MD What is "noise" versus being realistic (residency & career)?

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strawberrycucumber

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Hello,

This is my first post, so feel free to redirect this thread or let me know if I need to change anything!

When I was first accepted, I was incredibly overjoyed at the opportunity: I am the first in my family to attend a grad school of any kind, and this is a huge opportunity--not just for me, but for my family. Ranking was the last thing on my mind. But, of course, medical and pre-medical students talk, and I started to worry.

I am writing because I am trying to filter the chatter I have heard surrounding my undergraduate->medical school ranking trajectory and my subsequent residency/career opportunities. I attended a top 5 undergrad, and attend a 40-50ish ranked medical school. Another med student who attended the same undergrad and attends the same medical school as I do said program directors commented on her/his trajectory; combined with a lot of things I have read online, I am worried this will be a limiting factor.

Can anyone comment on the reasonableness of this fear? I hesitated even asking because I am sure this is an awkward question to ask, but I figured this was the place to ask it?

If this is an issue, what can I do to mitigate it?

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It's obvious what you can do to mitigate it. The same thing that makes any medical student successful. Do as well as possible in classes, step 1, obtain AOA, research, identify a competitive field early to find mentors, some volunteering (just to put something in the section like 1-2 experiences).

Yes it does help to go to a higher ranked med school. Yes those students need less of the above to match at an equivalent position. In the end though, any US med school can get you into any field of medicine. You might not do neurosurgery at MGH though.
 
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Why don't you just look at the match list of your school and compare it to other schools with a similar rank? The ones who do well have options.

If you're in Med school but still worried about your undergrad's rank, you're doing it wrong...
 
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Hello,

This is my first post, so feel free to redirect this thread or let me know if I need to change anything!

When I was first accepted, I was incredibly overjoyed at the opportunity: I am the first in my family to attend a grad school of any kind, and this is a huge opportunity--not just for me, but for my family. Ranking was the last thing on my mind. But, of course, medical and pre-medical students talk, and I started to worry.

I am writing because I am trying to filter the chatter I have heard surrounding my undergraduate->medical school ranking trajectory and my subsequent residency/career opportunities. I attended a top 5 undergrad, and attend a 40-50ish ranked medical school. Another med student who attended the same undergrad and attends the same medical school as I do said program directors commented on her/his trajectory; combined with a lot of things I have read online, I am worried this will be a limiting factor.

Can anyone comment on the reasonableness of this fear? I hesitated even asking because I am sure this is an awkward question to ask, but I figured this was the place to ask it?

If this is an issue, what can I do to mitigate it?

Just do your best, work to your goals, start small, take little steps every day, don't get too high, don't get too low, and eventually the cream will rise to the top. Every day is a potential game changer so never beat yourself up.
 
Eat well, sleep well, exercise, and remember to constantly experiment with more efficient methods of learning.

PS: If you want success badly enough, start making moves from day 1 to develop into the type of person capable of succeeding. "Current you" won't be able to do it, but if you invest in yourself properly, you'll grow into someone who can hold a seat near the top of their class and land the residency of their choice.
 
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Eat well, sleep well, exercise, and remember to constantly experiment with more efficient methods of learning.

PS: If you want success badly enough, start making moves from day 1 to develop into the type of person capable of succeeding. "Current you" won't be able to do it, but if you invest in yourself properly, you'll grow into someone who can hold a seat near the top of their class and land the residency of their choice.

Aka let Anki take the wheel as early as possible and never look back.
 
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No one will give a crap.

This only is true if OP doesn't give a crap. If OP gives a crap about matching UCSF or MGH he has to give a crap because they will give a crap.
 
Seconding that nobody will give a crap IF you do well. Plenty of students from elite undergrads attend less prestigious medical schools, especially when you consider the financial aid available to attract such students.

It matters not. Not even for ucsf and mgh. I came from a middle ranked medical school and applied to a highly competitive field and received interviews at all the top programs and matched at one and know with absolute certainty I was ranked to match at most others. So it doesn't have to matter.

But I did well in Med school. Very well. That's not quite the given that some people assume it will be.

Work hard. Good luck.
 
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You might not do neurosurgery at MGH though.

Last time I checked, Myrone Rolle didn't go to a top 50 med school and still matched NSGY at MGH... Rhodes scholarship and NFL mayyyy have played a role, but just saying...

In all seriousness, I agree what others have said here. Never came up where I went to undergrad during any interview and I think I'd be turned off by a program that cared about my pedigree that much. As far as getting a residency you want, you could be a big fish in a little pond where you are now and thrive. If you were at a top 5, maybe you'd be middle of the pack (or the front)...
 
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By definition it will limit your future. The closer you are to your job, the harder it is to change the trajectory. Also, places two levels removed from you will not matter. For example, undergrad doesn't matter when you look for residency since it's two levels below.
 
but from a top 40-50 you'll be in good shape to match anywhere if you've got the stats. This prestige obsession really needs to die. Learn to be happy somewhere other than at the top of the Ivory Tower, because the view is just as nice from the balcony.

