Strategically better to attend mid tier instead of top tier medical school?

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osprey099

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Basically, is it better to be a big fish in a small pond or a small fish in a big pond? I would imagine going to a top 20, your classmates are going to be students from the ivy leagues or top UG feeder schools like duke, jhu, washu or the stellar state school students vs at a mid tier, the field would be less competitive.
 
My thoughts:
1. You're not neccesarily competing against your classmates, esp at a top 20 school where they are mostly P/F. You are competing against medical students across the country. Nevertheless, this may be true in 3rd year where grades are more subjective.
2. You want to be surrounded by the best because that will make you better.
 
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If you're smart enough to get in, you're smart enough to compete.
 
Basically, is it better to be a big fish in a small pond or a small fish in a big pond? I would imagine going to a top 20, your classmates are going to be students from the ivy leagues or top UG feeder schools like duke, jhu, washu or the stellar state school students vs at a mid tier, the field would be less competitive.

Why not go Caribbean then? You could be like Shamu crammed into a goldfish bowl
 
Basically, is it better to be a big fish in a small pond or a small fish in a big pond? I would imagine going to a top 20, your classmates are going to be students from the ivy leagues or top UG feeder schools like duke, jhu, washu or the stellar state school students vs at a mid tier, the field would be less competitive.

Common question. After reading several threads on this exact same question, I came to the conclusion that it all depends:

-If you can perform relatively on the same level in both environments...then go to a Top 20.
-If your dream is to be Chief of XYZ at MGH, Hopkins, etc...then go to a Top 20.
-If you can perform better at a specific mid-tier school (e.g. due to curriculum, proximity to spouse and children, etc.)...then go to the mid-tier.
-If you get a generous scholarship from a mid-tier and you are pursuing primary care specialties...then go to that mid-tier.
-If you get a massive hard-on from saying you go to Harvard/Hopkins/other top-tiers...then go to a Top 20.
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The list goes on and on...so there is really no 'right' answer for everyone. It all depends on your own goals in life.

EDIT: You can always find exceptions to just about ANY situation presented. There is really no all-encompassing 'right' answer to the OP's question.
 
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Basically, is it better to be a big fish in a small pond or a small fish in a big pond? I would imagine going to a top 20, your classmates are going to be students from the ivy leagues or top UG feeder schools like duke, jhu, washu or the stellar state school students vs at a mid tier, the field would be less competitive.

I think you're underestimating the students at mid-tier schools and overestimating the students at the top 20. At some point, there really isn't all that much difference once people pass a threshold of ambition and talent, and people going to mid tier med schools have, in my opinion, surpassed that threshold. As such, no matter which "tier" you're going to, it's going to be like comparing being a fish in the Atlantic versus the Pacific - both are going to be huge and full of more than enough opportunities for everybody.

Common question. After reading several threads on this exact same question, I came to the conclusion that it all depends:

-If you can perform relatively on the same level in both environments...then go to a Top 20.
-If your dream is to be Chief of XYZ at MGH, Hopkins, etc...then go to a Top 20.
-If you can perform better at a specific mid-tier school (e.g. due to curriculum, proximity to spouse and children, etc.)...then go to the mid-tier.
-If you get a generous scholarship from a mid-tier and you are pursuing primary care specialties...then go to that mid-tier.
-If you get a massive hard-on from saying you go to Harvard/Hopkins/other top-tiers...then go to a Top 20.
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.
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The list goes on and on...so there is really no 'right' answer for everyone. It all depends on your own goals in life.

Second @Sin Nombre that scholarship will trump tier pretty much everyday regardless of specialty (just look at a mid-tier match list and realize you can go just about anywhere). In fact, unless you want academic medicine or a policy job, I don't think goals in life matter nearly as much as fit when it comes to choosing a medical school. Personal characteristics and the unforeseen will drive success of life goals more than decision to go to the number 15 or number 35 medical school in the country.
 
This assumes one is going to the a big fish anywhere. Do you think the curriculum at U KY is less rigorous than at Yale?

A student will get an excellent education anywhere they go.

Basically, is it better to be a big fish in a small pond or a small fish in a big pond? I would imagine going to a top 20, your classmates are going to be students from the ivy leagues or top UG feeder schools like duke, jhu, washu or the stellar state school students vs at a mid tier, the field would be less competitive.
 
