That statement assumes that all aoa programs are crappy and that all Acgme programs are awesome, which i know you know isnt true. People select residencies based on a number of factors, obviously, and not everyone's priorities are the same. The top priority for a lot of my classmates, for instance, is to stay local and they really don't care where they end up as long as they end up in the same city. Also, people view programs differently. You might think an elite academic hospital is best for you, but I feel more comfortable at a community or public state hospital. Everyone is different and some people select their residency where they feel most comfortable. I know it sounds like hippy bs, but it is true. I have friends who are competitive applicants for most fields of medicine, but they only applied to 4 to 6 aoa family medicine programs. I don't really understand them, but they are happy with their decision. I guess my whole point is, just because someone ends up at an aoa program doesnt mean they are not a competitive applicant or couldn't match in the Acgme. I, however, will be applying to the top 40 programs based on NIH funding and like 20 mid tier programs, lol