Top tier school vs mid tier for neurosurgery matching - does it matter?

[jbz24]

No there isn't. I've written pretty extensively on this very topic on these boards and can give you a lot of reasons why there is really no value for premeds to look at match lists. I'll revamp a few here, but there are even others in my prior threads.

First, you have no idea what a good match is. There are better and worse places in every specialty, and they don't align to the rankings of med schools. No place is good in all fields, and in fact many are quite malignant in several. So you can't go by program or specialty name. A premed might look at a list and say "this dude matched into ortho at XYZ" and think that's a good match because XYZ is a top ranked med school. But in fact XYZ might be the most malignant program in the country and at the botton of this dude's ranking list, so not really an appealing match at all. How can you know as a premed? You can't. This is the kind of stuff you only find out once you are in med school, choose a specialty, choose a mentor in the field, and find out the word of mouth buzz about the various programs. They aren't ranked anywhere, it's a word of mouth thing, largely determined by the personnel. Good vs malignant matters -- your life will be very bad if you choose someplace awful and have to be there for 3-7 years, even if the name sounds impressive. So no, you can't look at a match list and know anything until you get further down the road.
Next, a match is only good if people get what they wanted. A list that looks unimpressive but everyone got their first choice is better than one where everybody fell down to their 5th choice. Doesn't matter if the latter looks more impressive to you as a premed, it's a bad match. People will be crying on match day.

Bear in mind that the match doesn't tell you what people could get, only what they chose. There are a million factors that go into that choice, and people don't generally choose the most competitive thing they can get. The top person in the class is just as likely to choose IM or surgery as they are to choose plastics or derm. You have to realize that you are choosing what you are going to be doing for the next 40 years of your life. It's not something you do because it's prestigious, like choosing a school might be -- you actually have to like it. Many top students enjoy things like psych or peds or surgical procedures and thus will choose to go down these roads. For them getting their choice in these fields is a better match than getting derm or rads. Also bear in mind that folks coming into residency are 4 years older than when they applied to med school. Many will have spouses, fiancees, families, or otherwise have put down roots. So many will make choices that will work best along with the non-academic aspects of their lives -- they may not choose the best program in a specialty because it's not where their spouse has a job, etc.

Truth is, the match list only tells you something about that particular class and their goals, if they got them, not about how the school does. You are basically trying to extrapolate things but have no basis for doing so. It's basically like watching the last 5 minutes of a movie with the sound off and trying to extapolate what happened in the prior two hours. You will be wrong most of the time. Waste of time in my opinion. Don't bother with this. As a premed folks probably will still try to fool themselves that there is some information to be obtained, but I assert that without the context, the raw data will run you astray 99.99% of the time. Generally you will make better decisions with no data than misconstrued data.

I'll admit that when looking at match lists, I'm mainly looking at IM since that's what I applied to and I know very well what is considered a good program and what is not. As mentioned above, there's definitely selection bias that goes into match lists. However, it is unlikely to be only selection bias.

Looking at lists in terms of what number choice you got is also a waste of time then. Average students from lower tier schools will simply be closed out of interviews from top programs. I find it more impressive that a school's worst matches in IM consist of places like UPitt and Cornell. Even if this is their 8th or 9th pick, that means that those students interviewed at other great programs, and even though they might not have gotten their first choice, they still ended up at a great program that many people would be ecstatic to go to. But if we're going to talk about the futility of comparing match lists, I will stop, even though I still feel there is some usefulness in doing so.

---

Members don't see this ad.

 

[Parts Unknown]

The biggest problem in comparing lists is selection bias, but I refuse to believe it's only selection bias. My school cannot boast the matches that Harvard's school does, and I know many of my classmates are aiming for the top programs that Harvard's students are.

And I would guess that Harvard's students boast accomplishments that set them apart, even without the name "Harvard" on their ERAS applications. Hence the selection bias.

So we have this thing called prestige, which cannot be quantified and therefore matters anywhere from a whole lot to not at all. Congratulations, we have accomplished nothing.

 

[drizzt3117]

Not only is that purely speculation, but I bet it's not even close to that. Mid-230 average?!?!

I think it's pretty accurate. I don't think HMS publishes their board averages but Duke, Penn, and Wash U all have 235 and above averages. Even Keck averaged 232 last year. The national average last year was 221 with SD of almost 20, I don't think it's unreasonable that the best med schools in the country would be less than a SD above the national average.

 

[jbz24]

And I would guess that Harvard's students boast accomplishments that set them apart, even without the name "Harvard" on their ERAS applications. Hence the selection bias.

So we have this thing called prestige, which cannot be quantified and therefore matters anywhere from a whole lot to not at all. Congratulations, we have accomplished nothing.

I think that is an accomplishment in and of itself.

Seriously though, I disagree with some of you guys, but it's fine to have differing viewpoints.

 

[thesauce]

No there isn't. I've written pretty extensively on this very topic on these boards and can give you a lot of reasons why there is really no value for premeds to look at match lists. I'll revamp a few here, but there are even others in my prior threads.

First, you have no idea what a good match is. There are better and worse places in every specialty, and they don't align to the rankings of med schools. No place is good in all fields, and in fact many are quite malignant in several. So you can't go by program or specialty name. A premed might look at a list and say "this dude matched into ortho at XYZ" and think that's a good match because XYZ is a top ranked med school. But in fact XYZ might be the most malignant program in the country and at the botton of this dude's ranking list, so not really an appealing match at all. How can you know as a premed? You can't. This is the kind of stuff you only find out once you are in med school, choose a specialty, choose a mentor in the field, and find out the word of mouth buzz about the various programs. They aren't ranked anywhere, it's a word of mouth thing, largely determined by the personnel. Good vs malignant matters -- your life will be very bad if you choose someplace awful and have to be there for 3-7 years, even if the name sounds impressive. So no, you can't look at a match list and know anything until you get further down the road.
Next, a match is only good if people get what they wanted. A list that looks unimpressive but everyone got their first choice is better than one where everybody fell down to their 5th choice. Doesn't matter if the latter looks more impressive to you as a premed, it's a bad match. People will be crying on match day.

