Why top programs are considered "top tier"

[duckie99]

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When applying for residency and going on interviews I have learned one thing... pretty much every resident is happy with their decision to attend that program and the faculty/program admin are proud of the program.

As you can imagine this turns out to not be very helpful when looking at different programs. I had the opportunity to interview at a top tier program (which I will not name but is considered top 10) and a low tier program for IM. I wanted everyone to know that the hype between top tier vs low tier is 100% accurate. Top tier programs are supremely better in every single facet.

Let me explain:
1. The residents at the top tier place actually seemed happy. In my opinion the only way to tell is whether people come to voluntarily speak with you.

2. The top program has far more opportunities that run the table from clinical to research. Not even a comparison.

3. Facilities at the top program are by far and away superior from the actual department offices to the hospital and clinics. No comparison at all (however note that VA hospitals are generally the same). Top programs generally have a lot more funding and it shows with great places to work. The low tier program showed off their nicest hospital on the interview but as it turns out residents only spend around 20% of their time there...

4. No matter what anyone says a lower tier program does not show you the same diverse pathology as a top program. It's not necessarily their fault because the higher ranked the program the more likely it is to get referrals. Also, that is not to say a physician trained at a lower tier program won't be competent. But a physician trained at a top program is likely better even if only slightly.

5. Top programs have much much better fellowship matches. Lower tier programs seem to train a lot more hospitalists and outpatient docs (for IM).

6. A good way to superficially tell how good a program is considered is to see how many medical students from the school decide to stay and how many IMGs/DOs they have. Yes, DOs, you guys are competent but it is no secret top tier programs generally do not have very many, if any.


So likely some of this is common sense but unless you see the differences for yourself in person it is hard to appreciate honestly. Lots of SDN people will be going for only top programs. When comparing top programs to each other there isn't a huge difference and your choice likely boils down to a gut feeling. But there is a reason for rankings and I suggest you definitely consider them when choosing where to interview no matter what field you are pursuing.

 

[kedrin]

Hmmmm I forsee drama in the near future

 

[Smachadams]

 

[Textbookversion]

I love how 389 IM programs with ~16,000 residents in training was broken down into two categories: "top 10" and "low tier."

Nice analysis broski.

 

[music2doc]

I love how 389 IM programs with ~16,000 residents in training was broken down into two categories: "top 10" and "low tier."

Nice analysis broski.

It's IM. They're ALL bottom tier.



/sarcasm


🙄

 

[CuttingCorneas]

It's IM. They're ALL bottom tier.

 

[duckie99]

I love how 389 IM programs with ~16,000 residents in training was broken down into two categories: "top 10" and "low tier."

Nice analysis broski.

if you focus on the main university programs where even the low tier university programs are superior to most every community program my analysis is true.

Essentially the better ranked the program the better the program is in a wide variety of factors. Some of it is subject to opinion depending on an individual program but there is no comparison when looking at top 30 vs less than 70 ranked. Within the top 30 it boils down to gut feeling. However as a random example program rank 27 will always be much better than program rank 85.

This overall assessment is probably true from every field. There is a reason for rankings and you should not discount them.

 

[kjamess]

It's IM. They're ALL bottom tier.



/sarcasm


🙄

haha tell that to some of the people in the IM forums who had sky high numbers (who probably felt the same way you did) and only applied to top tiers. Now they are 🙁 after essentially getting pan-rejected.

 

[FlowRate]

haha tell that to some of the people in the IM forums who had sky high numbers (who probably felt the same way you did) and only applied to top tiers. Now they are 🙁 after essentially getting pan-rejected.

Yeah it's pretty crazy. IM in general is low-average "numbers," but the top programs are just as competitive as the other "top" specialties.

In my second year of med school, though, I'm coming to realize that it's all really about what you envision yourself doing. I currently want to do EM and don't really care that I could probably get in to something "better." EM is fun, cool, ridiculous, and I've liked just about every EM person I've met.