None of the situations I mentioned was all-encompassing. I may have unintentionally implied that it is advantageous to decline a top-tier acceptance in favor of receiving a generous scholarship from a mid-tier ONLY if you are pursuing a primary care speciality. I said "If you get a generous scholarship from a mid-tier and you are pursuing primary care specialties...then go to that mid-tier" to give an example where it was more likely to be a no-brainer.

You can always find exceptions to just about any situation presented. That is why there is really no all-encompassing 'right' answer to the OP's question.
 
This assumes one is going to the a big fish anywhere. Do you think the curriculum at U KY is less rigorous than at Yale?

A student will get an excellent education anywhere they go.

Considering Yale doesn't even have required tests during the preclinical years, I'm pretty sure just about every school is more rigorous :laugh:
 
None of the situations I mentioned was all-encompassing. I may have unintentionally implied that it is advantageous to decline a top-tier acceptance in favor of receiving a generous scholarship from a mid-tier ONLY if you are pursuing a primary care speciality. I said "If you get a generous scholarship from a mid-tier and you are pursuing primary care specialties...then go to that mid-tier" to give an example where it was more likely to be a no-brainer.

You can always find exceptions to just about any situation presented. That is why there is really no all-encompassing 'right' answer to the OP's question.

Right, I understand. I was just elaborating... significant scholarship money is hard to come by in med school for most people.
 
Everyone's smart wherever you go and there's a good chance you'll be below average (in a group of very, very smart people.)

So, I keep reading this on SDN...but...

I interviewed at school A where every student I met (even the MS1s) were frantic about passing boards and all they talked about was studying all the time every day. The administration at the school also kept talking about ALL the resources available (including an extra month of lectures specifically aimed at board test taking strategies) to students to make sure that most of them pass their exams.

I interviewed at school B where every student I met talked about all the activities they were involved with outside academics - sports, volunteering, teaching, shadowing, interest groups, social clubs. The administration at this school talked about how they encouraged students to stay connected to their non-medical interests and to the community at large. The administration never seemed concerned about their students doing well on their exams...

Step scores at school A are much lower than Step scores at school B

Some will classify my observations as differences between the two "feels" of the schools. I think that my observations reflect the average academic ability of students at the two schools...then again I don't have enough experience/understanding to know for sure. Thoughts?

Edit: I understand that academic ability /= doctoring potential, I don't have a better measure at my disposal right now.
 
So, I keep reading this on SDN...but...

I interviewed at school A where every student I met (even the MS1s) were frantic about passing boards and all they talked about was studying all the time every day. The administration at the school also kept talking about ALL the resources available (including an extra month of lectures specifically aimed at board test taking strategies) to students to make sure that most of them pass their exams.

I interviewed at school B where every student I met talked about all the activities they were involved with outside academics - sports, volunteering, teaching, shadowing, interest groups, social clubs. The administration at this school talked about how they encouraged students to stay connected to their non-medical interests and to the community at large. The administration never seemed concerned about their students doing well on their exams...

Step scores at school A are much lower than Step scores at school B

Some will classify my observations as differences between the two "feels" of the schools. I think that my observations reflect the average academic ability of students at the two schools...then again I don't have enough experience/understanding to know for sure. Thoughts?

Edit: I understand that academic ability /= doctoring potential, I don't have a better measure at my disposal right now.
Given that you were replying to a comment that everyone is smart everywhere you go, I can only assume that you're somehow using Step 1 scores and how hard they studied for them as a proxy for intelligence? If not I don't understand the point of your response.

If so, I think there are way, way too many other variables that can affect stress and performance that need to be considered before you can make the claim that school B kids are "smarter" than school A. That said, I'd obviously prefer to be at school B.
 
Given that you were replying to a comment that everyone is smart everywhere you go, I can only assume that you're somehow using Step 1 scores and how hard they studied for them as a proxy for intelligence? If not I don't understand the point of your response.

If so, I think there are way, way too many other variables that can affect stress and performance that need to be considered before you can make the claim that school B kids are "smarter" than school A. That said, I'd obviously prefer to be at school B.

Honestly, I don't really know what my point is - I'm in the process of trying to figure out what my experiences with these difference groups of medical students mean.

