why does the med school you choose matter

[banana5]

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[medhacker]

To answer part of what you asked:


There is a study out-there that shows a relation between the med school you attend and the amount of medical malpractice. So not to knock on the lower tiered school but it seems like graduates of "top-ranked" schools incur less malpractice.

 

[ND2005]

This might seem like a stupid question, but really I'm just naive about the process. I'm a freshman premed and have just sort of been lurking and trying to figure the whole thing out.

So from what I understand, everything you do in undergrad + MCAT determines where you can go to med school. There you learn and study and all that good stuff, take the boards, and that determines where you can do your residency, or what kind of residency you can do if you're aiming for a competitive one. My assumption is that the better the residency the better the training you will receive, and the better the doctor you will be. Then after that I'm guessing you get a job, and that is where I get confused.

So first things first. If the main point of med school (in terms of the sequence of events, I realize there are other purposes) is to prepare you for the boards, then why do people so often say that going to a ranked school will "open doors" later on? Is it just because they assume that these people will do better on their boards?

If residency were 100% based on boards, then maybe it wouldn't matter. But there are a lot of other factors, and school quality is one. You don't think a residency director will look a little bit harder at a candidate from HMS than he would a candidate from a lower ranked school? Also, the residency network still has something of a reputation as a good ol' boys club -- a phone call from the "right" doc in your desired specialty could help a lot.

Second, where do most people draw the line between saying it's worth it to go to the state school and not? I'm from NY, so it's the SUNYs or bust for me. I realize that most people would go to Harvard if they got in, but what about, say, USC (over the SUNYs)?

That's really up to the individual.

Third, why does the place you do your residency matter? Say you're interested in setting up a private practice, in whatever specialty. It seems that a doctor is a doctor, and if you know your stuff and have a good personality, word of mouth in this situation would get you all the patients you need. Is a "good" residency only relevant for those who are interested in academic medicine, or those who are interested in fellowships?

Well, for one not everyone is going to start their own practice, so having connections within a specialty, or being at a program with a great reputation, is very important. Plus, most people believe that you get the majority of your "real" training in your residency, so going to a good program there is the right way to start your career.

Fourth, and perhaps stupidest, how many allopathic schools are there in the US? I can't find the number by googling.

I want to say 126.




Continuing with the above, there are obviously a few other advantages to going to a top school. A lot of people would say (and I tend to agree) that the top schools are the top schools for a reason -- they teach well, they have a lot of resources, they consistently produce good doctors. Those things do matter. You shouldn't just be going to med school with the end product -- good board scores, good residency placements -- in mind.

 

[Camel]

Lol, too many questions to answer in one post. I'll address a few. As far as the number of med schools, one way to could would be at mdapplicants.com by checking their list (I think). As far as schools opening doors, that's basically talking about academic medicine and research. When you come from a name school (ranked), you are assumed to have been exposed to heavy and cutting-edge research. I mean, at Duke, the choices they presented for research locations were the NIH and the CDC... doesn't really get much more cutting edge. That exposure connects you with people, and you have an incredible opportunity to network. If you are interested in that aspect of medicine, it is VERY important. If you are interested in being a clinician, then individual performance far outweighs the choice in medical school. Good luck.

 

[kirexhana]

this is just a thought, where you go matters because clinical rotations that occur at a specific school allow for residency directors to get to know you better. thus, if you wanted to do your residency at UCLA, the easiest path would be to get into UCLA's med school. otherwise, to have a better shot at UCLA's residency you'll have to do an away rotation from the school you're at currently.

 

[Smoke This]

The stuff about better residency=better training: Not exactly correct. The ACGME rules ensure that all accredited residencies have equivalent clinical training. Essentially all that an MGH residency buys you is being able to tell people that you went to MGH. If you are planning on going into academic medicine or getting a competitive fellowship, it could also be helpful but it's not a requirement for that.

1. Going to a ranked school would open doors (potentially) in terms of getting residency interviews. I don't see any other reasonable advantage to it except for this. That still doesn't mean you'd get ranked to match, though, especially considering in a field like surgery (which I am going into) programs will interview 100+ applicants for 6 categorical positions. Fair or not, coming from a name school may help get your foot in the door but after that you're on your own. I don't think the assumption these schools will open doors is related to the board scores. There are some very average people at all top schools.

