$$$ vs. School Prestige for Academics

[deleted962973]

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OP in their original post gave a range of 60-80k - why you insist on choosing the lowest possible number to make your point doesn't really make sense.

Which is why I later said under most reasonable estimates it’ll still be under 100K, even if her debt is closer to the 80K side starting out. I’m not sure about Stanford/UCSF, but at schools like Pitt and Yale, research years are tuition-free (at Pitt you actually get a living stipend). At my Stanford interview, I was told that you can often get a grant as a research assistant while in school, which carries a stipend and tuition benefits. If the top 3 is Stanford, I think you are actually far overestimating how much it costs to attend. Stanford Med is extraordinarily generous when it comes to aid. I can’t speak on UCSF but thems the facts.

 

[deleted18755]

I'm in academics, and I wish I could disagree with you.

This is the problem when people give general advice about very specific situations.

In general, it is indeed true that academic jobs are relatively easy to secure; however, it is actually extremely difficult to do so in radiation oncology because the positions are so limited. It's not uncommon for even a very large medical center to go a few years without hiring a single new physician, and many years before hiring a radiation oncologist for any particular disease site, with market forces are only making it more and more difficult.

There is a very big difference in likelihood of securing a position at any top academic center vs any one in particular, especially since most academic radiation oncologists only treat one or two disease sites.

So if you're really sure you want to work at a top academic center in one particular region of the country as a radiation oncologist who will only be treating the one or two disease sites that you base your academic career on you may be looking at a position that comes up literally a few times a decade. It's a very difficult thing to accomplish no matter how awesome you are just because of supply and demand but the sooner you start networking and making connections (I mean as in get into the department as a M2/M3 and get a 6-8 year head start) the better your chances.

If it weren't for this unique situation I'd say 100% go to Vandy or any other top medical school debt free for sure.

 

[Neuronix]

This is the problem when people give general advice about very specific situations.

In general, it is indeed true that academic jobs are relatively easy to secure; however, it is actually extremely difficult to do so in radiation oncology because the positions are so limited. It's not uncommon for even a very large medical center to go a few years without hiring a single new physician, and many years before hiring a radiation oncologist for any particular disease site, with market forces are only making it more and more difficult.

We hire academic rad oncs every year and it's only occasionally from a top tier residency program. This is the same where I trained.

You might ask, how is this possible? Well faculty retention is poor at a lot of academic places. This goes back to Tenk's comment. Also, we have a lot of satellites that need rad oncs...

I think this cycle is slowing recently as the rad onc job market seizes up due to oversupply. People just get trapped in worse and worse positions, unable to move or re-negotiate. Whether one going to Vandy vs. Hopkins will matter for someone getting a decent job eventually in the bad job market that is rad onc is a question that I will shrug my shoulders at. I don't think where you went to med school matters much, but who knows.

 

[ginsengreset]

I think people here are saying two things:
1) Choose Vandy, because you'd have no debt. Vandy won't close any doors for you when it comes to landing a residency in a competitive specialty.
2) Choose Stanford/UCSF, because that gives you the highest chance of landing a competitive West Coast residency spot. A plurality of med students land a residency at their home program, and if you're at Vandy and the Stanford/UCSF/UCLA PDs decide to mostly rank their own students to match (they might be just as good as the other applicants, and the PDs already know them), you might be SOL at those places.

Both of these are true. Seems like it'll depend on whether OP prioritizes no debt vs increasing their chances of landing specific residency positions.

 

[Lucca]

I think people here are saying two things:
1) Choose Vandy, because you'd have no debt. Vandy won't close any doors for you when it comes to landing a residency in a competitive specialty.
2) Choose Stanford/UCSF, because that gives you the highest chance of landing a competitive West Coast residency spot. A plurality of med students land a residency at their home program, and if you're at Vandy and the Stanford/UCSF/UCLA PDs decide to mostly rank their own students to match (they might be just as good as the other applicants, and the PDs already know them), you might be SOL at those places.

Both of these are true. Seems like it'll depend on whether OP prioritizes no debt vs increasing their chances of landing specific residency positions.

Yah, it’s difficult to have a coherent discussion when there are really 3 highly specific goals the OP had in mind: rad onc, academics, west coast.

Now, academics can mean a lot of things so it’s too broad to talk about with any kind of specificity so let’s assume they want to match at one of the top 3 institutions in the country for their desired specialty at the very least. Like everyone else, I don’t think vandy will close any doors but at some places the door will be open just a little bit wider and I think that’s difficult to argue with unless we’re going to just deny info we have from match lists entirely.


West coast. This is the clearest one in my view. It’s easily demonstrable that the highest proportion of people matching on the west coast graduated from west coast medical schools. We could argue in circles all day about the drawbacks of reading into match lists, self-selection, etc. Personally, I’m a firm believer in “a bird in hand is worth two in the bush” and I’d rather take a very well trodden path to my goal than suppose I’ll be able to make it work doing things another way.