Bear in mind that the match doesn't tell you what people could get, only what they chose. There are a million factors that go into that choice, and people don't generally choose the most competitive thing they can get. The top person in the class is just as likely to choose IM or surgery as they are to choose plastics or derm. You have to realize that you are choosing what you are going to be doing for the next 40 years of your life. It's not something you do because it's prestigious, like choosing a school might be -- you actually have to like it. Many top students enjoy things like psych or peds or surgical procedures and thus will choose to go down these roads. For them getting their choice in these fields is a better match than getting derm or rads. Also bear in mind that folks coming into residency are 4 years older than when they applied to med school. Many will have spouses, fiancees, families, or otherwise have put down roots. So many will make choices that will work best along with the non-academic aspects of their lives -- they may not choose the best program in a specialty because it's not where their spouse has a job, etc.

Truth is, the match list only tells you something about that particular class and their goals, if they got them, not about how the school does. You are basically trying to extrapolate things but have no basis for doing so. It's basically like watching the last 5 minutes of a movie with the sound off and trying to extapolate what happened in the prior two hours. You will be wrong most of the time. Waste of time in my opinion. Don't bother with this. As a premed folks probably will still try to fool themselves that there is some information to be obtained, but I assert that without the context, the raw data will run you astray 99.99% of the time. Generally you will make better decisions with no data than misconstrued data.

He's right on. I did a year of research and saw my original class match last year. By looking at their match lists, a lot of top students matched into specialties and programs that you wouldn't think they wanted to be at if you didn't know them personally. Examples:
1. AOA, 250+, matched a competitive specialty with a prelim surg at a community hospital because it was near her house.
2. AOA, 250+, matched one of the least competitive specialties alongside 2 of our classmates who didn't perform in the same stratosphere as he did.
3. AOA, not sure of his step 1, matched at his #1 in one of the least competitive specialties near his hometown because he wanted to.
4. AOA, mid 240s decided to stay at our home program because his fiancee was close by. He received interviews at all of the top programs in his specialty, but didn't rank them highly.
5. AOA, not sure of her step 1, matched her #1 in one of the least competitive specialties

These go on and on. Looking from the outside, all you see is: non-academic program, non-competitive specialty, etc. You just don't get the full effect.

 

[drizzt3117]

I think there's also PD familiarity with students from given programs. Looking at match lists can show you whether year after year students match at a given program more often etc. Of course, you still need outside knowledge to determine if that match is good or not, but it can still be useful. An example would be the well-established trend of Columbia grads matching into Barrow. Someone who knows 100% that they're going into NS might choose Columbia over similarly ranked schools for that reason.

 

[Law2Doc]

...

These go on and on. Looking from the outside, all you see is: non-academic program, non-competitive specialty, etc. You just don't get the full effect.

Precisely. I think most of us post-match can give you a laundry list at least as long. Reason -- the rest of your life is a long time and prestige is not the end all be all. You are going to be working in whatever you choose for residency for a very long time so you need to like it. Doesn't matter what else you could get, if your numbers say derm but you loved peds, you are the smarter individual if you pick peds. Similarly if the top program in your desired field is in Boston, but you are well settled in Kentucky with a wife and kids, then you pick Kentucky, even if your numbers would get you into "better" places. That's the long and short of it -- the match list only tells you where folks ultimately end up going, not what they could have gotten. So a school with a list that looks bad may be composed of first choice dream matches for everyone on that list. It's the dumb premed who looks at it and says "only 2 rads and 1 derm it is a bad list". That ignores the fact that perhaps 30 people in that program could have easily had derm but 29 couldn't see spending their life dealing with eczema and ring worm. You can't know. But odds are that the data without the context will lead you to the wrong conclusion.

Also I agree somewhat with what Parts Unknown is saying. A lot of people who get into Harvard do so because they are accomplished and uber smart. Many of them continue to be accomplished and uber smart through med school and thus would end up with lots of choices in residencies. Does that mean Harvard played a role? I would suggest it didn't. In fact one should be more impressed with the place where folks matched well without starting out as accomplished.

In short the school isn't going to play the kind of helpful role a lot of people are ascribing to it. Go to where you will thrive and do well because you and only you are going to open the doors you need opened in this process. And don't waste too much time thinking you know what you are reading in match lists. You aren't. You are seeing a snapshot of where folks are ending up but without the context or knowing what they wanted, were shooting for, and what factors made them apply to various fields or geographic locations instead of trying to end up with something that would impress uninformed premeds. And keep in mind that a malignant match in a competitive specialty might be far far far worse a match than a good match in a non-competitive specialty. You won't know any of this kind of "malignant vs benign" components or how programs rank in each specialty (it's a very different list in each field) until late in med school when you pick a specialty and start picking the brains of mentors in the field.

 

[jbz24]

Precisely. I think most of us post-match can give you a laundry list at least as long. Reason -- the rest of your life is a long time and prestige is not the end all be all. You are going to be working in whatever you choose for residency for a very long time so you need to like it. Doesn't matter what else you could get, if your numbers say derm but you loved peds, you are the smarter individual if you pick peds. Similarly if the top program in your desired field is in Boston, but you are well settled in Kentucky with a wife and kids, then you pick Kentucky, even if your numbers would get you into "better" places. That's the long and short of it -- the match list only tells you where folks ultimately end up going, not what they could have gotten. So a school with a list that looks bad may be composed of first choice dream matches for everyone on that list. It's the dumb premed who looks at it and says "only 2 rads and 1 derm it is a bad list". That ignores the fact that perhaps 30 people in that program could have easily had derm but 29 couldn't see spending their life dealing with eczema and ring worm. You can't know. But odds are that the data without the context will lead you to the wrong conclusion.

Agreed about the number of students going into a given specialty, that has little utility. Still disagree about where they are going within a given specialty. There is self-selection and lists only tell you where they end up, but that's true for all lists, even ones from Harvard and other top schools.
If you take two similarly located places (like a Downstate vs. a Cornell or Columbia), Downstate places a handful of students for IM into community hospitals in NY. Sure, some of these may have been first choices, but I doubt most of these students would have picked these community hospitals over NYU, MSSM, Cornell, or Columbia if given the choice. Right, I can't prove this, and that's exactly your point, but I still think it's useful to know where these people end up, even if you don't know why.

And sure you can give a list of students with AOA, 250+ who decided to match into less prestigious programs. But can you give as long of a list of average students with lower board scores who matched into top tier programs? Probably not, unless you went to a top tier school yourself.

