Advice for the lowly med school applicant

I went to a state school that was identical in every way to the one which you are describing. In my limited experience, I did not witness anyone with the right credentials (board scores, grades, reccomendations) who had any trouble matching into a good program or even what is considered a "top program" by some people. As long as you feel you will get comparable training and be happy, I wouldnt beat yourself up too much over going with the state school. Some people might say there is a big difference between a top medical school and all the rest, but I think that good students are good students wherever they are at. I have actually had a couple of attendings who have said as much. They feel the top 50% at most medical schools are all the same and that you really only start to notice differences when you looked at the bottom half of different medical school classes. However, I will admit that it did seem like a small disadvantage not having a home ortho program. It means there will likely be little chance of doing any relevant research, you wont have a home chair to write a letter for you, and there is no chance at matching at your home program as a fallback. All of that may seem scary and probably caused me an ulcer or two, but in retrospect I do not think it really mattered. In the end, I am VERY satisfied that I chose to go to a state school. I got exactly what I wanted and did not have to sacrifice my finances or my happiness to do it. Trust your gut and good luck. PM me if you have any questions.

Like it or not, names open doors. Bigger name school, bigger name attending writing you a letter - all this helps to some extent. But I agree w/ overhaul that you should choose a school where you'll be happier (i.e., pass-fail!!!, better location, etc - all these things matter). As far as academics, I feel that what defines the school are the students - smarter students in your class make you work harder, and you'll learn more as a result.

I go to a school w/ a famous orthopaedic department, and when I did my aways, people knew where I was from, and at least acted like they were impressed. Whether this helps me in the end - remains to be seen.

And I would urge you to forget about the money. You'll be up your ass in debt either way. And assuming the health care system doesn't crumble in the next 10 years, you'll make the difference back within a year of being an attending.

BobAEPi has good points although I personally disagree with some of them. Here are my thoughts on some of the things that were brought up.

1) The "names open doors" phrase is used ad nauseam and I think is misleading. Yes, a big name in orthopaedics writing a great letter for you is obviously helpful. However, if you do an away rotation in get the same letter it is just as helpful. Also, I have yet to discover any doors that are "closed." I will venture that if you are competing for one of the top sports fellowships in the country that knowing the right person is essential, but in orthopaedics when there are so many outstanding residency programs I think going to a no name medical school means relatively little if you still have the board scores, grades, and recs to prove your worth. Even if the door gets opened because of a big name pedigree, you still have to walk through it and that means backing up that pedigree with performance. Maybe my argument doesnt hold water, but to me it seems the most common demoninator in matching successfully has nothing to do with pedigree and has everything to do with working hard regardless of where you are from.

2) Being around other students that work hard and are smart is good, but I think you will find that at most medical schools. Also, being around "smarter students" may inspire you to achieve greatness, but it also might cause you to fall like a house of cards. There is nothing wrong with being a small fish in a big pond, but I sometimes think the big fish in the small pond eats better.

3) I apologize in advance if the following is condescending, but after a rotation do you think anyone you work with will really care what school you are from? BobAPEi is from Cleveland which means he is attached to one of two very impressive and well respected orthopaedic programs. However, the success of those orthopaedic programs says very little about his abilities as a student and future resident. Again, if you work hard and are likeable, people will ultimately be impressed. But if on the other hand someone is a jerk and/or lazy it probably is not going to matter whether they go to the best medical school in the country and Rockwood & Green are their godparents. Attendings and residents want to work with people who are smart, hard workers, and easy to get along with. I venture that reputation of medical school is a minor not a major issue. I hope the above does not seem like an attack on you BobAPEi, I am just using you as an example since your pedigree is solid.

4) "Forget about the money." I am not going to say that money should be your top reason for choosing a medical school, but I definitely think you have to consider it. There can be a drastic difference between state tuition and private tuition. It may be true that if you go into orthopaedics which is one of the most financially rewarding of all specialties that the difference in debt does not seem all that significant. The difference between $125,000 and 250,000 may be nominal. However, if you fall in love with general pediatrics making horrible pay and suddenly find yourself in a city with a high cost of living, a stay at home spouse, four kids requiring private school, a dog, two cats, a mortgage, a parent in a nursing home, and alimony payments from your first marriage--the difference might seem more than nominal if you felt like your education and career opportunities would have been nominally the same at the two different medical schools regardless of career path.