 

[simsjackop]

However as a random example program rank 27 will always be much better than program rank 85.

 

[C5toC9]

Agree with most of what was said. However, some top tier places have old-looking hospitals so I don't think this correlates too strongly with ranking.

 

[FSU2013]

I love how 389 IM programs with ~16,000 residents in training was broken down into two categories: "top 10" and "low tier."

Nice analysis broski.

If you aint first, you're last.

 

[KinasePro]

It's IM. They're ALL bottom tier.

/sarcasm

I know you're joking, but the numbers are actually pretty crazy for IM. In 2011, there were more AOA applicants to IM residencies than there were total slots available in neurosurgery and ENT combined. IM seems to attract its fair share of badasses.

 

[45408]

I know you're joking, but the numbers are actually pretty crazy for IM. In 2011, there were more AOA applicants to IM residencies than there were total slots available in neurosurgery and ENT combined. IM seems to attract its fair share of badasses.

Subspecialties like cardiology and GI are quite competitive. From what I've seen, the high achievers going into IM are trying to get a good fellowship.

 

[45408]

Let me explain:
1. The residents at the top tier place actually seemed happy. In my opinion the only way to tell is whether people come to voluntarily speak with you.

Wasn't the case in my experience.

2. The top program has far more opportunities that run the table from clinical to research. Not even a comparison.

Most "top tier" programs are considered such particularly because of their research opportunities, so yes, this stands to reason.

3. Facilities at the top program are by far and away superior from the actual department offices to the hospital and clinics. No comparison at all (however note that VA hospitals are generally the same). Top programs generally have a lot more funding and it shows with great places to work. The low tier program showed off their nicest hospital on the interview but as it turns out residents only spend around 20% of their time there...

The absolute nicest facilities I saw, by quite a margin, was at a program I've never heard mentioned on SDN (except for one poster who has mentioned them a few times).

 

[duckie99]

Agree with most of what was said. However, some top tier places have old-looking hospitals so I don't think this correlates too strongly with ranking.

yeah that could be true. I won't interview at Hopkins, for example, but some of the old looking hospitals on the outside I've seen have been renovated and look fantastic on the inside. They just have the necessary funding. This isn't always the case though so you are essentially correct.


And younger naive arrogant med students... top IM programs are extremely competitive. Just as competitive as the surgical subspecialities. The averages for IM are lower because there are so many more spots. But this thread isn't about this...

 

[Slack3r]

I know you're joking, but the numbers are actually pretty crazy for IM. In 2011, there were more AOA applicants to IM residencies than there were total slots available in neurosurgery and ENT combined. IM seems to attract its fair share of badasses.

They're not going to those places to do IM. They're there for the pedigree to A) do research in academia or (more likely) B) use the name of their residency to land a fellowship in GI/cardiology (or maybe allergy/immuno).

Subspecialties like cardiology and GI are quite competitive. From what I've seen, the high achievers going into IM are trying to get a good fellowship.

This.

 

[duckie99]

They're not going to those places to do IM. They're there for the pedigree to A) do research in academia or (more likely) B) use the name of their residency to land a fellowship in GI/cardiology (or maybe allergy/immuno).

uhh,,, tons of high quality applicants decide to not do a fellowship. Hospitalist is pretty popular right now. I've heard it mulitple times from residents at all different places.

Also it does not take a top program to get cards or GI or any fellowship. The low tier program I was talking about in the first post sent several residents to cards and GI. I think a top program gives you more potential and likely will get you a better fellowship in the end but it isn't necessary that's for sure. You cannot merely use the name of a program with nothing to back it up to get a spot. It works for some fields but def not cards/GI/heme onc.

 

[KinasePro]

They're not going to those places to do IM. They're there for the pedigree to A) do research in academia or (more likely) B) use the name of their residency to land a fellowship in GI/cardiology (or maybe allergy/immuno).

This.

GI/cardiology are still IM subspecialties... what's your point? Whether they're going for a program's prestige, for sub-specialization, or to be hospitalists, there's still a large number of top students choosing IM fields over the more commonly considered competitive specialties.