Edit: Oh and I have to disagree with you that Harvard played no role. What does accomplished mean in terms of med school? Getting good grades, doing well on the boards, getting AOA. These are not school specific and half of the class in any med school, even Harvard, will fall into the bottom 1/2 of the class. Harvard may help with research, it may help with LOR writers, but the accomplishments you did before med school is less relevant than what you did during med school, unless it's research-related.

In fact one should be more impressed with the place where folks matched well without starting out as accomplished.

You are making as many assumptions as I am. How do you know if they were or were not already accomplished beforehand?

 

[calvinNhobbes]

You will get that residency based on the strength of your Step 1, your evals, contacts, and research.

Absolutely, but the question is, how much does going to a top ranked med school influences these parameters? Top tier med schools have on average higher board scores (most likely because to get into them you need higher MCAT scores meaning on average they are better standardized test takers), you have more well known faculty meaning better contacts, and you have more money for research meaning more and better opportunities.

Bob's 250 Step 1 beats your Harvard pedigree every time.

But that's not the point. The point is a 250+Harvard beats Bob's 250, and if Bob had a 220 he might not match at all while Harvard+220 probably will and maybe even at a great place because of his contacts.

That being said. I 100% agree that pre-meds should not really bother looking at match lists. Med school rankings and US news hospital rankings mean practically nothing for how good a residency is. And like you said, so much of it is personal and nothing to do with the reputation of the program. As you know, priorities change as you get older.

 

[Parts Unknown]

Absolutely, but the question is, how much does going to a top ranked med school influences these parameters?

Some.

 

[Law2Doc]

... Right, I can't prove this, and that's exactly your point, but I still think it's useful to know where these people end up, even if you don't know why....

Again, data that is taken out of context, where the context is the most critical factor (ie why someone is choosing something is critical when looking at people's "choices") is bad data. The critical part of the analysis, ie whether this tells you anything, is the "why". If you don't know it, it's useless data to you.

 

[Law2Doc]

...
You are making as many assumptions as I am. How do you know if they were or were not already accomplished beforehand?

That's my point. I'm suggesting you don't make this kind of assumption. I made an equally persuasive argument that the bad data leads elsewhere...

 

[jbz24]

That's my point. I'm suggesting you don't make this kind of assumption. I made an equally persuasive argument that the bad data leads elsewhere...

I agree it isn't "good data" from a purely scientific standpoint, but I disagree that match lists don't have useful information. Do you think that Harvard and SUNY Downstate's match lists would be identical if their students ranked their match lists solely by prestige of the residency program?

 

[alibai3ah]

No, what they purport to do isn't what the ranking measures. Because they include and heavilly weight things like percentage of folks going into primary care (ie noncompetitive fields), they undermine what you suggest. Speaking from someone who has now worked with a lot of people coming out of these schools I would suggest that the degree of clinical preparation certainly doesn't follow the primary care rankings. Many of the folks coming from the top research schools also have been very well trained in primary care. In fact, this is going to be person, not school specific because in med school you can always take electives that are going to make you better or worse prepared for the wards. Folks that avoid sub-Is and ICU electives are going to know less about patient management than those who took the minimum. Programs that are understaffed and in inner cities tend to allow med students to do more so they are going to be better prepared on the procedural (blood draw/IV/NG tube) aspects. But no, the number of folks going into, say, FP or peds doesn't mean the school is better at it because you don't really know if this is a measure of how good the program is in FP or peds or whether folks coming out of there simply have fewer choices. (Bearing in mind that I'm skeptical as to how much of a contribution med schools make to this individual journey anyway, but if you are ranking places you are pretending they do).

Well you are a resident and I'm just going to be starting medical school, so obviously you know much more.The thing that bothers me the most is that there is always a hierarchy... At the undergrad level, then the perpetual MD vs. DO battle, and once somebody makes it into an MD program, then it goes on, until residency where certain specialties are deemed more respectable than others....it just never ends.

I'm interested in primary care (for now), but it is annoying that people will automatically assume that people like me couldn't get into a more competitive residency.... even if they had the numbers to do so.

 

[Law2Doc]

... you have more well known faculty meaning better contacts, ...

Actually at some of the smaller places you might have better access to faculty, even if they aren't as big named. Having an attending who will pick up the phone on your behalf is far more important than getting an eval from a Nobel prize winner who barely acknowledged you during a rotation. And the Nobel winners are far more likely to ignore you, in my experience (although I'm sure there are exceptions).

The short answer is that school name isn't going to have much impact. You will pave your own way no matter where you go, and the 240 you are going to score you likely will score whether you got into Harvard or JoeSchmo SOM. You control your own destiny. The school name is so far down on the list of criteria that they generally will never get to it. Sure folks will argue, "all things being equal" but you know what? In this game all things are never equal. And to the extent school name matters, it matters not because of prestige or ranking, but because a place had residents from that program before and they did well. A PD couldn't care less where you went to med school. His concerns are twofold: (1) you have to be able to do the work without much handholding despite a steep learning curve, and (2) you need to pass the in-service and boarding exams. The better students from any med school will satisfy criteria #2, so pedigree is meaningless for this one. The former is where he gets headaches -- he simply doesn't want to deal with a problem intern that attendings have issues with and aren't comfortable leaving their patients under this person's care overnight. And so a typical PD will say, we had two grads from XYZ school last year and they were pretty good interns, and we had one from PDG as well who wasn't up to snuff. So next year we will definitely take more XYZ folks, but sure won't touch another PDG. And it won't matter to him if PDG = Harvard or Hopkins, and XYZ is JoeSchmo, because his biggest concern, the thing that would otherwise give him a headache, is addressed. And so that's the way school name gets used in real life. Only on pre-allo is it assumed that you get more of a "golden ticket" by getting into a top ranked place. In truth, you have only just started proving yourself. And you can be helped or screwed by the alumni in the years ahead of you who can endear or sour a PD to your school regardless of the name.

 

[Law2Doc]

... Do you think that Harvard and SUNY Downstate's match lists would be identical if their students ranked their match lists solely by prestige of the residency program?