2. I think it is always worth it to go to a state school if that is your best financial option. Only don't go to a state school if it would be so onerous for some reason that you couldn't tough it out for 4 years. The curricula are basically standardized and there is no real difference in the sort of education you'd get anywhere. Talk to a 4th year medstudent or simply look at the match lists on this forum and you will see that for the average applicant to most fields, going to a state or non-elite school has absolutely no impact on residency competitiveness. Even in fields like ortho, derm, etc. that are among the toughest matches you will still see plenty of people going into these from very ordinary (reputation wise) med schools. Nothing is impossible solely because of where you go to school.

3. Personally I don't really think where you do residency matters, except that if you want to be in a certain geographic area after residency, doing a residency in that same area is a fundamental way to make connections there. Once again residencies are closely monitored and reviewed periodically to ensure that their clinical training conforms to national standards, so there should be no substantial difference among them. You might argue that somewhere with a big name will have nationally prominent faculty teaching you and I don't dispute that, but whether that makes a significant difference in how capable you are after residency I think is debatable. Where having a big name in your program might help you is in getting a competitive fellowship, since specialty communities in medicine can be pretty small. Even so, going to somewhere without some national society president on the faculty, for example, doesn't automatically close doors for you. Do research. Publish as much as you can. Make connections when you present at national meetings, etc. I guarantee that if you look at medical school faculty even at the more renowned schools you'll find doctors from very average residencies (and very average medical schools). I think the only time your residency would close the door is if you deliberately do a very non-academic residency, such as in surgery if you were to go to a community program without a medical school affiliation and no research, but even then it wouldn't close the door to all fellowships, just potentially really competitive ones like pediatric surgery (for which doing lots of research is a de facto requirement).

4. It's around 120-125 allopathic schools. Don't know the exact number.

 

[jbar]

To the residency question, one of the big differences between programs that I have heard is quality of life. Some programs have differnent amount of nights per week that you are on call. Programs may differ if the educational oprotunities they provide, some may pay to send you to conferances, some don't. There may be differences in legnth of training, in emergency medicine some are 3 years, some 4 years.
The other thing is that in some specialties you have a very different experience for residency (and medical school) depending where you go in terms of the patients and diseases that you see. (Not better or worse, just different) For example, if you go to medical school in New York City you will see very different types of patients than if you go to schoool in New Hampshire. (DMS)

There are lots of other factors, in state tution, where your family lives, friends, where you want to be (I want to be in Boston, while the schools there may be no better than a school in Minn., it would make me personally happier to go to certain geographies than others)


In the end you get a feel from schools or programs and make a decision. While I know that I would get a good education from any of the medical schools I applied to, there are just some that I want to be at more than others.

 

[Brainsucker]

Look, undergrad, med school and residencies can all be thought of in a couple different ways:

Reputation and connections: Doesn't help you at all when you're there. Helps you a little to quite a bit going where you want for the next step.

location: Speaks for itself.

quality of education: This will vary depending on what you want to do. ACGME (or LCME, for that matter) accreditation is a low bar to set. There are definitely better and worse educational experiences. I'll give you an example of the variability: For neurosurgery, UCSF is the place to go if you're really interested in academic medicine. The research and residency are tremendous for that. The Barrow might be better for someone interested in private practice or even just a little less academic.

For you, you say you're interested in private practice. It still depends on the specialty you're interested in. If you want family practice, it doesn't matter where you go to med school and it matters little how you do. If you're interested in derm, on the other hand, you'll want a research-heavy med school so you can publish and get connected.

 

[ND2005]

The stuff about better residency=better training: Not exactly correct. The ACGME rules ensure that all accredited residencies have equivalent clinical training. Essentially all that an MGH residency buys you is being able to tell people that you went to MGH. If you are planning on going into academic medicine or getting a competitive fellowship, it could also be helpful but it's not a requirement for that.

ACGME rules do not ensure that all residencies are "equivalent" -- they ensure that all residencies are sufficient.

 

[banana5]

still some answered questions.. so bump

 

[dbhvt]

To answer part of what you asked:


There is a study out-there that shows a relation between the med school you attend and the amount of medical malpractice. So not to knock on the lower tiered school but it seems like graduates of "top-ranked" schools incur less malpractice.

That's really interesting mhack, I wouldn't have guessed that. Can you give us a link? I don't know much about malpractice, but I wonder how much of it has to do with the impact of name on a jury. A jury hearing that the doc is a Harvard grad might be less likely to move on a malpractice suit than a jury hearing the doc went to the Carribean.

