alrighty. don't kill me here. just based on my attendings, residents, and folks i met along the interview trail this season, here's the impression i got.
arguably top five (i know i'm listing six; in no particular order): ucsf, stanford, mgh, brigham, wash u (mir), penn
arguably top ten (i know we're approaching top twenty...in no particular order): duke, hopkins, ucla, ucsd, uwash, bidmc, nyu, cornell, umich
but a lot of factors go into what YOU would consider top tier. if you're from the south, add wake forest and vandy; if you're from the midwest, add mayo; etc. it just so happens that the programs above are considered to be great research institutions, are in desirable locations (cali, boston, nyc, etc.), and tend to get the cream of the crop year in and year out. most folks would rather be on the west coast or northeast for four years unless they have strong ties/personal reasons to go south or midwest, making these locations more sought after. thus, the regional bias in my list above.
a good rule of thumb told to me by several attendings (for the "ranking" sensitive folks out there): if you were to base your decision solely on prestige (which would be silly), pick a program with a huge name and great location. a harvard program, a ucsf, a stanford are going to continue to attract the best and brightest attendings and residents based on those two factors alone.
again, just my opinion. best of luck.