What I see is a group of students who do nothing but obsessively study vs a group of students who learn the same material, still have a life, and seem to have a better (score-wise) outcome. Does this mean that the students at the crazy study all the time school are less capable in some way? I don't know...that's my question.
 
Honestly, I don't really know what my point is - I'm in the process of trying to figure out what my experiences with these difference groups of medical students mean.

What I see is a group of students who do nothing but obsessively study vs a group of students who learn the same material, still have a life, and seem to have a better (score-wise) outcome. Does this mean that the students at the crazy study all the time school are less capable in some way? I don't know...that's my question.
I think it's kind of irrelevant. Why don't you just pick the atmosphere you'd prefer (assuming roughly equal tuition)?
 
So, I keep reading this on SDN...but...

I interviewed at school A where every student I met (even the MS1s) were frantic about passing boards and all they talked about was studying all the time every day. The administration at the school also kept talking about ALL the resources available (including an extra month of lectures specifically aimed at board test taking strategies) to students to make sure that most of them pass their exams.

I interviewed at school B where every student I met talked about all the activities they were involved with outside academics - sports, volunteering, teaching, shadowing, interest groups, social clubs. The administration at this school talked about how they encouraged students to stay connected to their non-medical interests and to the community at large. The administration never seemed concerned about their students doing well on their exams...

Step scores at school A are much lower than Step scores at school B

Some will classify my observations as differences between the two "feels" of the schools. I think that my observations reflect the average academic ability of students at the two schools...then again I don't have enough experience/understanding to know for sure. Thoughts?

Edit: I understand that academic ability /= doctoring potential, I don't have a better measure at my disposal right now.

Definitely an interesting observation. There's also some possibility that the students in part A are occupying the part of the stress-response curve where the law of diminishing returns comes into play. Studying too little will most likely lead to failure, and some degree of stress is needed to enhance performance, but after awhile too much stress and nothing but studying can actually impair performance. I'd much rather be in a place that emphasizes the importance of academic achievement but also emphasizes the importance of relaxation and hobbies and whatnot. Not sure if that could explain an entire school, of course. But it's certainly going to be a factor for some people.
 
Everyone's smart wherever you go and there's a good chance you'll be below average (in a group of very, very smart people.)
I would qualify this with a big "it depends," specifically with regard to who this is directed at and where they're going. There are definitely massive differences in student caliber between the highest-average-stat US MD schools and the lowest-average-stat US MD schools, and a high-stat applicant would be foolish to expect the same odds of average performance (relative to their class cohort) and both places.
 
This is so wrong and you'll be humbled by the caliber of students you see in any MD school. Even a low-tier school will have students who were wait-listed at great schools. Once you get to med school, everyone is or has the capability to be a big fish.

And it doesn't matter anyways, you're competing (in terms of Step 1) against all medical students. Doing even average is a tremendous feat.
 
This is so wrong and you'll be humbled by the caliber of students you see in any MD school. Even a low-tier school will have students who were wait-listed at great schools. Once you get to med school, everyone is or has the capability to be a big fish.

And it doesn't matter anyways, you're competing (in terms of Step 1) against all medical students. Doing even average is a tremendous feat.
I don't buy this at all. Most, meaning the majority, of students at my state med school would have no business applying to any schools that we would call "competitive" relative to the overall pool of medical schools. Yeah, there's a small minority of students at this school that were waitlisted/accepted to more competitive options, even top schools, but in general the caliber of student at my state school in particular is poor. I would know personally, since most of them come from my undergrad.
 
I would qualify this with a big "it depends," specifically with regard to who this is directed at and where they're going. There are definitely massive differences in student caliber between the highest-average-stat US MD schools and the lowest-average-stat US MD schools, and a high-stat applicant would be foolish to expect the same odds of average performance (relative to their class cohort) and both places.

I've always believed this as well, but this thread as given me an opportunity to question why I do. I wonder whether you're thinking about the step scores or something else?

Here's a reasonably long list of average step 1 scores. Seems to support what you've said.
 
I've always believed this as well, but this thread as given me an opportunity to question why I do. I wonder whether you're thinking about the step scores or something else?