Thirdly there’s the rad-onc thing. What will rad-onc be like in 4-5 years? I’m not qualified to speculate although Neuronix (and many other rad ones elsewhere on SDN) do not appear particularly optimistic. More important than that, what are the chances Op still wants to do rad onc after med school? I wouldn’t make any medical school decisions based on what specialty you want to go into it just because that is so apt to change.

Like the quoted post says, all up to Op to decide where he wants to spend his money: on savings and living a debt free life in residency or on min/maxing his career goals. I’m not trying to imply there is a necessarily correct answer but I’m with @WedgeDawg on this one

 

[deleted18755]

We hire academic rad oncs every year and it's only occasionally from a top tier residency program. This is the same where I trained.

You might ask, how is this possible? Well faculty retention is poor at a lot of academic places. This goes back to Tenk's comment. Also, we have a lot of satellites that need rad oncs...

I think this cycle is slowing recently as the rad onc job market seizes up due to oversupply. People just get trapped in worse and worse positions, unable to move or re-negotiate. Whether one going to Vandy vs. Hopkins will matter for someone getting a decent job eventually in the bad job market that is rad onc is a question that I will shrug my shoulders at. I don't think where you went to med school matters much, but who knows.

Interesting: when you say your department hires every year, is it for "real" site specific, protected research time and department supported/grant funded academic positions like the OP appears to be interested in or "academic pay for private practice work" babysitting a satellite center 30-90 minutes from the main campus with the title of "clinical instructor" or something like that?

It's crazy how fast things change in small fields like ours even over just 10-15 years so who knows what it will be like when any incoming medical student is looking for a job 10-12 years from now. Might as well minimize debt burden as much as possible!

 

[differentiating]

Again, you're neglecting interest accrual during medical school, loans needed to cover COL in Palo Alto - where the average studio apt costs $3k/month in rent, never mind groceries, clothes, transport and incidentals - board review materials, exam fees, medical insurance (which they force you to have) etc. Never mind the fact that OP wants to do something hyper-academic and likely will need to do a research year to make their app competitive - that's another year of tuition. There's no way OP is walking away with only 68k in debt if they choose to go to Stanford

That’s assuming they choose to live alone despite the cost trade-off. I pay ~$2k/month for all monthly costs, including rent, in the Bay Area - but I share an apartment with a classmate, as many do. Both schools also have subsidized student housing that is even cheaper, if you can get it. In my experience, COA at my school overestimates how much you need per year, and I’ve never needed to take out the full amount. Also, as noted above, most students are able to secure funding for research years.

 

[NITRAS]

@NITRAS I think that’s a disingenuous argument because no doctor needs 30 years to pay off a $60K debt. So it’s not going to turn into a million dollars. At most, assuming no payments during ~4 years of residency, it becomes $70-75K depending on interest rate. This really is not a lot if you’re making 200-500K imo. No debt is certainly better, but you can scrounge a bit for your first 2-3 years as an attending and come up with that. If your debt = income, then there’s an issue, but as it stands, I’d definitely invest 75K into a Stanford education.

I am not implying that an attending can't service $60k in loans, nor that they can't pay it off faster than 30 years. I'm implying that if they invested $60G in a quality mutual fund rather than buying a more prestigious name on your medical school, they'd have a million dollars after 30 years using traditional rates of return.

 

[Neuronix]

is it for "real" site specific, protected research time and department supported/grant funded academic positions

Do these actually exist? Sounds like a unicorn to me.

For reference, I'm a top tier trained MD/PhD with a very strong CV that couldn't even get a position like that after applying all over the country.

So... My faith that someone with an MD or even MD/MS from any med school will get that kind of position is quite low.

"academic pay for private practice work" babysitting a satellite center

Are you spying on me???

 

[Quantal Reasoning]

Vandy. It’s a top school, you can match anywhere. Take the money and run.

 

[begginandpleadin]

I go to Vandy and one of my good friends from here matched at a top institution for rad onc literally last year. So I highly doubt you would be inhibited regardless of what you choose, but it would surely be easier if you have your eyes set on going to a residency at that specific institution. Its always easiest to match to a particular institution when you actually attend it for school.

However, I chose Vandy over a higher ranked public institution against the advice of people here, as did some of my peers here. I can definitely see why its a tough choice, but for me I was more interested in the curriculum and what it could offer me, the resources, and how lax it is here (among other things). Moreover, the student environment is really unique in comparison to other institutions. Med school has legitimately been the best time I've had in quite a while, though that is just my personality too. Plus our faculty are very renowned as well, at least from my experience working with a few specific departments.

So just know that at the end of the day, you are obviously an excellent student whether you go to Vandy or Stanford or UCSF, and residencies will see that. The most important element is you being exceptional, which will not change wherever you go. You can build a compelling CV and in the end it won't really matter.

Thank You! Looking at the Vandy Match list I see great institutions, but not so many on the west coast... Do you think that's because there just aren't students with a desire to move west? I see a lot of people matching into southern institutions which I don't think I would enjoy

 

[differentiating]

You mention rad onc here, and neuro/nsurg in another crosspost. UCSF’s strength is neurology; I’m less familiar with the other two, or the strength of programs at Stanford or Vandy. I do think west coast residencies do tend to invite more California students to interview, in my experience on the trail, but whether fewer southern students are applying there in the first place is hard to know.