I'm not sure what you are trying to argue. I'm saying that match lists reflect choices as much, if not more, than achievement. People are choosing what they want to do for the next 40 years in their life, and geographically where they want to start their careers, taking into account family and SO concerns. Meaning these lists are meaningless if you are using them to see which place is "better" at getting people into certain paths.

I also would suggest that an objectively good list could be horrible if people didn't get what they wanted, and an objectively poor list could be fantastic if people got what they wanted. Want does not equal what they could get, mind you -- people are making a decision that affect their next 40 years and so they aren't shooting for the most prestigious, they are shooting for what they want to do. This is hard to convey to premeds who are only thinking in short, 4 year blocks with college and med school, but in general once you pick a specialty, that is the path you are on for decades. So it's important that you find what you like, or you will be miserable, even if premeds find it prestigious. Your mindset will change. Choice matters. And hence not knowing choice makes trying to interpret these lists useless.

I'm also suggesting, if the above wasn't enough to confound things, that premeds cannot read match lists because they don't know which programs are good in various fields (EVERY field has a very different list), and don't know which places are benign versus malignant. These are huge factors to consider, only after you have chosen your desired field, and again this is word of mouth you learn at a much later junction.
So you are wasting your time with lists. That's okay, a lot of us wasted our time with them. Only to come to realize in a few years that it was foolish.

 

[Law2Doc]

...
I'm interested in primary care (for now), but it is annoying that people will automatically assume that people like me couldn't get into a more competitive residency.... even if they had the numbers to do so.

Premeds will make this assumption. People further on in the path will know better. No way you should select a residency and spend your next 40 years at a path only to prove to some fools in pre-allo that you could do better, though.

 

[Ischemic]

Well you are a resident and I'm just going to be starting medical school, so obviously you know much more.The thing that bothers me the most is that there is always a hierarchy... At the undergrad level, then the perpetual MD vs. DO battle, and once somebody makes it into an MD program, then it goes on, until residency where certain specialties are deemed more respectable than others....it just never ends.

I'm interested in primary care (for now), but it is annoying that people will automatically assume that people like me couldn't get into a more competitive residency.... even if they had the numbers to do so.

Well, at the end of the day you can only be you and you can't control other people's perception for the most part. If you go home happy and content after a good day saving lives in IM, does it matter what your colleagues o anybody else think? Especially if they're ROAD and go home bitter and angry with unfulfilled expectations?

 

[jbz24]

Actually at some of the smaller places you might have better access to faculty, even if they aren't as big named. Having an attending who will pick up the phone on your behalf is far more important than getting an eval from a Nobel prize winner who barely acknowledged you during a rotation. And the Nobel winners are far more likely to ignore you, in my experience (although I'm sure there are exceptions).

The short answer is that school name isn't going to have much impact. You will pave your own way no matter where you go, and the 240 you are going to score you likely will score whether you got into Harvard or JoeSchmo SOM. You control your own destiny. The school name is so far down on the list of criteria that they generally will never get to it. Sure folks will argue, "all things being equal" but you know what? In this game all things are never equal. And to the extent school name matters, it matters not because of prestige or ranking, but because a place had residents from that program before and they did well. A PD couldn't care less where you went to med school. His concerns are twofold: (1) you have to be able to do the work without much handholding despite a steep learning curve, and (2) you need to pass the in-service and boarding exams. The better students from any med school will satisfy criteria #2, so pedigree is meaningless for this one. The former is where he gets headaches -- he simply doesn't want to deal with a problem intern that attendings have issues with and aren't comfortable leaving their patients under this person's care overnight. And so a typical PD will say, we had two grads from XYZ school last year and they were pretty good interns, and we had one from PDG as well who wasn't up to snuff. So next year we will definitely take more XYZ folks, but sure won't touch another PDG. And it won't matter to him if PDG = Harvard or Hopkins, and XYZ is JoeSchmo, because his biggest concern, the thing that would otherwise give him a headache, is addressed. And so that's the way school name gets used in real life. Only on pre-allo is it assumed that you get more of a "golden ticket" by getting into a top ranked place. In truth, you have only just started proving yourself. And you can be helped or screwed by the alumni in the years ahead of you who can endear or sour a PD to your school regardless of the name.

You keep talking about being the top med student from a school and you have control over your own destiny, which is completely true, but you ignore the "average med student," which let's face it, most of us were/are/will be. I find the top med schools to have incredible matches for their entire class, which other schools cannot boast, but if you want to dismiss that as bad science then so be it.

Definitely agree about the residents ahead of you can help/hurt you. Wouldn't it be helpful to see that though, that the school you attend sends X number of students to Y program because they have a great connection? I would, but I guess it's bad science...

 

[J1515]

Actually at some of the smaller places you might have better access to faculty, even if they aren't as big named. Having an attending who will pick up the phone on your behalf is far more important than getting an eval from a Nobel prize winner who barely acknowledged you during a rotation. And the Nobel winners are far more likely to ignore you, in my experience (although I'm sure there are exceptions).

The short answer is that school name isn't going to have much impact. You will pave your own way no matter where you go, and the 240 you are going to score you likely will score whether you got into Harvard or JoeSchmo SOM. You control your own destiny. The school name is so far down on the list of criteria that they generally will never get to it. Sure folks will argue, "all things being equal" but you know what? In this game all things are never equal. And to the extent school name matters, it matters not because of prestige or ranking, but because a place had residents from that program before and they did well. A PD couldn't care less where you went to med school. His concerns are twofold: (1) you have to be able to do the work without much handholding despite a steep learning curve, and (2) you need to pass the in-service and boarding exams. The better students from any med school will satisfy criteria #2, so pedigree is meaningless for this one. The former is where he gets headaches -- he simply doesn't want to deal with a problem intern that attendings have issues with and aren't comfortable leaving their patients under this person's care overnight. And so a typical PD will say, we had two grads from XYZ school last year and they were pretty good interns, and we had one from PDG as well who wasn't up to snuff. So next year we will definitely take more XYZ folks, but sure won't touch another PDG. And it won't matter to him if PDG = Harvard or Hopkins, and XYZ is JoeSchmo, because his biggest concern, the thing that would otherwise give him a headache, is addressed. And so that's the way school name gets used in real life. Only on pre-allo is it assumed that you get more of a "golden ticket" by getting into a top ranked place. In truth, you have only just started proving yourself. And you can be helped or screwed by the alumni in the years ahead of you who can endear or sour a PD to your school regardless of the name.