I will now step down from my soapbox. As I said, BobAPEi makes valid points, I just have a different perspective. Sorry about the long post. The above rant might be related to the fact I am on call on my 5th month of general surgery rotations and longing for the good life. . . .

SDE- the bottom line is that orthooverhaul is right- IF you have great grades, and IF you rock the boards, and IF you do some interesting research (ok, this may or may not be important if you passed the first two "IFs"), and IF you perform above your peers on your away rotations, and IF in the course of getting to know your away rotation attendings you are able to get 3 or 4 stellar LORs, then yes, there will be no doors that are "closed" based on your choice of school.

HOWEVER, there are some advantages that are hard to simply dismiss as insignificant about going to a top medical school or a school with a top ortho department. Most importantly, you have to take into consideration that you may not be No. 1 in your class, you might not be AOA, you might only be statistically speaking (in general all med students are quite smart) a middle of the class guy. This is not in anyway to judge you or your talents- this is just to say that it is impossible for everyone to be AOA. With that in mind, there is no doubt that such students from big schools will get more of a benefit of a doubt. Just something to think about. I have personally witnessed how having a longterm relationship with big name faculty has helped "middle of the class" students over the past few years from my school secure "top" residencies due to letters written and phone calls made on their behalf. I'm not saying it's impossible without a big home institution, I'm saying it's relatively easy if you have one at your school. Fair or not, there does seem to be a trend of ortho programs (especially the big academic ones) being filled with a disproportionate number of students from similarly big research medical schools. Take a look at threads like matched credentials. While almost universally everyone who matches is excellent, it seems that most of the time when someone was slightly more mortal on paper, they happened to be from a top research medical school. Most of the time, it seems that matched students from a lesser known state medical school were top of their class. Just an observation. Question- is it easier to get to the top of your class at these schools? I highly doubt it.

Other things to consider are the advantage of establishing mentors early who will be looking to help you along the way, having residents who have just recently been through the process as a wonderful resource, etc. I'm sure there are other things I'm not thinking of.

I could go on and on, but I'll just end by saying that it really just comes down to margin of error. Any and all of your career goals can happen from whatever school you choose. I firmly believe that some paths are easier and give you more chances to reach those goals. You have to decide for yourself what the extra money is worth to you. Just my opinion.

I can confidently say....I did better at my home ortho rotation than I did at any of my aways....why is this....more automomy at home....trauma setting and they needed me to step up and genuinely contribute...I knew the system....I knew the city.....I had friends and family to support me during my 110 hour weeks.....who knows...BUT i got some great letters from my home rotation....and I think that will be a key to matching.....so I agree with all of the above said....but I think you are at a major disadvantage with no home ortho rotation.....
I have chatted with orthooverhaul before and he is a super impressive guy and he would have matched no matter where he went.....but for the more "human" guy having a home ortho program will make a major differece.....I consult the attending and residents here when I need advice or help, and I would not have that support system if I had only done aways......I would personally think long and hard if you really want to do ortho.....IT IS SOOOOO COMPETITIVE, I think you will appreciate every advantage you have, and stastically speaking you have the best chance of matching at your home school....

some may refute this but I would pick a school who at least has an ortho department if thats what I really wanted to do......but you are a long way off

i think a lot of it depends on what you longterm goals are, which of course will likely change as you go through medical school and learn more about the field. not having a home ortho program is definitely a negative and you will have to work a little harder to get involved in research and make contacts, but it can be done. that said, though, if you look at any of the top name programs, the majority of their residents are from top schools. there is no question that going to a school with a high power ortho program will help you match at another high power ortho program assuming you do everything else that needs to be done (i.e. step 1, honors, research, etc). if you want to go into academics, going to a top name program definitely helps down the road. going into private practice, it doesn't really matter and may actually be deterimental as community programs typically operate more and earlier. if i had to choose and was certain ortho was for me, i would choose the school with the stronger reputation and ortho program if other factors such as location, family, weren't playing major roles.