A word of caution. Sure, if you got the score, but from someone who have gone through this, it means you can be "median" at harvard and get harvard residency or "top 5%" at a top 40 school and get harvard residency.

Prestige in medicine is a train, and once you "fall off" it's difficult to get back because each stage is smaller.

From what you said, many thousands of premed at hopkins? To IR fellowship spot of EIGHT a year at hopkins, the attribution is tremendous.

I fell off the train during residency, listening to people before me thinking that only training is important and weny to an incredibly strong training program with high volume that has absolutely no name, and I realized while training is important, the most important distinction of a residency program is actually how much it will help you for your next step since almost all train you adequately.

I've interviewed at a certain program where they straight up tell you "yeah, we aren't the best in doing certain specialized thing, but groups see my departmental letterhead and say, come on in, we'll train you"

That's how much prestige means.

Also, I also blew off prestige when I was younger, but now I realized it's important for people who want to live in NYC or Socal since job markets are competitive. At the SF bay area, most young IR guys come from a handful of programs, and those programs aren't "top 50" if you know what I mean.
 
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I understand what you're saying, but I think you're crazy if you think you straight up can't get a job in certain areas if you didn't ride the top 10 train the whole way through. Maybe the best opportunities are closed. Maybe you can't be a UCSF/Stanford professor coming from a top 50, but you can find a job, and if you can't, it's not just because of where you trained. I can guarantee you that SoCal needs more IR physicians than just the ones they train at top places, and there are plenty of other competitive markets to fill, all drawing from the same pool of top applicants. A 1 minute google search revealed plenty of IR docs in that area that aren't with UCSF who don't have resumes stuffed full of top tier places. I'm not going to deny that you get more opportunities with a stronger name, but at a certain point you need to look at your life and decide what's most important. Personally, I chose to go to a school where I'd be happy for 8 years over another area where I'd be kicking myself because I hated the area. I didn't drop halfway down the rankings to do this. I'm not stupid, but I gave up top 20 for top 30, and honestly I don't regret it. I also can't see myself needing to be in NYC or SoCal when I'm an attending in my 40s. At that point I'll be more concerned about school districts than whether or not I'm living in the suburbs hour from SF/NYC vs. Philly/Boulder/Atlanta/etc...

You can't keep pushing off being happy for the sake of prestige and opportunity later. You have to recognize what, objectively, prestige is bringing you, and at what cost. I'm not willing to destroy my 20s so that some day, maybe, I'll get more job offers in SoCal. I'm going to work hard so I can match into whatever specialty I want in a place that will allow me to do research. I picked a school that wouldn't limit my residency options but would let me live in the kind of place I wanted to live for a solid chunk of my life. Yeah don't pass up Yale for the Bob Ross Fingerpainting Hospital of Boston because you like Boston more than New Haven, but I'm personally hoping to not be 65 years old thinking I'd spent my whole life working hard so I could be slightly more rich or slightly more well-known while giving up all the things that make life enjoyable chasing something that ultimately amounts to prestige and maybe a job I want.

You don't have to believe me, but I interviewed at many, many IR fellowship this year and all this is personal experience and direct conversation with people who are looking for job right now. I am speaking of the job market at this moment.

The other thing is education at a DO school or less well known school is usually just as taxing for students. You can't say "oh I am going 10 spots down the ranks so I don't destroy my 20s"
 
It was more about location, COL, and which school I liked best/where I thought I'd be happier. Honestly, couldn't be happier with my school's culture and I guess that decision could've easily gone the other way (i.e. I could've liked the higher ranked school more), but I didn't, so I didn't let it bother me. OP was upset about top 50 vs. top 10. Yeah there's a huge difference when you start moving beyond that into mid-low tier schools and obviously DO schools, but top 50 vs. top 10? Unless you really care about being a world expert, you can do anything from any of them.

Again, I'm sure there are advantages in the job market, but I really don't buy the idea that you have massive geographical restrictions coming from a solid academic residency program. There's just thousands upon thousands of non-top 10 doctors practicing in NYC/SF/Boston demonstrating exactly the opposite. NYC has tons of hospitals, only a few of them are attracting the best of the best. They've got tons of private practices, and they're filled with non-top doctors. It may be harder to get a job, but don't tell me top 10 vs. top 50 is the difference between being able to practice in NYC and being a shill in some rinky dink town in suburban Georgia.

My argument is one of cost-benefit. How much are you going to hustle for that extra prestigious residency/fellowship? How many weekends will you give up? How many missed outings with friends will you endure? How many birthdays will you miss even before you start residency, where you will miss these things regardless? What will you get out of that cost? You're telling me what you get out is advantages in finding jobs in select competitive areas. I'm telling you that doesn't seem like an even remotely even trade off unless your whole life is in NYC/Boston/SF and you need to stay there.

A couple things. A lot of prestiguous IR fellowships such as MD Anderson or Memorial Sloan Kettering give academic days. UCSF call schedule is objectively less brutal than my program's call. So you are actually getting MORE weekends with more support in a larger residency. It's a misconception that people will be more miserable in a larger center.