Your post should be stickied. Extremely well said. Only on SDN will you hear "With all other things being equal...." because everyone here is infatuated with prestige and finding out what is the "best" in everyone else's eyes. All things are never equal. You will never have the student from SUNY Downstate vs. the student from Harvard with identical step scores, research, grades, previous work experience, personality, and audition rotation experience. A PD would never say "Well they both rotated here and did ok, but this guy came from Harvard so we're taking him." That's not how it works. Coming from Harvard doesn't automatically mean you can make medical management decisions on your own or know when to ask for help from a senior resident. As L2D said, PD's want to take an intern who is going to be self sufficient, get along well with the other residents for the next 3-7 years, and not have to have his hand held. If you want to argue that smarter and more academically successful people overall come from Harvard and therefore will be very likely to succeed, then I agree. But it's not the name of their school that is making them succeed. It's their individual qualities.

Want does not equal what they could get, mind you -- people are making a decision that affect their next 40 years and so they aren't shooting for the most prestigious, they are shooting for what they want to do. This is hard to convey to premeds

Again, right on the money. Whether a 250+ USMLE w/ AOA wants to do FP, EM, or Dermatology, you will never know from a matchlist. Every pre-med thinks they're going into a ROAD specialty and truly believes that every medical student desires to be a radiologist, ophthalmologist, anesthesiologist, or dermatologist.

 

[jbz24]

I'm not sure what you are trying to argue. I'm saying that match lists reflect choices as much, if not more, than achievement. People are choosing what they want to do for the next 40 years in their life, and geographically where they want to start their careers, taking into account family and SO concerns. Meaning these lists are meaningless if you are using them to see which place is "better" at getting people into certain paths.

I also would suggest that an objectively good list could be horrible if people didn't get what they wanted, and an objectively poor list could be fantastic if people got what they wanted. Want does not equal what they could get, mind you -- people are making a decision that affect their next 40 years and so they aren't shooting for the most prestigious, they are shooting for what they want to do. This is hard to convey to premeds who are only thinking in short, 4 year blocks with college and med school, but in general once you pick a specialty, that is the path you are on for decades. So it's important that you find what you like, or you will be miserable, even if premeds find it prestigious. Your mindset will change. Choice matters. And hence not knowing choice makes trying to interpret these lists useless.

I'm also suggesting, if the above wasn't enough to confound things, that premeds cannot read match lists because they don't know which programs are good in various fields (EVERY field has a very different list), and don't know which places are benign versus malignant. These are huge factors to consider, only after you have chosen your desired field, and again this is word of mouth you learn at a much later junction.
So you are wasting your time with lists. That's okay, a lot of us wasted our time with them. Only to come to realize in a few years that it was foolish.

You know exactly what I was trying to argue but you side-stepped my question. If you were able to control how med students ranked their lists, so that they ranked purely by prestige of the programs on their list, do you think Harvard's match list would be identical to Downstate's? If it's simply board scores, grades, AOA, they should be identical according to your argument. You're saying that the main reason why the lists are different is because you don't know how the students ranked their list. However, if you say there's more to it than that, what's left? LORs, research opportunities, ECs. These can be very school-specific as well, with more opportunities with well-known faculty at more prestigious schools.

You've also said before a good list could be horrible if they did not get their first choice. However, again, it shows you that if they did not get their first choice and still landed an excellent residency, then that means they had multiple interviews at other great choices. It's very likely that students from lower ranked schools were simply weeded out before interviews and didn't even have that option.

Prestige and perception matters a lot in this world, even if it's for stupid reasons. To say med students are on equal level at the onset of med school is highly dishonest. You can control your destiny if you're the top student in your class, but if you're just the average student, you might not be able to fully. Whether prestige matters only a little or a lot, I have no idea. But it doesn't matter at all? I don't think so...

 

[jbz24]

If you want to argue that smarter and more academically successful people overall come from Harvard and therefore will be very likely to succeed, then I agree. But it's not the name of their school that is allowing them to succeed. It's their individual qualities.

I agree and I don't have a true argument against that. I just feel that the Harvard name and those very likely to succeed are not mutually exclusive. PDs won't know that an applicant is very likely to succeed, but if they see the Harvard name, then they can equate the two.

 

[J1515]

You've also said before a good list could be horrible if they did not get their first choice. However, again, it shows you that if they did not get their first choice and still landed an excellent residency, then that means they had multiple interviews at other great choices.

This is where we aren't all seeing eye to eye. What are you calling an "excellent residency"? As far as I'm concerned, if I didn't get my first or second choices I would've been unhappy. I don't care if you thought my third choice was "excellent." My third choice might've been Hopkins or Duke, but I didn't want to be there and that's all that matters to me. It's my life that I have to live. It doesn't matter to me what other people think is excellent.

 

[jbz24]

This is where we aren't all seeing eye to eye. What are you calling an "excellent residency"? As far as I'm concerned, if I didn't get my first or second choices I would've been unhappy. I don't care if you thought my third choice was "excellent." My third choice might've been Hopkins or Duke, but I didn't want to be there and that's all that matters to me. It's my life that I have to live. It doesn't matter to me what other people think is excellent.

Sorry, replace "excellent" with "top tier." You might be unhappy with Hopkins or Duke, but many people are not. It's very difficult to interview at these programs, let alone match into them. The number on your rank list that you match at means very little. If you rank all of the programs you applied to (even ones you did not interview at), then this would be more accurate. People who apply to top tier programs, but did not receive interview invites, will very likely match into their top choice if it only consists of lower tier programs. And whatever works for you. There are definitely more important things than prestige. It's just important to know that prestige helps, to whatever degree, in the match selection process if you're aiming high.

 

[Law2Doc]

I agree and I don't have a true argument against that. I just feel that the Harvard name and those very likely to succeed are not mutually exclusive. PDs won't know that an applicant is very likely to succeed, but if they see the Harvard name, then they can equate the two.