Thanks guys for all your responses... I really appreciate the sincere advice of your experience. Its still relatively early in the app cycle, so I'm not sure what other opportunities will come my way, but when it comes time to make a final decision, I will definitely ask for more specific advice.

I talked with an orthopod (ivy leage grad, academic doc) that I shadowed about this and his reccomendation closely mirrored much of what I've heard on here so far... he basically told me to ask for his (and your) advice to evaluate ortho programs at schools I get accepted to... I am by no means a stellar applicant (although I feel extremely fortunate so far) so my choice will no doubt be an interesting one...

Thanks again!

Go to the better school. Why? Bigger name schools increase your options. Period. You will have more connections and better resources. Your faculty most likely trained with the gatekeepers at academic programs--no matter the specialty. Sure you can match Neurosurg at Mayo coming from BuFu State, but if you don't think it would be easier coming from Harvard or Hopkins, you're sleeping.

Also, the credential has value both in matching and in future salary. Is it a largely unnecessary bell + whistle? Sure. But compare it to buying a Mercedes.

What's the difference between a CL 500 and a CL 66?
$90 grand. get in the car.

If there was absolutely no value to having bigger bragging rights, these schools would not be able to fill their classes each year. Whether or not the value is equal to the extra $150k in tuition is a good question. I would say yes (though when I'm weeping over my loan checks, I sometimes question it). You will never have to feel as if you're playing 2nd fiddle to anyone. And unlike the ride, it never depreciates.

-Grizzle-

I would take one LARGE exception to what Grizzle claims....

He is still in med school and so has no real idea how the real world of medicine works. He is still blinded by the world of ivory tower academic medicine, but in reality, I would contend that where you go to med school has little or NO bearing on future salary. This holds true for orthopedics and all other specialties of medicine.

One gets paid the same for a total hip, breast reduction, colonoscopy, etc REGARDLESS of what their med school diploma or residency certificate reads. What you make in private practice depends on your volume, region, payor mix, overhead, etc. etc. In fact, if someone were to actually do a study (would be worthless, but interesting nonetheless), I wouldn't be surprised to see graduates of more prestigious schools actually making LESS money because of the simple fact that those graduates may be more inclined to remain in academic medicine. If you think academic medicine (in all fields) pays more on average than private medicine, you may want to seriously look at numbers.

The bottom line, however, is that picking a medical school based on future potential earnings is a bad idea. Go with where you will fit, and feel like you will get the best education. Like anything else, you will get out of med school what you put into it. I can guarantee you that if you sit for four years at Harvard with you thumb up your butt and perform poorly, you will be extremely unlikely to get into any ortho program simply on name alone.

I will agree wholeheartedly with this statement:

"The bottom line, however, is that picking a medical school based on future potential earnings is a bad idea. Go with where you will fit, and feel like you will get the best education. Like anything else, you will get out of med school what you put into it. I can guarantee you that if you sit for four years at Harvard with you thumb up your butt and perform poorly, you will be extremely unlikely to get into any ortho program simply on name alone."

But I will take exception to this one:

"He is still in med school and so has no real idea how the real world of medicine works."

Grizzle is actually a guy with a job at a little program in the Midwest. And since he has worked closely with people who are hospital administrators and those who buy and overhaul health systems for a living, he knows that hard work is important, and necessary, but sadly rewards are not directly proportional to effort expended.

I don't think name brand should be anyone's number one determining factor (I have turned down bigger name schools and programs than my own), but I also don't think the desire to save some cash or the misguided thought that med school will be easier at a state school should be the determinant.

-Grizzle-

Listen to Grizzle.
He knows what he's talking about.

I have a quick question... I have been accepted to a school that I love for a ton of reasons (curriculum, strength of clinical rotations, affiliated with ortho res. programs, location, cost, etc). But one thing about the school has been bothering me; the school only allows one month off to study for Step 1. Admittedly, I know next-to-nothing about step 1, but alot of the other schools that I have interviewed at allotted more time than this... Is this generally enough time to prepare? Is this something to be concerned about, or will this be more than enough time for a slightly-above average test taker to study for (and do well on) step 1?


