wherever you went to college didn't matter. Although this is true, I realize now that it was only true to an extent... meaning a better university=better outcomes or at the very least it was easier to get better outcomes. People may argue about confounding variables like "if you were good enough to go to Harvard you were good enough to do well anywhere," but at the end of the day you only can look at the outcomes. Better school=better connections=better chances of going somewhere great for medical school.

I think that made sense of college at least, since getting into medical school is super difficult and particularly the top ones. How much value does that mindset hold for the transition from medical school to residency? Almost 90+% of people match right? If someone decides to do stuff outside of medicine, how difficult is it really for them to do that stuff after becoming a physician? I see plenty of physicians doing research as clinicians even if they haven't been to one of the research power house schools.

You ask people at those schools like Harvard, and they say it makes a difference. You ask people in the T20 spectrum and they say it doesn't make a difference. Then you ask people from mid-tier schools and they say it definitely makes a difference. So who's right?

1977 MD grad here from huge state school. Retired, pathologist, dream career, very low 8 figure retirement. Never sued ( in FL!).

No one is right. There are 2 main, huge factors: 1) Your dedicated effort. Med school is now your JOB. It is NOT school. You MUST adopt that mature, determined mindset and be an adult. All other endeavors are secondary, tertiary,etc. 2) basically, luck. You need to be in the right place at the right time and meet the right people. BUT, luck must encounter YOUR prepared mind, attitude, physical well-being, etc.

Then, it works out or it does not, but you did all you could do.

 

[JZp2]

Everyone and no one. You are largely confusing correlation and causation. Stars do well anywhere. A disproportionate number of them are attracted to top schools, where they excel. If you needed a top school to excel, Mass Gen wouldn't take anyone who didn't come from a T5 or T10 school, and no one from a lower tier school could possibly become a plastic surgeon or dermatologist.

Yes, top schools have more, "better" research and networking opportunities, but stars find their level anywhere, and even top schools have people who SOAP every year, so they really don't guarantee anything, or make you any better than you already are. Academia is probably the only real exception to this, since prestige and credentials seem to make a difference there, and top schools and top residencies serve as a kind of Good Housekeeping seal of approval. Otherwise, if you just want to be a humble clinician, causation vs. correlation!

So if you don't anticipate going into academia, your med school prestige won't really matter for residencies?

 

[JZp2]

Matters for residency/fellowship matches to a degree, but less and less as you go up the chain.

In real life, none of this matters if you aren't going into academia (and particularly academia at the places that care about their own names like Harvard, Penn, Hopkins etc). Location is a bigger factor in terms of local hiring.

There's a lot of self selection though. The type of people who grind it out trying to go to the top schools are often interested in research and academia, so more likely to place within those institutions for research/fellows. I knew AOA people in my class who crushed every test (250+ steps) and got their top choice residencies that didn't necessarily have the same "brand" name but were close to their family/community in the specialties of their choice. Profile wise they were up there with any of the top ortho/ENT/derm matches in my class but it doesn't look as fancy on a match list.

So could you say that you should shoot for the top schools to make it easier to have a "pick" for residency location?

 

[JZp2]

Just anecdotally, a resident from a brand name IM program told me that when she applied to different private practice jobs, she sent applications to various job postings using either her personal email or her hospital email (which has the name of her program). She had a much more difficult time getting interview offers when she used her personal email compared to her hospital email. Of course, n=1.

I didn't expect private jobs to care about residency prestige. I thought it was more location based (like you make connections locally to secure jobs). That actually brings up a good point, how do you even find a job after residency (both hospital and private practice)?

 

[JZp2]

Define "a top residency program?"

99% of posters in the pre-med forums and in life in general do not know the above answer nor does "name recognition hospital" correlate with "top residency" in whatever "specialty."

Furthermore, if my PP group is interested in a candidate, their email address doesn't matter 😂 unless it's like [email protected]. And then, we're definitely bringing them in to find out the back story.