PDs don't. Premeds do. There's a huge difference. A PD gets to see the whole record and makes decisions accordingly based on that. As I said before to the extent school comes into play really is whether they had previous interns from that program who did well or tanked. I promise you that there are a number of top schools that do a horrible job of preparing folks for working on the wards, and quite a few low ranked places that do a fantastic job. A lot depends on the hospitals associated with the med school -- a poorly staffed inner city place is going to generate med students who know how to do a lot more than a fancy suburban hospital where the med students get lots of elective time, and don't have to do many sub-Is or ICU rotations. Top ranked or bottom ranked places can fit either bill. The PD won't be swayed by the name, they will be swayed by the record and the alumni. Premeds on the other hand get excited by the school name.

 

[jbz24]

PDs don't. Premeds do. There's a huge difference. A PD gets to see the whole record and makes decisions accordingly based on that. As I said before to the extent school comes into play really is whether they had previous interns from that program who did well or tanked. I promise you that there are a number of top schools that do a horrible job of preparing folks for working on the wards, and quite a few low ranked places that do a fantastic job. A lot depends on the hospitals associated with the med school -- a poorly staffed inner city place is going to generate med students who know how to do a lot more than a fancy suburban hospital where the med students get lots of elective time, and don't have to do many sub-Is or ICU rotations. Top ranked or bottom ranked places can fit either bill. The PD won't be swayed by the name, they will be swayed by the record and the alumni. Premeds on the other hand get excited by the school name.

Sorry, I'm not following your logic anymore. If these top schools that you are referring to are not training their students well, then why are they still across the board matching their students into top tier residency programs? PDs would hate them and would not rank them highly, but this obviously does not happen. Oh, it must be because only the students from top ranked schools want to go to top residency programs. Please

 

[Law2Doc]

Sorry, I'm not following your logic anymore. If these top schools that you are referring to are not training their students well, then why are they still across the board matching their students into top tier residency programs? PDs would hate them and would not rank them highly, but this obviously does not happen. ..

Um, the schools aren't matching them, to the extent someone matches well, they do it themselves. As I mentioned before, premeds don't know how to read match lists, and you (as a med student) would really only know what the good matches are if you've sat down with a mentor in that particular field, so I have to disagree that they are "across the board" matching their students into top tier programs. You don't know which ones are settling for malignant programs in the field of their choice, what they actually wanted, etc. You just don't know. You can't know. Because the lists don't tell you what you think they tell you. Your analysis of them is meaningless unless you know the choices made by the folks applying, and which programs are good versus malignant and how they rank in each field. You don't. I sure don't, and I'm already through the process. So it's a waste of time harping back to match lists you want to say what you are asserting, when more likely they don't.

 

[jbz24]

Um, the schools aren't matching them, to the extent someone matches well, they do it themselves.

Fine but half of the class will be the lower 1/2, so you can argue all you want that you don't know why people matched into their program, and I'm telling you that the lower half of their class still does well. I don't think there's a large enough discrepancy between schools that large numbers of students from a lower tier school will opt to stay in a lower tier residency program while this does not happen at a Harvard. It's hard enough to get an interview at a top program, let alone match to one. And please, it's pretty easy to get a feel for the good residency programs, even here on SDN. There is not going to be a rank list of programs, but there's a general consensus.

 

[J1515]

Fine but half of the class will be the lower 1/2, so you can argue all you want that you don't know why people matched into their program, and I'm telling you that the lower half of their class still does well.

What did the lower half of the class get on their boards? Where did they rotate? What research did they do? Did they get high passes or did they just get by with passes? Did they honor their subi in the field they want to go into?

And please, it's pretty easy to get a feel for the good residency programs, even here on SDN.

Really? What do you think makes a good residency program? Why do you think Hopkins, Yale, and Duke are good programs?

 

[Morsetlis]

Thanks Law2Doc for the insight.

Do you know if there's anything a pre-med might do, though, to start on the road to a specialty?

 

[mmmcdowe]

What did the lower half of the class get on their boards? Where did they rotate? What research did they do? Did they get high passes or did they just get by with passes? Did they honor their subi in the field they want to go into?



Really? What do you think makes a good residency program? Why do you think Hopkins, Yale, and Duke are good programs?

What a lot of people don't realize is that there are a lot of amazing residencies that aren't the major affiliate of a medical school. Barrow Neurological Institute (St. Joe in Phoenix) anyone?

 

[J1515]

What a lot of people don't realize is that there are a lot of amazing residencies that aren't the major affiliate of a medical school. Barrow Neurological Institute (St. Joe in Phoenix) anyone?

That's what I'm trying to get at. Everyone on SDN (especially premeds and MS1s) is so obsessed with prestige they never stop and think about making their own decisions on what may be best for them as an individual.

 

[jbz24]

That's what I'm trying to get at. Everyone on SDN (especially premeds and MS1s) is so obsessed with prestige they never stop and think about making their own decisions on what may be best for them as an individual.

No offense, but this isn't what's being argued. I never once said that prestige should be the number one factor in making a decision. All I said was that it is a factor when applying for residencies. I've said my bit though, not much else I can say. I'm done in this thread.

 

[Law2Doc]

... And please, it's pretty easy to get a feel for the good residency programs, even here on SDN. There is not going to be a rank list of programs, but there's a general consensus.

Here is one example of where your train has gone flying off the tracks. Whether a residency program is good or not is VERY specialty specific. You don't get a "feel" for what is good versus malignant. You can only know this if you sit down with a mentor in the field or recent residents of that program. All of the top med school affiliated residencies have at least one specialty where they are not particularly well regarded. There are no programs that are good at everything. There are some that are downright regarded as malignant. Yes, there are programs at the top of the US News research ranking that are known to be malignant in one or more specialties, and tend not to be highly ranked by residents. And guess what -- all premeds and most med students will not be able to tell you which ones, feel or not. So no, there's no "general consensus" only your own misguided view of what brand name is better (notwithstanding that in at least one specialty, maybe many, it's probably not). To know a good match list you'd have to know which programs are good in each field. I'm sorry but having a general notion of the hierarchy in medicine gets you squat in knowing the general hierarchy in, say, radiology, surgery, OB, and so on. It will not be the same. The top 10 won't be the same. The top 20 won't be the same. There will be programs in some fields you have never heard of that happen to be the top programs in the country in that field. That's just how it works -- residency is a new ballgame and your "feel" for what the rules are won't serve you well. That's the point I've been trying to convey. You won't know squat until you get to the stage where you can get the word of mouth, and even then you won't know squat about the other 30 specialties and what's a good match in those. So there's really no prayer for a premed who hasn't even picked a specialty to try and evaluate a match list. It's the definition of futility.