 

[jebus]

dbhvt: http://qhc.bmjjournals.com/cgi/content/abstract/12/5/330

Objectives: Following earlier research which showed that certain types of physicians are more likely to be sued for malpractice, this study explored (1) whether graduates of certain medical schools have consistently higher rates of lawsuits against them, (2) if the rates of lawsuits against physicians are associated with their school of graduation, and (3) whether the characteristics of the medical school explain any differences found.

Design: Retrospective analysis of malpractice claims data from three states merged with physician data from the AMA Masterfile (n=30 288).

Study subjects: All US medical schools with at least 5% of graduates practising in three study states (n=89).

Main outcome measures: Proportion of graduates from a medical school for a particular decade sued for medical malpractice between 1990 and 1997 and odds ratio for lawsuits against physicians from high and low outlier schools; correlations between the lawsuit rates of successive cohorts of graduates of specific medical schools.

Results: Medical schools that are outliers for malpractice lawsuits against their graduates in one decade are likely to retain their outlier status in the subsequent decade. In addition, outlier status of a physician’s medical school in the decade before his or her graduation is predictive of that physician’s malpractice claims experience (p<0.01). All correlations of cohorts were relatively high and all were statistically significant at p<0.001. Comparison of outlier and non-outlier schools showed that some differences exist in school ownership (p<0.05), years since established (p<0.05), and mean number of residents and fellows (p<0.01).

Conclusions: Consistent differences in malpractice experience exist among medical schools. Further research exploring alternative explanations for these differences needs to be conducted.

 

[Reimat]

I don't know much about malpractice, but I wonder how much of it has to do with the impact of name on a jury. A jury hearing that the doc is a Harvard grad might be less likely to move on a malpractice suit than a jury hearing the doc went to the Carribean.

That's exactly what I was thinking - and this could probably be verified by looking at the statistics of malpractice of graduates from Harvard vs. Wash U or any Ivy-league school vs. a top non-Ivy.

However, OP, you must take into account that 50% of people on SDN are gunners with the USNews rankings memorized, so many of the responses you'll get are people telling you "if you don't go to a top 10 med school..." followed by ominous threats of what could happen. All med schools are good - just worry about working hard as an undergrad to get into one. And life will be good. 😀

 

[DNAroolez]

so if a person was looking into say, pediatric cardiology what kinds of qualities should that person look for in a med school?... you all seem so knowledgable and i am quite clueless to be honest!

 

[Risa]

Fourth, and perhaps stupidest, how many allopathic schools are there in the US? I can't find the number by googling.

If I type "medical schools" into google, the top link is the AAMC website, and when I click on that the first sentence on the page starts "The AAMC represents the 125 accredited M.D.-granting U.S. medical schools..."

 

[tkdusb]

If I type "medical schools" into google, the top link is the AAMC website, and when I click on that the first sentence on the page starts "The AAMC represents the 125 accredited M.D.-granting U.S. medical schools..."

pwned

I just wanted to say it before someone else did

 

[fishtacos]

dbhvt: http://qhc.bmjjournals.com/cgi/content/abstract/12/5/330

acccording to that article "High" and "low" outliers are defined as above the 90th percentile or below the 10th percentile of the distribution of the percentage of graduates sued."

interesting article but . . . it has nothing to do with the actual ranking of the schools, and as far as i could tell, the authors never mentioned which schools fell into the high and low outliers categories. plus, if you read the discussion, it makes it sound like schools like harvard might even get sued more because of the specialities its students choose. I don't think this is the article medhacker was thinking of.

 

[Bones2008]

In terms of why the med school you go to matters, here's an example. One of the residency programs at my hospital (UMich) uses a rubric to evaluate applicants, with categories that are weighted according to importance. The categories are what you'd expect: USMLE score, letters of evaluation, school quality, personal honors/AOA, etc. What you might not expect is that the #1 overall most important characteristic of an applicant for this particular program is where he/she went to medical school, as determined by the "rankings." It's actually weighted twice as much as USMLE scores. Keep in mind this is just one example (and probably a bit of an extreme one at that), but recognize that many residency programs do care where you go to school. Whether or not that ends up having any bearing on your life is open to debate (see posts above).

 

[banana5]

bump