If you lurk around SDN enough, you might get the impression that IM is full of schlubs who couldn't match into Derm. I'm just saying that it's actually pretty impressive how many top applicants end up in IM (and Peds, too) each year.

 

[secants]

GI/cardiology are still IM subspecialties... what's your point? Whether they're going for a program's prestige, for sub-specialization, or to be hospitalists, there's still a large number of top students choosing IM fields over the more commonly considered competitive specialties.

If you lurk around SDN enough, you might get the impression that IM is full of schlubs who couldn't match into Derm. I'm just saying that it's actually pretty impressive how many top applicants end up in IM (and Peds, too) each year.

Yup, I was one of those people during my first two years of med school. Boy was I wrong when I started my IM clerkship.

 

[duckie99]

Yup, I was one of those people during my first two years of med school. Boy was I wrong when I started my IM clerkship.

...uh yeah because you were working with residents who've been doing IM for years. Of course they will know more than a new 3rd year med student.

It is no denying though that the average IM applicant couldn't match derm while the average derm applicant could match IM and likely at a very good program. That's not saying IM residents aren't as smart as derm residents. But derm residents got better scores and had more drive during med school.

 

[Textbookversion]

...uh yeah because you were working with residents who've been doing IM for years. Of course they will know more than a new 3rd year med student.

It is no denying though that the average IM applicant couldn't match derm while the average derm applicant could match IM and likely at a very good program. That's not saying IM residents aren't as smart as derm residents. But derm residents got better scores and had more drive during med school.

See, this is what is annoying about people in medicine. Meaningless dick measuring along with a poor understanding of math.

If you take all the derm residents and line them up, I can find an equal number of IM residents with equal or better stats than those derm residents. IM is just BIG. There are a LOT of IM slots, and as a consequence you get a large spectrum of candidates.

Let's take a big academic center. You might have 5 derm residents/yr and 50 categorical IM. Sure if you rank the IM guys from 1-50 I'm sure the median resident gets beat handily by all 5 derm residents... but that doesn't mean IM is full of dullards who just can't keep up with the acne experts on board exams. You could very well have 15 brilliant residents in your university IM program and still have the average be way way lower than derm.

 

[KinasePro]

See, this is what is annoying about people in medicine. Meaningless dick measuring along with a poor understanding of math.

If you take all the derm residents and line them up, I can find an equal number of IM residents with equal or better stats than those derm residents. IM is just BIG. There are a LOT of IM slots, and as a consequence you get a large spectrum of candidates.

Let's take a big academic center. You might have 5 derm residents/yr and 50 categorical IM. Sure if you rank the IM guys from 1-50 I'm sure the median resident gets beat handily by all 5 derm residents... but that doesn't mean IM is full of dullards who just can't keep up with the acne experts on board exams. You could very well have 15 brilliant residents in your university IM program and still have the average be way way lower than derm.

Yep. In 2011, there were 456 AOA seniors who matched into IM, and only 307 total derm training spots available (~half of which went to AOA students).

It's not accurate for duckie99 to say that "derm residents got better scores and had more drive during med school." The data shows that there are actually more top students in IM than total derm training spots available. Derm is clearly more competitive on average, but its a misconception that derm/ plastics/ ENT have the top students. Top students are everywhere, and an ass-load of them go into IM.

 

[Slack3r]

So what about "top tier" FM? Or is it still ok to dump on FM?

 

[Substance]

So what about "top tier" FM? Or is it still ok to dump on FM?

Top tier FM is an oxymoron.

 

[45408]

See, this is what is annoying about people in medicine. Meaningless dick measuring along with a poor understanding of math.

Brilliant.

 

[S3S4]

When applying for residency and going on interviews I have learned one thing... pretty much every resident is happy with their decision to attend that program and the faculty/program admin are proud of the program.