Here's a reasonably long list of average step 1 scores. Seems to support what you've said.
Personal experience. My undergrad has no shortage of privileged premeds that despite thousands of dollars of parents money at their disposal, struggle to crack 30 on the MCAT and still glide into our state med school with 28's because the school's standards are low (for various reasons). More students at this med school come from my undergrad than anywhere else, and the average entry stats for the med school are low. Yeah, if I went there I am fully aware I might encounter some baller (or many even) that could blow me away in terms of academic performance. However, by every measure I can evaluate, the great majority of students there are nowhere near intimidating competitors.
 
Personal experience. My undergrad has no shortage of privileged premeds that despite thousands of dollars of parents money at their disposal, struggle to crack 30 on the MCAT and still glide into our state med school with 28's because the school's standards are low (for various reasons). More students at this med school come from my undergrad than anywhere else, and the average entry stats for the med school are low. Yeah, if I went there I am fully aware I might encounter some baller (or many even) that could blow me away in terms of academic performance. However, by every measure I can evaluate, the great majority of students there are nowhere near intimidating competitors.
Yes, this is what I meant in my original question.

From personal experience, I know a lot of people going to top 20 med schools from my undergrad and they are not people I would like to compete with. I also know a lot of people from my high school who went to the public state colleges in my state and all of them have been accepted to mostly mid-tiers. Knowing them and their work ethic, I would much rather compete with them than against the kids from my undergrad going to top 20s..
 
Personal experience. My undergrad has no shortage of privileged premeds that despite thousands of dollars of parents money at their disposal, struggle to crack 30 on the MCAT and still glide into our state med school with 28's because the school's standards are low (for various reasons). More students at this med school come from my undergrad than anywhere else, and the average entry stats for the med school are low. Yeah, if I went there I am fully aware I might encounter some baller (or many even) that could blow me away in terms of academic performance. However, by every measure I can evaluate, the great majority of students there are nowhere near intimidating competitors.

I'm always a little hesitant to use MCAT scores as the ultimate metric for comparison and it also seems like personal experience might be a little misleading, but I see what you mean.
 
I have been wondering about this question recently.

It seems like you have to excel in every academic aspect to get into competitive specialties. Step 1 and good LORs seem like the two most important factors.

Can anyone speak to how important pre clinical/ clinical grades are in the hierarchy of admission factors in one's residency application?

I feel like deciding between a mid tier vs top school also depends on how you the schools grade you during the pre clinical/ clinical years. If the class is curved, it seems like it would be better to be at a less competitive school.

I'm a little surprised at people's reaction to your question:

"There is so much wrong with this question."

"This is so wrong and you'll be humbled by the caliber of students you see in any MD school. Even a low-tier school will have students who were wait-listed at great schools. Once you get to med school, everyone is or has the capability to be a big fish.
And it doesn't matter anyways, you're competing (in terms of Step 1) against all medical students. Doing even average is a tremendous feat."​

I don't think there's anything wrong with being strategic about where you want to go (can you guys explain what you mean?) especially if you're interested in getting into a competitive field. I definitely know it is easier to get good grades at one school vs another. The pool you're competing in makes a huge difference when you're graded on a curve.
 
So, I keep reading this on SDN...but...

I interviewed at school A where every student I met (even the MS1s) were frantic about passing boards and all they talked about was studying all the time every day. The administration at the school also kept talking about ALL the resources available (including an extra month of lectures specifically aimed at board test taking strategies) to students to make sure that most of them pass their exams.

I interviewed at school B where every student I met talked about all the activities they were involved with outside academics - sports, volunteering, teaching, shadowing, interest groups, social clubs. The administration at this school talked about how they encouraged students to stay connected to their non-medical interests and to the community at large. The administration never seemed concerned about their students doing well on their exams...

Step scores at school A are much lower than Step scores at school B

Some will classify my observations as differences between the two "feels" of the schools. I think that my observations reflect the average academic ability of students at the two schools...then again I don't have enough experience/understanding to know for sure. Thoughts?

Edit: I understand that academic ability /= doctoring potential, I don't have a better measure at my disposal right now.

Does school B use P/F grading? If so that would explain a lot.

For the most part, higher ranked schools tend to have more relaxed and supportive atmospheres.
 
Yes, this is what I meant in my original question.

From personal experience, I know a lot of people going to top 20 med schools from my undergrad and they are not people I would like to compete with. I also know a lot of people from my high school who went to the public state colleges in my state and all of them have been accepted to mostly mid-tiers. Knowing them and their work ethic, I would much rather compete with them than against the kids from my undergrad going to top 20s..

