Wait JJ, so are you even certian you want to be a doctor?? To turn down an acceptance elsewhere because you didn't get into a top 5 school seems a bit extreme.
(If you are still waiting on an acceptance, that changes everything then and you can disreguard my message.)
As for the residency match, the current system is better than the previous system. Before people would get offers that were binding on a rolling basis. If you turned the offer down, you may never get another offer. If you took the position, you'd wonder if it was the best residency you could have gotten. Currently the major dispute is residency pay, there's no competiton among programs for getting the best by buying them. For the most part residents get paid the same.
You have obviously done very well in school to have gotten this far into the process.
Best,
Lochmoor