Medical Should I apply to just top 10 / 20 schools this cycle?

[gyngyn]

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Hi everyone!

I am applying this cycle, and wanted to hear your honest thoughts on the pros / possible ramifications of such a plan was. A bit of background : I am a traditional, over-represented minority (ORM) applicant from a state school (full ride) with a LizzyM ~75- 76, depending on if old/new conversions shifted upwards (better GPA than MCAT). Excellent LORs (I think? based on reactions from recommenders but I understand it's never truly possible to know); long-term, sustained research (no publications though); average / slighty below average clinical experience; decent non-clinical volunteering; lots of leadership and teaching experience. There is one activity in my profile I think will definitely help me stand out as I've received nat'l / int'l recognition in it (don't want to say for the sake of anonymity) and is a consistent theme in my application.

I am highly interested in academic medicine in a competitive surgical specialty, and it's become obvious to me from countless threads / looking at match lists / talking to others I know that going to a top 10 or 20 school will definitely help tremendously. I've gathered that while going to a lower-ranked program does not necessarily close any doors, it makes that goal much more difficult esp. since I'm interested in both academics and said competitive specialty. I do realize that it's possible I will change my mind during the 4 years of medical school and fall in love w/ a less competitive specialty, but in the decently possible scenario I don't change my mind I don't want to have created an uphill for myself to conquer from the very beginning. And even in this scenario, a higher-ranked school will definitely help w/ matching into more academic programs.

I am okay with taking a gap year if it is really necessary, but also am looking forward to starting sooner if possible.
I was wondering if it would be a good idea to only apply to top 20 schools this cycle? If I somehow get into one of them, then that's great - I'll attend and never look back. If I don't, then I will reapply (with my senior year now in my profile, during a gap year) to my entire current school list (including the previous top 20's w/ new application updates, hopefully significant).

I read somewhere that if one is admitted to any school during an application cycle, then understandably it's imperative they attend otherwise it is essentially a kiss of death as a re-applicant. This is why I want to apply first to just top 20 schools (which are ideal for my future goals), and if they don't work out after 2 cycles, then to be happy / work with whatever I can get. I am not one to really care about school name / prestige that much (hence why I chose my state school over some of HYPSM previously), but am aware that in this case the medical school name is probably very helpful for my future goals.

Any thoughts are appreciated - thanks so much!

Medical school is not like college (or law school).
Public medical schools produce some of the most highly regarded applicants to residency.

 

[lord999]

If you are going into academic medicine as a practitioner, with all due respect to my colleagues who are such, that isn't that hard as academia pays something like 30% under what the market clearing rate in private practice is, so there are almost always opportunities at even the best schools to be there. That's because for all the abuse that my colleagues take on top of practice (service work and politics), it really doesn't necessarily offset the benefits of academic company and teaching over the long-term for most. Some persevere, but they are truly exceptional if that is the case. And if someone in academic medicine practice and not administration says its about the money, they are either lying to you or do not understand their financial situation properly. Academic medicine has its benefits, but it has more drawbacks than private practice for less tangible rewards.

If you are going into academic medicine as a physician scientist, then you need to get a bit more serious about your research and figure out what you can publish. It'll be good for you to see a paper through in the lab. If you are already clear that you would be that dedicated to the research world, you should consider MSTP as a career pathway as the admissions are both easier and harder, but the journey is much longer. That said, since you do not seem to comment specifically about what you are working on in the lab, that's usually a warning sign that research is something you do rather than something you are.

As a rhetorical question (one that you need not answer us), why do you want to go into academic medicine? It's not clear from your answer, and you need one to make it work for you. If you have no reason other than it's what you see, then it would be better just to focus on getting into your specialty through good fundamental performance in your medical school training and exam taking.

But, I still think the hardest part is getting into a competitive surgical specialty, and yeah, going to a Top 20 school helps, but not if your grades and exams are only average. You face the same disadvantage now competing for a medical school slot from a state school, and if your grades are decent, I doubt that the handicap is noticeable at all. With a LizzyM that high if truthfully scored, you should be fine if you continue your performance in medical school at that level. But that's a Spartan "if". The past does predict future success, but not absolutely.

 

[Goro]

If you only managed to get accepted to Wake, Miami, or SLU, would you rather not be a doctor?

 

[gyngyn]

Thanks for the responses everyone!



@gyngyn : Would you say that coming from a higher-ranked school still helps (and to what degree) in terms of residency applications (incl. to academic-focused / higher-ranked residencies within the same specialty)?

@lord999 : Thanks for bringing all of this up, certainly really important issues to consider. I'm definitely aware that at this point, a lot of things can (and probably will) change, so even though I may be interested in academics now, let's say, to generalize, to replace [academic medicine] with [something related to medicine where coming from a higher-ranked school will help, which I may not even be aware of at this point].
Part of me actually does regret choosing my state school (even though I'm overall satisfied & happy w/ my experience), even w/ a full ride, over a higher-ranked school (Yale) since (1) I didn't realize how top-heavy undergrad the representation at top medical schools was then, (2) it wouldn't have necessarily been harder to earn a similar GPA (since HY tend to have a lot of grade inflation, of course I would have worked equally hard but it may have actually been less stressful & the Ivy GPA looks better probably), (3) possible 'intangible' connections even outside of medicine. I notice this too with medical schools, in which a lot of the top schools have P/F (vs. 'lower-ranked' schools which are often graded on an H/HP/.../P/F basis), are better connected in terms of faculty / research / with other institutions / etc., and typically (for a combination of reasons probably) match much better into academic-focused residencies for competitive specialties. Therefore, I want to set myself in the best possible position when I start medical school, and to have something that could possibly help me throughout not just medical school but my entire career. Of course, if I am not able to do that, then I will work from wherever I start but I would definitely prefer to start at a higher point if I can.