As you can imagine this turns out to not be very helpful when looking at different programs. I had the opportunity to interview at a top tier program (which I will not name but is considered top 10) and a low tier program for IM. I wanted everyone to know that the hype between top tier vs low tier is 100% accurate. Top tier programs are supremely better in every single facet.

Let me explain:
1. The residents at the top tier place actually seemed happy. In my opinion the only way to tell is whether people come to voluntarily speak with you.

2. The top program has far more opportunities that run the table from clinical to research. Not even a comparison.

3. Facilities at the top program are by far and away superior from the actual department offices to the hospital and clinics. No comparison at all (however note that VA hospitals are generally the same). Top programs generally have a lot more funding and it shows with great places to work. The low tier program showed off their nicest hospital on the interview but as it turns out residents only spend around 20% of their time there...

4. No matter what anyone says a lower tier program does not show you the same diverse pathology as a top program. It's not necessarily their fault because the higher ranked the program the more likely it is to get referrals. Also, that is not to say a physician trained at a lower tier program won't be competent. But a physician trained at a top program is likely better even if only slightly.

5. Top programs have much much better fellowship matches. Lower tier programs seem to train a lot more hospitalists and outpatient docs (for IM).

6. A good way to superficially tell how good a program is considered is to see how many medical students from the school decide to stay and how many IMGs/DOs they have. Yes, DOs, you guys are competent but it is no secret top tier programs generally do not have very many, if any.


So likely some of this is common sense but unless you see the differences for yourself in person it is hard to appreciate honestly. Lots of SDN people will be going for only top programs. When comparing top programs to each other there isn't a huge difference and your choice likely boils down to a gut feeling. But there is a reason for rankings and I suggest you definitely consider them when choosing where to interview no matter what field you are pursuing.

It's a little disturbing that people like you keep perpetuating the generalized notion of DO/FMG students in residency program = poorer quality program. In one aspect, you're right: it is no secret top tier IM programs have very few, if any, DOs in their programs. But to say this reflects on the strength of the program (measured by caliber of students, quality/diversity of education, and facility resources) is simply misleading.

The main reason that you don't see many/any DOs at top programs is because the programs do not consider them in the application process (even if their website says otherwise). I can assure you this is not because the DOs who apply did much worse on boards or have less personality or EC's. Some of us take the same board exams MD students take, and end up scoring pretty well. But even top DO students are not offered interviews at many of these places because of old-school PD's beliefs. Those few "mid-tier" programs that do accept occasional DO/FMGs into their program are usually selecting the top students from such programs/countries, and I would bet these select few do better than many MD students at the same institution.

"Top tier" programs' only legit, non-biased stance on their selection process is likely research, and it's no surprise MD students have more (on average) than DO students, in part because most financially-driven DO schools don't give a rat's ass about providing their students with research opportunities.

I'm posting this not to start another DO/MD thread (god knows that subject needs to end), but in hope that people don't get deterred by programs with DO/IMGs based on your presumed insight into residency strengths. I have many MD and DOs in my family, and I am not biased either way. I wish physicians in all areas of the country would unify instead of continuing this division, but I'll keep dreaming. Things at the "top tier" programs will probably not change anytime soon, but hey, it's their program and they decide who gets in. Just realize that if by some fat chance there is a DO on any of your IM interviews, most likely he/she is there because of something more impressive than most other applicants there.

 

[KnuxNole]

If someone doesn't want to do fellowships or despises research, is it safe to say that "low tier" places are more desirable?

 

[rocketbooster]

It's a little disturbing that people like you keep perpetuating the generalized notion of DO/FMG students in residency program = poorer quality program. In one aspect, you're right: it is no secret top tier IM programs have very few, if any, DOs in their programs. But to say this reflects on the strength of the program (measured by caliber of students, quality/diversity of education, and facility resources) is simply misleading.

