If you are talking about applying early decision to a medical school, I would not recommend that. If your numbers are good enough to get in off of ED, you should be applying to a number of schools as sometimes your state school or that one state school may not be the best school for you or may not offer you the best financial aid package (many private schools offer scholarships or grants). If you are talking about going to a state school in general and still getting into a competetive residency, it's very doable. Most state schools send a few students into the most competetive residencies every year, such as neurosurgery, urology, opthamology, every year. The only difference is that whereas a state school may have 3 students going into urology, a private top ten school may have 6 students going into urology. Out of 150 students at both classes, this difference could be accounted for by less people wanting to do urology at the state school as state schools tend to be more primary care oriented, or the caliber of students at the respective schools, as a top 10 school has a more careful screening process and may just accept a higher percentage of students that are completely dedicated towards their medicine, are better test takers, or show more leadership in medical school. Note that none of these reasons reflects on the medical school, just on the individual student and how the individual student chooses to live their lives. I go to a state medical school and many of my classmates (mainly female classmates), want medicine to be a part-time career so they don't do as much in terms of building up their resume because they don't want to go to a competetive residency and are happy with an MD. Also notice that the most competetive residencies still accept a number of students that went to foreign medical schools (the fellowships do as well). This is because residency programs care primarily about the caliber of the applicant, going to a good school can help your resume but it is by no means necessary to do what you want.
