I think the poster choose Upstate over Downstate because Upstate has a Binghamton campus (1st, 2nd year is at Syracuse, 3rd, 4th year at Binghamton). Since the poster is graduating from Binghamton (check the sig) that why the choice was made.
Downstate is higher ranked school...but the statement Upstate produces more FM students is not true at all. There was a student who went into Neuro Surgery last year.
3 went into Neurosurgery 2 at Mount Sinai, 1 at Duke. 1 Derm I think, 5 got Opthalmology, 5 people got Ortho, 5 got ENT (1 Yale). The year before that 2! people got Radiation oncology (only ~60 programs nation wide), one got it this year.
Many of the upper tier students who want Radiology and Anesthesia at choice programs are very successful, 9 total for Rads at places like Duke, UVa, UPitt, and Thomas Jefferson last year. 10 for Anesthesia at Case Western, Rochester, and many hospitals within NYC.
For Internal Medicine and Peds, the school has matched many of its students at top tier programs in the Northeast, Yale, MGH, BID, Brigham and Womens, Hopkins, UPENN, Columbia Pres, NYU, Barnes Jewish Hosp/Wash U etc etc.
The only thing I haven't seen is a wildly large number of students getting into top tier West Coast Programs (matters more if you're a California student). Last year there were 2 people who got Pathology at Stanford, one got Ortho at St. Mary's in San Francisco, 1 medicine at Cedars-Sinai. The year before that, someone got Urology at UCSD (only ~200 spots nation wide), medicine at UCSF and General Surg at USC. This is more likely a reflection of the composition of the class (>90 from Northeast) versus difficulty matching into the West Coast.
Feel free to PM if you have any questions. I'm a fourth year from California at Upstate and am very happy with my experience here for med school. I can assure you that access to top tier programs in competitive specialties is not an issue with our campus.
The most differentiating feathure between us and a place like Downstate is the patient population. Here you get a mix of rural and working class urban patients from North PA to the Southern border of Canada and everything in between Rochester NY and NYC. Downstate you are the main medical center in Brooklyn, so you're talking a very large city population with all of the city issues.
I personally liked the mix I received at Upstate, even though I will most likely do my residency in a major city.