The main reason that you don't see many/any DOs at top programs is because the programs do not consider them in the application process (even if their website says otherwise). I can assure you this is not because the DOs who apply did much worse on boards or have less personality or EC's. Some of us take the same board exams MD students take, and end up scoring pretty well. But even top DO students are not offered interviews at many of these places because of old-school PD's beliefs. Those few "mid-tier" programs that do accept occasional DO/FMGs into their program are usually selecting the top students from such programs/countries, and I would bet these select few do better than many MD students at the same institution.

"Top tier" programs' only legit, non-biased stance on their selection process is likely research, and it's no surprise MD students have more (on average) than DO students, in part because most financially-driven DO schools don't give a rat's ass about providing their students with research opportunities.

I'm posting this not to start another DO/MD thread (god knows that subject needs to end), but in hope that people don't get deterred by programs with DO/IMGs based on your presumed insight into residency strengths. I have many MD and DOs in my family, and I am not biased either way. I wish physicians in all areas of the country would unify instead of continuing this division, but I'll keep dreaming. Things at the "top tier" programs will probably not change anytime soon, but hey, it's their program and they decide who gets in. Just realize that if by some fat chance there is a DO on any of your IM interviews, most likely he/she is there because of something more impressive than most other applicants there.

Sorry but the op is pretty accurate in this part of his post. I'm not saying top DO students are not as good as many MD students, but seeing how many DO/IMGs there are in a program is definitely a good way to judge the caliber of the program.

My school's Peds and Neuro departments are known to be lousy. Having recently done these rotations myself, I can attest to the fact that nearly all the residents are DOs/IMGs and only one resident out of both programs attended my med school. And she had low board scores I may add.

I understand it's not fair for top FMG candidates to be ignored by top programs/fields since they didn't have the option to attend an American allopathic school, but if you're a DO or IMG (Carribean) student, I don't really feel bad for you because you knew the DO limitations going into med school yet chose to attend the DO school anyway. You could have waited a year, retook your MCAT or volunteer or do whatever you needed to be competitive for MD and apply for MD schools the following year. I have several friends who are at DO schools who are definitely as smart as me, had easily fixable MD apps if they had waited a year but decided to go DO instead. That was their choice and it's their responsibility before choosing their med school to figure out what makes you competitive for residency.

 

[Slack3r]

Top tier FM is an oxymoron.

Lol, so yes?

 

[S3S4]

Sorry but the op is pretty accurate in this part of his post. I'm not saying top DO students are not as good as many MD students, but seeing how many DO/IMGs there are in a program is definitely a good way to judge the caliber of the program.

My school's Peds and Neuro departments are known to be lousy. Having recently done these rotations myself, I can attest to the fact that nearly all the residents are DOs/IMGs and only one resident out of both programs attended my med school. And she had low board scores I may add.

I understand it's not fair for top FMG candidates to be ignored by top programs/fields since they didn't have the option to attend an American allopathic school, but if you're a DO or IMG (Carribean) student, I don't really feel bad for you because you knew the DO limitations going into med school yet chose to attend the DO school anyway. You could have waited a year, retook your MCAT or volunteer or do whatever you needed to be competitive for MD and apply for MD schools the following year. I have several friends who are at DO schools who are definitely as smart as me, had easily fixable MD apps if they had waited a year but decided to go DO instead. That was their choice and it's their responsibility before choosing their med school to figure out what makes you competitive for residency.

Not really sure why we had to hear from the peanut gallery on this, but not surprising from your frequent postings. Everyone's entitled to their opinions I guess, but I dont mind what people like you think about DO applicants, clear as it is. As for my opinion, I believe patients would care more about med school grades, board scores, and clerkship performance than some undergrad extracurriculars, but thats just me. Like I said, if some PD's don't think the same way, that's their entitled opinion.

Yes, of course many people go to DO schools as a back-up, but some people have their own reasons, and this matters more to those students. I'm not saying that a residency with only DOs and FMGs will give you an experience as good as BID, of course not. Like I said, PD's choose who they want in their program, but to imply that if there are DOs in a program (albeit a minority), the program is not as strong as one without DOs, is not right in my opinion. I know countless DO students with board scores better than yours (from a previous post), yet you will likely not see them in programs with students who have the same scores. Once out of residency, these scores matter in relation to the application of knowledge learned in med school. Luckily the bias you show is becoming less apparent in most parts of the country, and I hope you will realize that the "friends" you are preaching about may work along side you in years to come.