 

[bluebubbles]

go to a top 3 school. marry rich.

 

[EMS0821]

why would you choose to put yourself into debt which will compound over 7+ years (school and residency) when a good school is offering to let you go there for free? look at vandy's match lists, im sure they have what you're looking for in droves

 

[Lucca]

the 200 iq move

go to a top 3 school. marry rich.

 

[begginandpleadin]

For the sake of argument, if one wanted to match to a really top IM residency, would the difference be as pronounced or is it very specialty specific?

 

[Broseiden]

.

 

[begginandpleadin]

So I’m actually originally from California too, and I definitely want to return there same as you (Nashville is great but CA is where I want to settle long term). Originally I told myself I would never leave the state if I had a choice... So much for that lmao.

There are about 8-15 students per class from California, we are usually the most represented state but that is still a small portion of the total class, which they keep to less than 100. So in reality we are sending back just as many people as we take.

I was worried about choosing Vandy over the CA schools too (without the same financial issue you have). I reached out to Vandy about it and they put me in touch with some students who had matched to California. Most people match where they want here, especially if the priority is to go back.

I feel like you still have a ton of time to make a decision, so go to both second looks and see if that helps elucidate the choice a bit more.

Thanks so much!

 

[Med Ed]

For the sake of argument, if one wanted to match to a really top IM residency, would the difference be as pronounced or is it very specialty specific?

If the goal is IM then you would get a much broader consensus to go to Vandy and be debt free. The only potentially compelling reason to pick a top 3 with debt over Vanderbilt with no debt is that you were proposing to enter a specific, maximally competitive speciality and end up in a specific practice setting in a specific, highly desirable region of the country. Change one of those criteria and you can write your own ticket anywhere from Nashville.

 

[stickflip723]

If the goal is IM then you would get a much broader consensus to go to Vandy and be debt free. The only potentially compelling reason to pick a top 3 with debt over Vanderbilt with no debt is that you were proposing to enter a specific, maximally competitive speciality and end up in a specific practice setting in a specific, highly desirable region of the country. Change one of those criteria and you can write your own ticket anywhere from Nashville.

Would the same advice apply to those of us with an interest in surgical specialties?

 

[Med Ed]

Would the same advice apply to those of us with an interest in surgical specialties?

Yes.

The top 5 advantage mainly applies to getting R01 funding and eventually becoming chair of a department at a well known institution. In other words, going down the path of the consummate high-power academician. A mere interest in surgical specialties pales in comparison.

 

[ginsengreset]

Would the same advice apply to those of us with an interest in surgical specialties?

Vandy vs T5 definitely would not matter if you just want to match, say, ortho somewhere. Now, if you wanted to match plastics (whose residencies often have only 2-3 spots per year), and specifically want to match into plastics at Stanford/UCSF/UCLA, then it might matter that you go to one of those top West Coat schools as opposed to Vandy.

 

[Walter Raleigh]

Just to note @oldking
For 2018 NRMP
integrated plastics surgery averages 5.8 abstracts
Neurosurgey 14% w/PhD
Residency Match: The 7 most competitive medical specialties

Do things like MacArthur Genius Grants, PhDs, and military service help in entering these competitive specialties? How common are things like first-author NEJM or JAMA papers for neurosurgery residents?

 

[Naruhodo]

Do things like MacArthur Genius Grants, PhDs, and military service help in entering these competitive specialties? How common are things like first-author NEJM or JAMA papers for neurosurgery residents?

You are joking about the MacArthur grants right? You realize that those are typically given to very established people in their fields (i.e. not someone straight out of med school). As for first author NEJM or JAMA papers I can pretty much guarantee the answer is exceedingly rare. PhDs and military service are slightly more common, but not choices to be undertaken lightly and doing either just because you're interested in a competitive specialty (and not because of being drawn to them on their own merits) would be a terrible idea.

My advice (for what it's worth): 1) Do the things you are passionate about well 2) If that path leads to medical school, get in and do that 3) Shadow the specialties like NSG that you think you are interested in to figure out if that's really the life you want 4) Study and work hard to do well on clerkships, sub-i's and Steps 5) Sit down with a trusted advisor or two to candidly discuss your interests in medicine and your application strategy to residencies 6) Stop worrying about things like genius grants and first author NEJM papers that typically take years of dedicated research time. You'll be extremely lucky if those things come later in your career, and frankly you don't need them to do almost anything you set your mind to.

 

[sweatytshirt]

Vandy is colloquially known as "The Harvard of The South", but if you have the opportunity to actually go to Harvard, or another top 3 school that doesn't borrow it's nickname, then I would choose that over Vandy. You could match into the residency program you want with Vandy, but a top 3 school may make it just that much easier to match into the specific location(s) you want, wherever you want.