And as others have alluded to above. If you're a top student at prestigious t20 school, you're a top student a local state med school and both can get you interviews at any program is you do well.

90%+ of the hospitals and jobs in this country are non teaching and non academic programs.

One of my partners is trained at two different super duper prestigious named residency and fellowship programs (SDN premeds would be in awe). On paper, he's an absolute stud. In the OR, he does some very weird academic **** during cases that don't make any difference to patient outcomes, take twice as long, and annoy all the hospital staff. He drank too much academic kool-aid....after a couple years now, he's starting to drop some of that stuff. 😂

I don't know what even constitutes a top residency program since it's so far away. I have been told it depends on Doximity or like med school there is the consistent reputation of a residency.

What do you look for in a candidate by the way? How do you determine someone can work with you if they are just out of residency without taking where they did their residency into account?

 

[JZp2]

1977 MD grad here from huge state school. Retired, pathologist, dream career, very low 8 figure retirement. Never sued ( in FL!).

No one is right. There are 2 main, huge factors: 1) Your dedicated effort. Med school is now your JOB. It is NOT school. You MUST adopt that mature, determined mindset and be an adult. All other endeavors are secondary, tertiary,etc. 2) basically, luck. You need to be in the right place at the right time and meet the right people. BUT, luck must encounter YOUR prepared mind, attitude, physical well-being, etc.

Then, it works out or it does not, but you did all you could do.

So should you seek a school/residency where you can be happiest/have enough time compared to its reputation/possibility of connections?

 

[KnightDoc]

So if you don't anticipate going into academia, your med school prestige won't really matter for residencies?

I honestly don't think so, based on the fact that at least a few people each year seem to get into really awesome residencies from really lower tier schools. My conclusion is that these are the people who could have gone to a top school, but, for one reason or another, typically finances, location and/or support system, chose the lower ranked school.

Top tier schools get a whole bunch of those people and have great match lists, pretty much from top to bottom. Everyone looks at those lists and thinks going to those schools will enhance their opportunities.

Going to a great school certainly won't hurt anyone, but, as I said, it really won't make people any better than they already are. Just ask adcoms at top schools, like @LizzyM and @gyngyn. People SOAP even at the best schools. Probably because they over reach, and/or think the top school will automatically make them a top candidate, because, well, the match list.

Top candidates are top candidates, no matter where they come from. Schools hiring for academic positions seem to love the top school credential, mostly because those jobs are so far and few between that they can get away with it. But, empirically, there are TONS of specialists all over the country, in every single specialty, competitive or not, that did not attend a T20 med school or residency.

So, bottom line, all things being equal, there is no reason not to choose a top school if you have the opportunity. Often the fin aid or scholarship opportunities are even better there than at other schools. But, if the money, location, vibe, whatever, is better for you at a lower tier school, then all things are not equal, and there is really no reason to pay significantly more for a fancy name on a diploma, again, unless your dream is to run a department at a teaching hospital one day,

If you are good enough to have the opportunity to go to a top school, it is very likely you will be a star no matter where you go. It's the same for UG. HYPSM have great stats regarding getting people into med schools. And yet, a lot of people from no-name UGs also do very well each year. How is this possible? Because a lot of people don't want to pay $75K+/yr for UG, so choose public Ivies, honors programs at lower ranked UGs, or full scholarships at still other lower ranked schools.

They do very well, mostly because they are stars who could have gone to T20 UGs if they wanted to. Adcoms can see this, based on their record of accomplishment as set forth on their applications. And they are accepted at top schools, along with their T20 UG counterparts.

Isn't it obvious that the same thing happens with the residency match? Everyone coming from a T5 or T10 does NOT get their first choice, and everyone coming from a low ranked school does not end up in family medicine. Causation vs. correlation. Top people gravitate to top schools, but top schools do not turn ordinary people into superstars, and lower schools similarly do not turn rock stars into slugs.