Second, I am talking about a specialty where there are only a few practicing. I think there are probably less than 50 academic IR guys in NYC, and it's really not a thing you can do full time in the community setting. So in my scenario, name matters a lot. It's the difference between having a job doing cool angio cases all day vs a job reading mammograms and placing mediports.

Unless you go to primary care, ED, or internal medicine, where a market can support thousands, the job market thing may be far more important than you think.
 
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This thread brings up the classic question, "what is my potential?"

Truth is OP, sure, there are factors you can't control now like where you are going to school yada yada yada. There are things you can control, and you just gotta deal with it. If you work hard and put the onus on you then you can start talking about how you are limited by your school brand name. Until you are the top of your class, something you can control, then other premeds talking about how you are limited by your school is just silly and not helpful.

Fact is, the onus to succeed and place well and get the best career is completely in your hands and in your control. How hard you work, how much time you put into your school and your life, is always going to outweigh the factors you can't control in any factor of your life. The only people limited by their school brand name are the ones who aren't at the top of their class hoping for a free ride - these people will never be as successful as the hard workers in med schools.
 
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Ask yourself OP "What kind of career do I want?"
Then "Can I get there from here?" --

I your answer is confined to specialty, geography and type of practice, then the answer is "Yes"
If your "What kind of career?" answer is "Chief of pediatric neurosurgery at Johns Hopkins" then the answer is probably already "No".
 
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You missed my point.

OP, worry about what you can control - not what you can't.

I don't think that's really true. Med school admissions really are a crap shoot, and I do know a guy going to a top 5 who had a 32 MCAT who really wasn't anything special. He was a good guy, but he really wasn't an exceptional student, not URM, and he didn't even have any other top 50 acceptances. He ended up in the bottom 50% of the class (from what he told me it's sound like he was pretty close to the bottom), but advisors are still urging him to apply to top tier residencies despite below average boards, and he's been told that if he wants it, any specialty is still very much on the table.

Your med school will limit you, and you should keep that in mind when choosing. For him, there was no doubt that he should go to the top 5 over his low-ranked state school. It's safe to say that he would not have been the top student at his state school, in fact, he probably would've been below average given his board scores. These differences become less and less noticeable as you move to top 10 vs. top 20, top 20 vs. top 30, etc... but they are there, and people should be aware of them. My point is really that you shouldn't be making massive sacrifices for prestige or a slightly easier job hunt. Physician job security and job options are some of the best out of any profession, regardless of specialty or pedigree of institution. If you've already got the scores, by all means pick prestige, because it helps. I'm just urging people not to lose their minds over this non-sense, because you're already in a prestigious career. You'll make plenty of money, and you'll be able to work in nice areas if you want. The happiest physicians I've met are not the ones whose careers have been filled with money and prestige, so don't sacrifice your happiness for either in the long run.
 
Well I don't know IR. I'd imagine it's a small community, and that likely does limit where you can work, much like being in rad onc. That being said, it's a small community, and the vast majority of people won't be in that situation by default.

As far as the residency thing goes, I meant that you'd have to bust your a** in med school. There's a massive difference in quality of life in those at the top vs. the bottom of my class. You'll always inherently be making sacrifices (e.g. if I had decided to go to the "better" school I was admitted to, if I decide to try to hit 270 on step 1, etc...) in favoring prestige/career over other things in life. Everyone will bust their a** in residency, but you could still attempt to figure out where the most cush residencies are and head in that direction. Your life wouldn't turn out horrible, despite what those on SDN have to say about it.

I guess I'm just not sure what we're all chasing so hard? We're in a career with better pay, job security, and geographically flexibility (for most specialties) than the vast majority of other careers out there. The only downside to this job is the massive competition and struggle the whole way. Why not let go of some of that stress and just take what comes? It's all good stuff. I guess I'm saying even the worst of what this career has to offer is good enough for me, so I'm just going to continue doing what's been working for me, because unlike 90% of my classmates, I've struck a pretty good balance with what I want now and what I want later, and I'm honestly 100x happier for it.

I imagine you don't know IR, but this is a common problem plaquing most subspecialty because there are less demand for those people and there has been consolidation in healthcare.

A nonexhaustive list of examples

- ENT
- Optho
- pain management
- surgical subspecialities, including urology etc
- interventional neurology
- medicine subspecialities include GI, pulm, renal, etc

You face this problem unless you do EM, neurology, primary care, OB or any other nonspecialized fields.
 
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attending a 40-50ish ranked medical school will not preclude you from attending whatever residency you want. just do well (get good grades, letters of rec, etc.), and as long as you are a likeable person for interviews, you have potential to match at any program. also, you don't need to attend a "top-tier" residency to get a great job after training. it may, perhaps, help to come from a top program if you want to be a program director or chief of medicine somewhere, but not for getting the type of work you want in the place you want. hope that helps a little.
since you're in med school right now, my current advice would be... do the best you can, remember to take care of yourself, and take things one month or block at a time.
 
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