Anyhow, interesting debate, and good luck with some of those notions. I'm going back into my hole for a while. Cheers.

 

[45408]

I'm interested in primary care (for now), but it is annoying that people will automatically assume that people like me couldn't get into a more competitive residency.... even if they had the numbers to do so.

That's mostly SDN for you, not the rest of the world. Internal medicine and pediatrics need brilliant minds just as much as plastic surgery does. The show House glamorizes what IM docs do, and I have a lot of respect for an internist who keeps a patient with a dozen co-morbidities well-balanced with a good regimen of medications. I definitely don't assume that people going into primary care are dumber than the specialists, because I know some very intelligent students whose goal it was to match into an uncompetitive specialty.

 

[45408]

And please, it's pretty easy to get a feel for the good residency programs, even here on SDN. There is not going to be a rank list of programs, but there's a general consensus.

No, it's not easy to get a good feel, and no, there's not a consensus. SDN was actually of very little help to me when picking out my programs (except for one specific resident who gave me some good feedback...after I'd already gone on my interviews). I did a decent amount of searching, and there was no consensus and no good feel.

Furthermore, the programs that I thought were good programs were all places that almost no one here has heard of. I interviewed at a couple of prestigious places, and I didn't put any of them in my top 3. There's actually one prestigious program (whose name has been thrown around several times in this thread) that I would NEVER go to, because of the information I've found out about them.

Maybe some specialties are easy to figure out through SDN, but mine sure wasn't.

 

[gujuDoc]

No, it's not easy to get a good feel, and no, there's not a consensus. SDN was actually of very little help to me when picking out my programs (except for one specific resident who gave me some good feedback...after I'd already gone on my interviews). I did a decent amount of searching, and there was no consensus and no good feel.

Furthermore, the programs that I thought were good programs were all places that almost no one here has heard of. I interviewed at a couple of prestigious places, and I didn't put any of them in my top 3. There's actually one prestigious program (whose name has been thrown around several times in this thread) that I would NEVER go to, because of the information I've found out about them.

Maybe some specialties are easy to figure out through SDN, but mine sure wasn't.

Totally a sidenote to you TheProwler. But I gather that 2 days from now is the big day for you. Match Day. Good luck.

 

[Excelsius]

One of the biggest points this thread lacks is the answer to the question "why?" At first the question was about getting into neurosurgery (or any other competitive field). It was shown that students from many different medical schools regularly match into competitive specialties. Then somehow the argument switched to the "top" residency programs and how important the prestige is... It seems that the final point of the thread is lost by climbing higher and higher on the "topness" ladder without much cogitation about why. So back to the question again: what is it that we are trying to prove here? Is the question whether you can become a neurosurgeon if you graduate from the bottom half of medschools or it is about who can get into the top residency programs? The first question was the original intent of this thread and the answer to that is easy: yes, you can become a neurosurgeon no matter what school you go to. PD surveys have proven that point. If you are wondering what will help you, it would be beneficial to concentrate on the individual aspects of a given medical school rather than NIH grant money. In neurosurgery, one of the most important things you would need to look at is a department of neurosurgery available at the school you want to attend. Is this necessary? No. Is this much more helpful than the amount of research money your school gets? Yes. It just makes things much easier when you have someone in NS who intimately gets to know you over your time at the school. Without a department, you would have to apply for an away rotation and often end up spending little time at the rotation - the attendings might not get to know you well enough to write a strong letter.

Another consideration better than NIH money: are the attendings/PDs approachable? If you have a very well known doctor who cannot be bothered by students, your recommendation letter is nonexistent or very poor at best. In contrast, a mentor at a lesser known school who can write you a strong letter is not only beneficial, but might help you even find a good program.

There are many other aspects that would take too long to discuss. Common sense should tell you that you would be a more productive individual and a happier person if you end up in an institution (medschool or residency) with healthy interpersonal relationships and respect. Would you rather attend an institution where everyone is only concerned about competing to the point of animosity and disrespect than an institution where you go to mountain biking with your PIs and have gatherings on most holidays at his/her home? It is just absurd to skip all these extra dimensions that various programs offer and go straight to NIH funding. You will realize this when one day you think you're too depressed to become a doctor.

The more nebulous second question about who can get into higher ranked residency programs is very meaningless. Does the name of your medschool play some role? Yes, varying from one PD to the next. But there are far more important questions here: how much more are you willing to pay for a name? Why are you considering a "top" residency? Do you think a more famous name is going to translate into larger recognition or salary?

The bottom line is that once you become a neurosurgeon (or any other specialist), you are going to be judged by your accomplishments, not by the school you attended. So a neurosurgeon from Drexel can be much more successful than an NS from Harvard. It just doesn't matter. This isn't law school where top tier pays top money.

One of the eye openers for me was Doctors' Diaries on PBS. I don't know what most people realized when they saw this, but my realization was that graduates from the top schools are absolutely unremarkable. Here we have a group of students from Harvard med, yet did a single one of them achieve glorious success? No. In fact, several of them struggled as doctors. In the end, their big name school and the famous residency was not enough to make these people either successful, or even more importantly, happy. If anything, experience teaches you that financial and academic success are independent of the schools we attend.

There is nothing wrong with trying to reach the highest branches on a tree as long as you realize that sacrificing a lot of time and money on such an endeavor has very little returns. Moderation is always beneficial. Note that all of the most successful scientists and people around the world achieved their success not at famous schools, but in front of their desks (like the one behind which you're sitting now), reading books on their own. One achieves the highest level of enlightenment by autodidaction. Harvard takes you, but it doesn't make you.

 

[FluffyRabbit]

Holy cow. Excelsius, you are awesome.

 

[Morsetlis]

One achieves the highest level of enlightenment by autodidaction.

Here we'll have to disagree.

The rest of your post was brilliant, though.

 

[Mandiblespeaks]

My friend just matched Neurosurgery. Not sure where yet but he got in. And he is graduating from SUNY B.

