I have a friend who fellows and attendings refer to as the "effortless genius"; he got high 280s STEP 1 and has quite the credentials…just finished fellowship under 30. It seems that the main (perhaps only) difference is that he has time to do whatever he wants, when he wants, but even he told me that medicine is not about genius--no matter how intelligent you are, if you don't know certain drugs, procedures, basic foundations, there is no way you will get it right. Medicine requires dedication and perseverance more than anything. Seeing patients usually requires very little intelligence per se because you go through the same scenarios over and over, it becomes monkey work. There's also references, web, co-workers if you don't know. Maybe, just maybe, being a "genius" could be more helpful in academic medicine?