For emergency medicine, which is what I am most interested in, some of the Ivy programs are incredibly weak.
At Emory, where I am working on a research project, I was talking to one of the interns who went to med school at Harvard, and she was telling me that their EM program director is a surgeon, and surgery dominates the department.
Now what does that mean? It means the EM residents are the redheaded stepchildren, and they don't get to do or learn anything.
The really good programs are the ones that give their EM residents a lot of autonomy and responsibility. So who gets to manage the airway? Who gets to do the FAST? And so-on.
To tell you the truth, my work at Emory has exposed me to academic medicine in a very positive way. I never thought in a million years that would interest me, but now I cannot imagine myself not having at least some hand in teaching and doing research as an emergency physician and resident.
Off the top of my head, I cannot think of one Ivy program that I would even apply to for EM, other than the ones in NYC. NY Hospital-Queens is a Cornell affilliate, and St. Luke's-Roosevelt is affiliated with Columbia. I'll do my homework and maybe that list will grow, but I'm not going to try for Ivy so I can get my name to look pretty on a match list if I wouldn't be getting the best training available.
And depending on my board scores, I've done some things that are probably going to make me a pretty strong EM applicant. I'm not saying I'll be able to pick and choose, but I think I'll have some attractive options.