Why, when you think of your future interactions with your classmates, are you so focused on how they are your competition and not how they will be your colleagues?
 
As an exceptional person (better than others) I purposefully did not apply to top tiers so I could gun the hell out of my idiotic mid-tier classmates and destroy them on exams, rounds, and life in general.
 
Basically, is it better to be a big fish in a small pond or a small fish in a big pond? I would imagine going to a top 20, your classmates are going to be students from the ivy leagues or top UG feeder schools like duke, jhu, washu or the stellar state school students vs at a mid tier, the field would be less competitive.

This is a horrible idea for a number of reasons:

1. Residency directors don't care about preclinical grades for the most part. Grades are way down the list of things directors look at behind step 1, M3 clinical grades, M4 away rotation grades, LORs, research, school reputation, and even some medical school ECs. Yes, a few competitive specialties favor applicants with AOA (with is determined in part by preclinical grades) but even that isn't nearly as important as step 1 and clinical grades.

2. Nearly all top tier schools are moving to P/F which means you won't have to worry about the competition anyway.

3. Your step 1 score is the main factor in residency applications. The score you get is mostly a factor of how hard you study, not which school you attend. That being said, its much easier to start reviewing earlier and focus on boards relevant material when you don't have to worry about grades at a P/F school.

4. If you're interested in competitive specialties, the research opportunities and connections you can make at top tier schools can be very helpful especially if your step 1 or clinical grades are below average.

5. School reputation does play a small (but significant) role in residency applications.
 
Perhaps a bit off topic, but how significant is the P/F versus the TRUE P/F debate? I've been told that some of the top P/F schools still maintain an internal rank. Is this something to be concerned of so long as one is passing?
 
Med students almost universally go on to residency training (an actual paid job) in one of 25(ish?) medical specialties upon graduating. What initially will be important in determining whether or not you even get an offer to interview for this post med school job will be your individual med school performance plus Step 1 (a standardized test you will take at the end of year 2). You will probably be competing against many other job applicants and their individual records from all over the country for any one job. Assuming it’s a US med school, where you go to school, or whether it is low, mid or top 20 is less important than how you performed in school. So to answer your question, as almost 3 out of 5 med school applicants do not get accepted anywhere, it’s just better to be a fish in whatever pond you can get into first of all. If you are lucky enough to get multiple med school invites, then I’d strongly consider the least costly. All US med schools are good and can get you post med school interview offers to residencies.
 
This is a horrible idea for a number of reasons:

1. Residency directors don't care about preclinical grades for the most part. Grades are way down the list of things directors look at behind step 1, M3 clinical grades, M4 away rotation grades, LORs, research, school reputation, and even some medical school ECs. Yes, a few competitive specialties favor applicants with AOA (with is determined in part by preclinical grades) but even that isn't nearly as important as step 1 and clinical grades.

2. Nearly all top tier schools are moving to P/F which means you won't have to worry about the competition anyway.

3. Your step 1 score is the main factor in residency applications. The score you get is mostly a factor of how hard you study, not which school you attend. That being said, its much easier to start reviewing earlier and focus on boards relevant material when you don't have to worry about grades at a P/F school.

4. If you're interested in competitive specialties, the research opportunities and connections you can make at top tier schools can be very helpful especially if your step 1 or clinical grades are below average.

5. School reputation does play a small (but significant) role in residency applications.

AWESOME ANSWER, Thanks!
 
My class has kids from Duke, Harvard, Princeton, etc but I never saw myself as inferior to them just because of where they went to college or that they may have scored a few more points better on the MCAT. If anything, there's so many people with cool stories and experiences that they motivate me to do cool stuff as well.
 
I went to a good school for undergrad (Top 30) but it wasn't a big name or anything. I remember on two occasions I asked two of my professors (one who had taught at Yale, the other at Harvard before coming to my school) what differences they saw between those ivies and this mid-tier private university. Surprisingly, they both said essentially the same thing: "The top 15%, no difference, the bottom 15% no practical difference, and the middle students at the Ivies are better at playing the game and showing up than the middle students at my school."