 

[DarkHorizon]

Attending top medical schools and residences is surely impressive and matters some for academics, especially ivory towers. But no one really cares in the community. I assure you of that. Most people don’t even know where you did your training. They care if you’re personable, competent, and compassionate. Patients and your colleagues alike. I promise you.

 

[Browns99]

Somewhat on topic and I posted in another thread.....At the top programs or those considered prestigious, you have top trained faculty(likely a great % also trained at the program), better clinical experience, greater depth of cases, more funding and the list goes on. This does not mean that you will get poor training at the community programs, but I'm giving you objective facts as to why those top ranked programs are just that....top ranked for good reason.

There stands a reason that prestige matters in med school, since it is considered by PDs. I would also note that, coming from a top ranked residency, you have a leg up for a fellowship and lastly, it is likely to open some extra doors in the job market as well.

 

[deleted314957]

So should you seek a school/residency where you can be happiest/have enough time compared to its reputation/possibility of connections?

Big time, for med school, residency( more so) and fellowship you really, really need to go where you think you will be happiest. The “reputation “ stuff most prominently exists in the minds of the folks at those particular institutions. When I was hiring physicians, institutional rep was way down on my list of priorities.

 

[deleted314957]

Attending top medical schools and residences is surely impressive and matters some for academics, especially ivory towers. But no one really cares in the community. I assure you of that. Most people don’t even know where you did your training. They care if you’re personable, competent, and compassionate. Patients and your colleagues alike. I promise you.

Amen.

 

[deleted314957]

Somewhat on topic and I posted in another thread.....At the top programs or those considered prestigious, you have top trained faculty(likely a great % also trained at the program), better clinical experience, greater depth of cases, more funding and the list goes on. This does not mean that you will get poor training at the community programs, but I'm giving you objective facts as to why those top ranked programs are just that....top ranked for good reason.

There stands a reason that prestige matters in med school, since it is considered by PDs. I would also note that, coming from a top ranked residency, you have a leg up for a fellowship and lastly, it is likely to open some extra doors in the job market as well.

Very few doors in my experience hiring physicians for my group. Competency was ASSUMED. I focused more on fit and finish.

 

[Hzreio]

75% of a recent dermatology match class are from T25 schools. Not saying correlation = causation but still pretty interesting

 

[KnightDoc]

75% of a recent dermatology match class are from T25 schools. Not saying correlation = causation but still pretty interesting

TBH, I don't find it that interesting at all that 75% of a competitive specialty come from the top 15% of schools. In fact, I'm surprised it's not higher.

It's strong evidence of correlation. The fact that it's not closer to 100%, and the data set isn't limited to T10, provides evidence to me of a lack of causation.

Of course, this is very far from scientific and YMMV, but these numbers are far from unexpected given the composition of the class at the top schools, as well as the match lists we all eagerly consume each March.

 

[deleted314957]

75% of a recent dermatology match class are from T25 schools. Not saying correlation = causation but still pretty interesting

Means nothing in practice. Again, anecdote and not statistically valid but one derm i did frozens for, over a 23 year period, about 8-10 per week( I got to know his practice pattern REAL good) was a Duke grad and I discouraged everyone I knew from having ANY derm surgery by him. Even elliptical excisions of non facial lesions. Some folks are just pretty good at what they do and some are not. I don’t think EVMS teaches derms to do trunkal skin ellipses any different than Duke. Just a matter of different personal abilities ( or if they give a damn or try to see too many patients, etc.)

 

[DarkHorizon]

I should add a caveat to my comment.

Going to a top medical school would probably help in getting a residency of choice, at least moreso than low tier school. This may also help with fellowships as well for competitive specialties like GI, cardiology, plastics, peds surgery etc.

However, once you’re in practice, the ability to fill your schedule is not gonna be driven by where you did your medical school and residency. You’ll build your reputation as a young physician by being available, able, and affable. No one will care whether you went to Harvard or Howard.