Understanding 'tiers' of residencies

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PillsburyDoughBoi

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First of all, residents/attendings of this thread, I know you guys are not fond of this type of thread but please read on as I've done research but still uncomfortable in my guesstimations.

Just wanted to make a quick thread to make sure I'm applying safely. I'm a US MD from low-mid Southeast medical school, step 1 ~240, step 2 ~260, top 1/4 of class. I plan on applying to around 45-50 programs, mainly because I have no particular ties to anywhere in the US and would welcome a change in scenery to spend the next 3-4 years.

On top of ~10 'high-tier' reach programs I've selected, listed below are the remaining programs I am applying to and I've listed them by tiers of my own opinion based on my searches online/SDN/spreadsheets/etc. Now I know there is no unanimous way to define tiers, but I want to make sure that on top of my 15 or so reaches, if I were to apply to a vast majority of the programs listed below that I am setting myself up for my personal goal of atleast 12 interviews. My biggest fear is that I am undervaluing the 'tier' and competitiveness of some of these programs, so please advise accordingly if I am. Always open to adding more programs and other 'safeties' to ensure my goal of sitting at 12-15 interviews and especially having a possible comfort of denying interviews.

Solid mid tier programs:
Yale
UPMC
Brown University
George Washington
UVA
UC Irvine
UC Davis
UAB
UNC
UTSW
UT Houston
U Miami
MUSC
University of Iowa
Ohio State
Indiana U
U Minnesota
U Kentucky
Georgetown

Lower tier programs:
Thomas Jefferson (TJUH)
Boston University
University of Rochester
University of Maryland
Icahn/St. Luke's
Penn State
USC
Loma Linda
Cedars Sinai
University of Arizona - Tucson
UIC
Loyola
KU
Mizzou
Louisville


EDIT: I understand these tiers are very subjective, so I am not making this thread to create contention. Rather, I am looking to see if my opinion of tiers which guides my app process is at least in the right ballpark. Thanks in advance
 
Brown started LAST YEAR and excludes the top hospitals in their network.... perhaps you need to go back to the drawing board on this list.

What does tier even mean in your book? Impact on career plans? or just how "Wow'd" your classmates will be?

Good advice: go to a program you like where you will get great training. This idea of tiers certainly pushes you guys to make bad decisions more than good, so it is certainly not a good conceptual framework.
 
Your list is scattered across the United States, surely you must have some preference for location? I would suggest applying to less programs.
 
In the big picture of life in anesthesiology, once you are out of residency/fellowship, where you did your residency doesn't matter a hill of beans unless you plan to practice in academics.
 
Tiers is nice for impressing your grandmother's friends. Look to see where they have big cases for residents with great intraop teaching. Lots of exposure to blocks, procedures, interesting pathology, nonmalignant faculty, cool hardworking coresidents. It's hard to tell without being in the program but that's what is important.
 
Psai said:
Tiers is nice for impressing your grandmother's friends. Look to see where they have big cases for residents with great intraop teaching. Lots of exposure to blocks, procedures, interesting pathology, nonmalignant faculty, cool hardworking coresidents. It's hard to tell without being in the program but that's what is important.
Click to expand...

Agree with this. And I’d add to make sure the CRNA school is in check if there is one. Doctors shouldn’t be competing with nurses for the better cases.
 
When you look at lists of tiers the one thing they do not consistently represent is the quality of the program. Typically they refer to the level of competitiveness among applicants for entrance and the general level of name recognition which hopefully translates to quality of training but often doesn't. More than one program that has been considered upper tier has been on probation in the past 10 years for a variety of academic or work-based reasons. You will be fooling yourself if you think the tiers assigned really dictate quality.

The best information you can get about a program is during the interview day. The general feels of your interactions with your faculty interviewers and your overall perception of the happiness among residents.

If you feel predisposed to any specialty it will be useful if your residency offers it and it's a good fellowship because it's often not too difficult to be able to stay. If you already know you want to do a fellowship elsewhere then you may benefit from a residency which does that kind of case (cardiac, peds, etc.) in a decent volume but for whatever reason doesn't have a fellowship, this allows you the possibility for more intense training since you won't be competing with fellows for cases. I can't speak much to the existence of SRNA schools as I have only worked at one place with a major affiliation with one and the residents had a clear priority over them. If you have a strong predisposition to research then name recognition can often translate more to quality and you can discuss this on interviews, etc.
 
We all know that internet advice is questionable at best. Do you have a trusted mentor/advisor in the anesthesiology department at your home institution who can help you go over your list? When I was trying to put together a list, it was very helpful to talk about programs with the attendings in the department who knew me and had some idea of what I was like. Certain "Top tier" programs may be a terrible individual fit and I was grateful for the time and money they saved me by steering me in a different direction.
 
It's a bit late for this advice now, but if you had a strong predisposition to one or two programs from the get go, that is a good reason to do an away rotation. I did an away rotation at two programs I was strongly considering and it completely repelled me from one and made another my top choice.
 
DM27 said:
It's a bit late for this advice now, but if you had a strong predisposition to one or two programs from the get go, that is a good reason to do an away rotation. I did an away rotation at two programs I was strongly considering and it completely repelled me from one and made another my top choice.
Click to expand...