 

[KnuxNole]

Keep in mind that you might have quite a few senior residents/attendings who are D.O.s, Carib grads, and FMGs too. I know that people would still give them 100% respect and not think they are dumb by any means, but if they made it to residency and are learning well and taking care of patients in a competent matter, that's a 👍.

 

[calvnandhobbs68]

It's a little disturbing that people like you keep perpetuating the generalized notion of DO/FMG students in residency program = poorer quality program. In one aspect, you're right: it is no secret top tier IM programs have very few, if any, DOs in their programs. But to say this reflects on the strength of the program (measured by caliber of students, quality/diversity of education, and facility resources) is simply misleading.

The main reason that you don't see many/any DOs at top programs is because the programs do not consider them in the application process (even if their website says otherwise). I can assure you this is not because the DOs who apply did much worse on boards or have less personality or EC's. Some of us take the same board exams MD students take, and end up scoring pretty well. But even top DO students are not offered interviews at many of these places because of old-school PD's beliefs. Those few "mid-tier" programs that do accept occasional DO/FMGs into their program are usually selecting the top students from such programs/countries, and I would bet these select few do better than many MD students at the same institution.

I'm not sure where that top post said any of this. He was just saying that if you see more DOs/IMGs it's a sign of a not top tier program (whether this is true or not). It's like saying more residents with brown hair means it's probably a lower tier program. Their brown hair didn't cause the program to be lower tier. The top tier programs just like people with blonde hair better.

 

[SpecterGT260]

It's a little disturbing that people like you keep perpetuating the generalized notion of DO/FMG students in residency program = poorer quality program. In one aspect, you're right: it is no secret top tier IM programs have very few, if any, DOs in their programs. But to say this reflects on the strength of the program (measured by caliber of students, quality/diversity of education, and facility resources) is simply misleading.

.

Nobody is saying fewer DO students equals better quality students.

What IS being said (and is perfectly valid) is that Top programs have the highest calibur students. That is a no brainer. That is WHY they are the top programs. People aren't climbing over each other to get into a program just for its namesake. The competition is ridiculous and everyone has outstanding pedigrees who applies = outstanding applicants/students. There are also fewer DOs in these programs. The statement is an attempt at a logical extension

 

[MCAT guy]

Lots of sdn students use medicine to stroke their ego. The work is self-serving.

 

[Renaissance Man]

How do you even keep track of the top tier programs in all the different specialties? Obviously Harvard and Hopkins are probably up there for quite a few of them, but with so many different options and residency programs, I couldn't tell you what the top-10 is for many (any?) specialties.

 

[S3S4]

Nobody is saying fewer DO students equals better quality students.

What IS being said (and is perfectly valid) is that Top programs have the highest calibur students. That is a no brainer. That is WHY they are the top programs. People aren't climbing over each other to get into a program just for its namesake. The competition is ridiculous and everyone has outstanding pedigrees who applies = outstanding applicants/students. There are also fewer DOs in these programs. The statement is an attempt at a logical extension

true, and if this is what the OP was implying, then I apologize. My response was because I have seen this idea many times in posts and think many people automatically view a program ith a DO as a "lower-tier" than one without. It honestly wasn't meant to change the thread's topic or start a debate, it was just my opinion on part of his post.

 

[Evil_Abed]

See, this is what is annoying about people in medicine. Meaningless dick measuring along with a poor understanding of math.

Brilliant.

Haha, truer words have never been spoken. I don't know what it is about med students, but it seems like many (most?) of the students I come across have a very poor foundation in (and, thus, a strong aversion to) math, physics, or basically anything involving numbers. Hell, most don't even seem to understand the simple difference between a mean and a median -- I see this a lot on SDN too (surprisingly).