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Top 20 is always a crapshoot. Top 40 should be quite comfortably within reach though. Do some productive research so that you have some type of presentation/manuscript before apps go out and I think you should be in reasonable shape.

That being said, top schools really only matter if you’re trying to go into academics or research. If your goal is private practice, go somewhere that educates their residents well and keeps you happy.
 
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