 

[calvinNhobbes]

Here's some non-NRMP data, of course it is ortho specific:

Orthopaedic resident-selection criteria. Bernstein AD, Jazrawi LM, Elbeshbeshy B, Della Valle CJ, Zuckerman JD. J Bone Joint Surg Am. 2002 Nov;84-A(11):2090-6.

I don't think I can post the actual table due to copyright, but here is a summary:

109 of 156 ortho PDs rated 26 items for ortho residency selection.
Medical school reputation ranked 9th, behind obvious things like doing an away rotation at the program, USMLE, class rank, ortho LOR, the interview, and AOA. But it was rated more important than the Dean's letter, personal statement, publications, research experience, and non-ortho LORs.

 

[fahimaz7]

Here's some non-NRMP data, of course it is ortho specific:

Orthopaedic resident-selection criteria. Bernstein AD, Jazrawi LM, Elbeshbeshy B, Della Valle CJ, Zuckerman JD. J Bone Joint Surg Am. 2002 Nov;84-A(11):2090-6.

I don't think I can post the actual table due to copyright, but here is a summary:

109 of 156 ortho PDs rated 26 items for ortho residency selection.
Medical school reputation ranked 9th, behind obvious things like doing an away rotation at the program, USMLE, class rank, ortho LOR, the interview, and AOA. But it was rated more important than the Dean's letter, personal statement, publications, research experience, and non-ortho LORs.

I thought of you on Monday. Apparently, we matched 13 ortho spots this year, and one guy got left out. He scored a 253 on Step 1! But, our department was able to find him a spot in the scramble (not sure where), in ortho!

I don't know much more than that, since it was second hand information (coming from the residency director here).

Crazy times.

 

[Knocked Up]

When, oh when, will you people realize this. It doesn't matter what school you are coming from (outside of inbreeding). It's all about who is the best test taker.

Look at the nrmp data from last year:

http://www.nrmp.org/data/chartingoutcomes2011.pdf

Note a few things people. Lots of stuff is similar between the those who matched and those who didn't. The most significant differences between those who match and those who don't is:

1) BOARD SCORES!!!!! These carry weight in gold, just like the MCAT. There is a (significant!!!) difference between matched vs unmatched.

Everything else is the same. Yes, the harder workers have a few more publications and probably slightly more Honors during 3rd year. Prestige factors are completely taken out of the picture when you rotate and get on the chairmen's good side. A phone call definitely makes a difference, but it won't add 20 points to your score.

Again: correlation = causation. BOARD SCORES ARE ALL THAT MATTER. HIGHER RANKED SCHOOLS HAVE HIGHER MCAT AVERAGES. THIS MEANS KIDS ARE GOOD TEST TAKERS. GOOD TEST TAKERS GET HIGH BOARD SCORES, WHICH GET THEM THE RESIDENCIES.

It is not easy to break a 240 on Step 1. Hence not many people outside of the top 40 get notable residency spots, because again they aren't as good of test takers as the students at MCAT ***** schools (columbia, umich, washu, hopkins, all the holy grail institutions.

Again, residency match = test score from 1 day of your life. Get it straight.

 

[Praefectus]

Nice. You fervidly responded to a thread that's more than a year old. I suppose you'll want a commemorative plaque?

 

[thesauce]

Nice. You fervidly responded to a thread that's more than a year old. I suppose you'll want a commemorative plaque?

More than 2 years old. We've all made this mistake, though.

 

[Praefectus]

More than 2 years old. We've all made this mistake, though.

Whoops, my bad.

 

[drizzt3117]

I know it's an old post, but I think in the presence of real data, this may be an instructive topic...

The Big 6 Neurosurgery Programs:

MGH: (100% Top 25)
Harvard
Harvard
UCSF

Hopkins: (67% Top 25)
Columbia
NYU
Johns Hopkins

Columbia: (50% Top 25)
Columbia
UMDNJ

Mayo: (33% Top 25)
Michigan
Mississippi
Meharry

Barrow: (50% Top 25)
Oklahoma
Northwestern
Universidad Anahuac, Mexico
UCLA

UCSF: (100% Top 25)
UCSF
UCLA
Wash U

Total: 12/18 spots = Top 25 (67%)

 

[Telekinesis]

I know it's an old post, but I think in the presence of real data, this may be an instructive topic...

The Big 6 Neurosurgery Programs:

MGH: (100% Top 25)
Harvard
Harvard
UCSF

Hopkins: (67% Top 25)
Columbia
NYU
Johns Hopkins

Columbia: (50% Top 25)
Columbia
UMDNJ

Mayo: (33% Top 25)
Michigan
Mississippi
Meharry

Barrow: (50% Top 25)
Oklahoma
Northwestern
Universidad Anahuac, Mexico
UCLA

UCSF: (100% Top 25)
UCSF
UCLA
Wash U

Total: 12/18 spots = Top 25 (67%)

That alone should be proof that the med school you attend doesn't really matter.

 

[Knocked Up]

I know it's an old post, but I think in the presence of real data, this may be an instructive topic...

The Big 6 Neurosurgery Programs:

MGH: (100% Top 25)
Harvard
Harvard
UCSF

Hopkins: (67% Top 25)
Columbia
NYU
Johns Hopkins

Columbia: (50% Top 25)
Columbia
UMDNJ

Mayo: (33% Top 25)
Michigan
Mississippi
Meharry

Barrow: (50% Top 25)
Oklahoma
Northwestern
Universidad Anahuac, Mexico
UCLA

UCSF: (100% Top 25)
UCSF
UCLA
Wash U

Total: 12/18 spots = Top 25 (67%)

Yes, drizzt3117 I agree. However, I think the point everyone is missing here is that it is NOT the school that is landing these residencies. If you were to poll every single one of these kids off this list and ask their Step 1 score, they would be on the right hand side of the bell curve for neurosurg matches.

Yeah, Randy matched BNI, but you should also know his board score (which I won't disclose) before you make any assumptions. The same should be noted for those MGH residencies. How do you not know that they didn't destroy the boards, and THAT is what got them those spots. Name is not going to make up for a 220 in NS.

We see scattered prestigious residencies on every match list at (nearly) ever school. Why? Because there is bound to be at least 1 kid who destroyed the boards at said school AND wanted that type of residency. It's easy to take a year off of medical school and gain a few pubs, it's not easy to get a 240+ on the Boards.