@Goro : Definitely not; as I stated previously, if I didn't end up at a Top school even after trying my absolute best then I would work from where I ended up at, but again I want to ensure I give myself the best possible chance (and not make any doors harder to open from the get-go) - hence why I was wondering if it would be reasonable to apply over two application cycles (first to just ~Top 20 schools, loosely defined), and then to my entire current list (for which all of the non-Top 20's I've include I would also be happy to go to of course, but will be aware that I probably won't get the same benefits / connections / intangibles as from a top school and will probably need to work harder for the same result as a Top 20 grad).



There is also the possibility of not applying this cycle and just applying next cycle, which I've considered, but I still hope to apply this cycle because (1) I think (and from feedback I've received from pre-med advisors & current medical students) my app is strong for Top 20 schools and hence worth a shot given my current profile, and I would prefer to start earlier if I can, (2) I will definitely have meaningful changes to my application if I were to be a re-applicant.

Any medical school with a department in your specialty of choice can help you get into that specialty.
Many "famous" medical schools have very weak departments. Many "non-famous" schools have amazing departments and connections.
In my specialty (Ob-Gyn) for example, would you care to guess which is reputed to be the strongest program at the present time?

 

[Goro]

Definitely not; as I stated previously, if I didn't end up at a Top school even after trying my absolute best then I would work from where I ended up at, but again I want to ensure I give myself the best possible chance (and not make any doors harder to open from the get-go) - hence why I was wondering if it would be reasonable to apply over two application cycles (first to just ~Top 20 schools, loosely defined), and then to my entire current list (for which all of the non-Top 20's I've include I would also be happy to go to of course, but will be aware that I probably won't get the same benefits / connections / intangibles as from a top school and will probably need to work harder for the same result as a Top 20 grad).

Why would waste a year of clinician salary by applying only to T20s? This is saying that you'd give up 200K+ in order for what, a name over your state school?

Do you even have the stats and app for a T20?

Apply smartly and strategically.

 

[lord999]

@gyngyn : Thanks for letting me know! I wasn't as aware of that previously. In that case, would you suggest adding on schools that are strong in competitive specialties one is potentially interested in? (again, am aware that most students change their mind but want to keep as many doors open as possible)
@Goro : That's not what I was saying at all (I understand if the message didn't catch on though as both my initial and follow-up posts were quite long posts). Thank you anyways though!

Reframing what Goro said and what I also will say, is it worth a committed year to lose for the possibility of bettering your T20 chances for the possibility of getting into a competitive specialty for a dream that you have not decided on yet? Especially when everyone else including me is giving you an opinion that it is more important to worry about your internal stats while in medical school rather than going to a state medical school itself? (Don't misread this as me endorsing all schools, this doesn't apply to out of the country ones.) Given your relative confidence in your performance, I would take a guaranteed state school admission, perform well, and then see where my luck leads. Don't worry, not all of medical leadership or key subspecialties are Ivy or Stanford trained! The sacrifice for possibility is more remote than seems normal for a cost/benefit breakdown.

Also, if you do have that attitude toward P/F situations, don't apply for Mayo in the T20 list. Mayo goes with a P/F system even for the two preclinicals, which I know my students regret, because Mayo sets the P at a much higher standard than numerical grades, oftentimes punitively so, and the results are still genuinely excellent. Mayo has strong selectivity bias rather than weeding out as a membership philosophy. But the reason that the philosophy is a P/F is because there is only good enough and not good enough for practice. Mayo does take "good enough" at a higher standard than what normal numerical grades would have been though.

Selectivity bias is the key, but you can have what you want, there are enough to go around for even competitive ones unless you're going for the OPM 745-07/0602 designate (Astronaut, Medical Officer designate), and in that case, you should have gone to the academy like my graduate school classmate.

 

[Goro]

@Goro : That's not what I was saying at all (I understand if the message didn't catch on though as both my initial and follow-up posts were quite long posts). Thank you anyways though!

Just going by what you wrote:
hence why I was wondering if it would be reasonable to apply over two application cycles (first to just ~Top 20 schools, loosely defined), and then to my entire current list (for which all of the non-Top 20's

 

[gyngyn]

@gyngyn : Thanks for letting me know! I wasn't as aware of that previously. In that case, would you suggest adding on schools that are strong in competitive specialties one is potentially interested in? (again, am aware that most students change their mind but want to keep as many doors open as possible)

I suggest applying to your state public schools (if any) as well as any private schools that match your mission and stats.

 

[Mr.Smile12]

I am skeptical of rankings of specialties unless I understood why they were highly ranked. Is it research dollars? Citations? Budgets? Industry contacts? Understand how rankings are created and realize they are only important for PR and media stories, and not relevant to personal career decisions unless you are specifically looking at resources. It's a measuring stick but not gospel.

You mentioned surgery-based specialty earlier, so I'm not sure why you think a top 20/40 program is necessarily better to set up an application to such programs. I generally default to networking with admissions, student services, alumni, etc., and this is no different. Many of my past advisees have done very well getting into residency programs that you may think are successful attempts at "punching above one's weight" because they worked hard and got very strong advising and mentoring to set them up for future success. In many cases a lot of your mid-level programs according to rankings comprise of vigorous leadership that has been given a change to restructure a department to be more competitive, and being part of a rising program is a wonderful opportunity too.

There's no shame for taking on as little debt as possible in your education. Your perception of undergraduate school representation is a different topic that may reflect different biases of selection in the admissions process because elite schools love to select other elites but they have to take students from a variety of schools (educational diversity and geography is very important too).