Now I'm really curious
 
I stressed about getting into a "top" tier program and rotated at one that I was sure would be my number one. Ended up hating it, enjoyed my home program 1000X more and its not even entertained in the discussion of mid/top programs. I think as long as you can find a program that doesn't close any major doors you're interested in down the line, which is most of the programs, you're in good shape. I understand all the guys who have talked about that intangible gut feeling - it's real and this whole concept of tiers, minus the top 10 programs, is really an individual list to make.
 
One thing you can do, later in the cycle, is second looks. I would say their usefulness is limited. When I made my rank list I had a back and forth between my #1 and #2 choice because one was a name that I felt carried more nationally. I did a second look at that program and the resident they paired me with was very pleasant, but basically spent most of the time complaining about the PD and how he felt the program was treated the residents, all of which mirrored a lot of concerns I had and also had heard implied by some people who "knew" former residents. That second look made the decision a lot easier but I did still rank them #2.

In my particular instance I was very happy I did the second look, even though it felt awkward asking for one. However, I will say I did not need to travel an appreciable distance to go to it. If I had to fly I definitely would not have considered it.
 
I think you need to think about what you're post-residency goals are. "Top Tier" should really only enter the discussion if you plan on a career in academics/research. It may also help of you want to a big name fellowship somewhere across the country. If you plan on PP, then focus more on the programs close to where you want to practice as there will be more of an alumni network/connections which will pave the way to the good gigs.
 
Thank you for all your informative replies!

I understand the notion of considering 'tiers' may be ill-advised in the sense that once I become a practicing physician (preferably in academics), other stuff like how happy I am, work environment, duties, salary, and location of the job I am able to acquire is going to be much more important.

However, my purpose was to ensure I had enough programs that I can consider to be "safer" picks while applying. I am willing to spend a few hundred dollars to have the freedom to decline interviews rather than end up with a meager amount of interviews. As for location for residency, I ideally want to end up in either a good-sized metropolitan area or a college town and for job afterwards, I would ideally like to practice in the proximity of a major metropolitan city (ie suburbs and ideally in the W coast or PNW where I hope to settle much further down the line). I am DEFINITELY shotgun-applying to many programs in that region as well but as a candidate from the opposite side of the country with little ties to the area, I am having a sense it might be tough for those programs to consider recruiting me. Therefore, I would like my worst case scenario to match into an academic program in either a major city or bustling college town (I'm single) that is a good fit for me. I will not be able to assess the latter until I at least see the program so I am relying on the advice from SDN, spreadsheets and word of mouth and the hope of an interview to evaluate further. This list was reviewed with my home PD but he humbly admitted he doesn't know much in particular about the W coast programs as he is brand new PD with not as many connections yet.
 
I would also be careful "tiering" programs. Anything you can match into with the word "university" in the title is good. As said above, you need to have some idea of a career goal, ie fellowship, academics, and private practice, and also possibly narrow you decision to a location, because similar to real estate, when it comes to job connections location is important.
 
PillsburyDoughBoi said:
Thank you for all your informative replies!

I understand the notion of considering 'tiers' may be ill-advised in the sense that once I become a practicing physician (preferably in academics), other stuff like how happy I am, work environment, duties, salary, and location of the job I am able to acquire is going to be much more important.

However, my purpose was to ensure I had enough programs that I can consider to be "safer" picks while applying. I am willing to spend a few hundred dollars to have the freedom to decline interviews rather than end up with a meager amount of interviews. As for location for residency, I ideally want to end up in either a good-sized metropolitan area or a college town and for job afterwards, I would ideally like to practice in the proximity of a major metropolitan city (ie suburbs and ideally in the W coast or PNW where I hope to settle much further down the line). I am DEFINITELY shotgun-applying to many programs in that region as well but as a candidate from the opposite side of the country with little ties to the area, I am having a sense it might be tough for those programs to consider recruiting me. Therefore, I would like my worst case scenario to match into an academic program in either a major city or bustling college town (I'm single) that is a good fit for me. I will not be able to assess the latter until I at least see the program so I am relying on the advice from SDN, spreadsheets and word of mouth and the hope of an interview to evaluate further. This list was reviewed with my home PD but he humbly admitted he doesn't know much in particular about the W coast programs as he is brand new PD with not as many connections yet.
Click to expand...

I think you're selling yourself a bit short. I had similar step scores and rank to yours and went to a med school that was more known regionally. Having said that, I did apply pretty broad but I got a bunch of interviews even a handful of "Ivy's". I matched my #1 pick. I think more importantly think about where you want to be and what you may want to do and focus on that area with a good amount of programs, probably 20 is a good number and then do like 10 interview (because interviewing is also expensive). With 10 interviews and as long as you're not a douche you should match.
 
Psai said:
Tiers is nice for impressing your grandmother's friends.
Click to expand...

Have to admit, the farther I go in my training, it's kind of nice to be able to impress my grandmother's friends. Makes my grandmother happy and proud, and that makes it worth it for me.
 
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