Smart people are smart, and generally you won't notice much difference amongst the best whether it's at elite schools or non-elite schools. Honestly, the most important lesson I had to learn was that this stuff just doesn't matter. We have the benefit of being in a profession where none of this stuff matters very much, and what you can do will affect your success far more than where you did it, or how well you did it compared to your classmates, or who you know. Sure these things will always come into play in a few cases. However, generally, if you concentrate on dedicating yourself such that people know that you do good work, you'll get to where you want to go.
 
School reputation does play a small (but significant) role in residency applications.”

According to the NRMP survey of residency program directors (PD), the most important factors in their decision making is how the residency (job) applicant performed in med school (especially MS3, letters of rec, Dean’s letter, etc). The preclinical years and the name at the top of the diploma are less important in the PD’s decision making process. According to the PDs, the fact that the name at the top of the diploma is from any US med school is more important than whether the med school is well known.

“If you're interested in competitive specialties, the research opportunities and connections you can make at top tier schools can be very helpful especially if your step 1 or clinical grades are below average.”

I somewhat disagree. When you apply electronically, residency programs will tend to use screening filters meaning if you don’t have a high enough GPA and Step 1 score, your application will probably be sent to the reject pile despite your research or connections. And just because you made some “connections” at med school, I think this is a greatly overblown factor. Not every med student is going to make a “connection” with some well respected person while in med school. Also don’t these well known people have some integrity or do they just write rec letters for everyone? I’m not saying that rec letters do not get written by well known people for weaker candidates, I just do not think it’s widespread, especially when you’re talking about competitive residencies.

As to AOA question: some med schools do not have AOA chapters (I think Stanford, UCSD and some others). So AOA certainly makes an application stronger, but it may not have any bearing depending on one’s med school.

I apologize, we’re getting away from OP.

.
 
Honestly, I don't really know what my point is - I'm in the process of trying to figure out what my experiences with these difference groups of medical students mean.

What I see is a group of students who do nothing but obsessively study vs a group of students who learn the same material, still have a life, and seem to have a better (score-wise) outcome. Does this mean that the students at the crazy study all the time school are less capable in some way? I don't know...that's my question.

Group B students are better at pretending to be chill. Don't be fooled.
 
Group B students are better at pretending to be chill. Don't be fooled.

There are students who do nothing but study (only useful to a certain point), and students who know it's all about balance: study enough to do well but also know how to enjoy life outside of academics. I definitely noticed (slight) differences between schools, with some students more stressed/neurotic than others.
 
There are students who do nothing but study (only useful to a certain point), and students who know it's all about balance: study enough to do well but also know how to enjoy life outside of academics. I definitely noticed (slight) differences between schools, with some students more stressed/neurotic than others.
Some people perform better by just studying 24/7 and doing nothing else. Everyone's different. Also, enjoying life outside of isn't necessarily going out with other medical school students exploring the city/town. It could be anything from binge watching netflix shows or playing video games
 
Some people perform better by just studying 24/7 and doing nothing else. Everyone's different. Also, enjoying life outside of isn't necessarily going out with other medical school students exploring the city/town. It could be anything from binge watching netflix shows or playing video games

Oh, I completely agree. I know it's more than the two extremes (I'm somewhere in the middle, probably), I'm just trying to address the "don't be fooled" comment -- there are students who study relatively little, have fun (in different ways), and do just fine academically.
 
Regardless of where you go for medical school there is going to be an amazing selection of students. The beauty of medical admissions being so competitive is that essentially everyone is capable and, with the right foci, can succeed at nearly any level. At 'top' programs you're probably going to run into more individuals focused on the academic side of medicine and at the other 'levels' you're going to find a greater focus on the clinical side of medicine, but since the pre-clinical curriculum is essentially P/F across the board, it's not like it's going to be a competitive environment at either place. Go where you feel welcome, go where you get a cheap education, go where you think you will do the best toward your own personal goals. In the end, that's all that matters - whether you are happy with yourself and what you have done in your life.
 
I don't buy this at all. Most, meaning the majority, of students at my state med school would have no business applying to any schools that we would call "competitive" relative to the overall pool of medical schools. Yeah, there's a small minority of students at this school that were waitlisted/accepted to more competitive options, even top schools, but in general the caliber of student at my state school in particular is poor. I would know personally, since most of them come from my undergrad.

And these are the ones who end up in primary care, usually.
 
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