You know what the bottom ranked person in a class is called?
Doctor.
True, however you'll experience a lot more in a top ranked residency. You also might not get into the specialty which you love and end up in a residency which you horribly hate as bottom rank.
Furthermore, in certain specialties like Gas doing a lower rated residency or a DO residency will impede on your chances for employment ( DO anesthesiologists have expressed this as truth).
Not everyone wants to get into the roads specialties. Those who do are seeking money, respect, power, etc.
Really now? This is a horrible generalization. They likely are most happy in that specialty, and hell maybe you'll end up in ROADS because you love one of those specialties.
If you got into medicine for the right reasons, you will be happy in your specialty, whether it be here or in a lesser ranked hospital. You will perform the same procedures, etc. So you might not get the ONE ZEBRA CASE THAT MAKES HISTORY, but who cares? You might get a little better funding for research, but it's not like you can't get funding elsewhere.
Not doubt, however you'll doubtingly be better trained and experience a lot more and there are benefits including easier transition into a fellowship. What if you find your in love with a particular part of your specialty like sports med or immunology?
I just want to be a doc, have my patients, maintain a good relationship with family and friends, and help the American health care system. Rotating at Columbia is not at the top of my list.