Thanks in advance!

-sde

I think 1 month is enough time to study for the boards. I had the opportunity to study longer, but took the test after 1 month. It does take 1 month of SOLID studying, but I feel like I would have been burnt out with more time. I think most schools only give about a month off in between 2nd and 3rd years.

1 month is definitely enough. youll already be on your way since you spent your last few weeks of second year studying for your finals and shelf exams. i agree with the post above, if you take more than that much time your very likely to burn out. It happened to a bunch of friends of mine and while i was partying after having finished the test, they were still complaining about studying and how much they just wanted to get the test over with. Some even attributed their below expected scores to too much time to study.

No matter how long you take, just study really hard and do as many questions as you can and youll be fine

Some of you are remarkably in tune with the system and some are remarkably arrogant and ignorant (a dangerous combination)

Go where you will be happy.

Someone who expresses this much interest this early in their career is probably better off at a place without an ortho program(a potential distracton). Why? Because of the order of what is important to program directors (like me)


You have to kick butt in the first 2 years of med school. Start by Honoring Anatomy (typically easy for most people interested in ortho).

You should get over 220 or 230 on the boards

You need to do well in most of your clinical rotations-including psych, ob, peds etc.

Then you need to get good ortho letters-typically acquired during away rotations. Without a home program you would have to do at least 2.

Meet the above criteria and you will match at a good program.
Want to get to a top tier program? (whatever that means) demonstration of a real commitment to ortho and research helps, but most research endeavors of applicants are just fillers, a real effort on something simple (even a case report) with a local orthopaedist/physiatrist or even radiologist rounds out the application.

All program directors know what is real and what is BS, we also know that many med schools (especially 'top' ones) flagrantly inflate grades, put 3/4 of the student body in senior AOA and make everyone president of the orthopaedic club.

I do not know what this local state school is, but the other positive for any med school rests on the amount of work and involvement afforded to 3rd and 4th year students. I have to admit that students who cut their teeth in inner city hospitals or other sites where they have to function at the level of an intern are much more appealing. Anyone can look good in an ivory tower if they kiss enough butt.

Lastly, the money thing IS a big deal: I went to med school at a state funded site, my loans are 125K. I know plenty of other MDs with loans over 200-250K from private institutions. Staffords are like at 7 or 9% now right? You will not make a dent in them until your in your 2nd or 3rd year of practice (11yrs from now).

Hope this was helpful

two points:
1. Go to the best school. The Ortho people at your schools are the ones who can get to know and like you over the 3 years and write a whole lot better letters than you can EVER get doing an away rotation where you are one of 20 applicants at that school. Besides, you can't do research at a school without an ortho department. And who you know gets you into the better residency program which will allow you to work in whatever city you want to work at.

2. The amount of time studying for the boards does matter a ton. My school went from a traditional curriculum of one month board studying to one that gave roughly 10 weeks. The avg board scores went from 219 to 225, and trust me, the extra time helped EVERYBODY. The people who wanted a vacation and took it early got a longer vacation. Without exception, the people who took most of the time scored amazingly.

i am going to have to agree with orthoprogdir. i came from a regional campus of a large state medical school with no ortho dept at our site. i did not have superstar boards, but did well on my third year rotations and on my aways. being at a more "community" based medical program really allowed me to learn how to function at the level of an intern while in medical school. we had direct attending to student interations and didn't have any of the heirarchy issues or amazing amounts of scut work. worked well for me. i am now in my fourth year of ortho, have gotten my number one choice for fellowship, and have every opportunity open. going to a state school did not close any doors for me. also, be very weary about what you call a "small pond". i also had some of that attitude going into med school and realized quickly that there are a hell of a lot of really bright people that will show up to occupy that "pond" on day one!!

no matter what you choose, it is not university of (insert state) or harvard that shows up for rounds on your first ortho away rotation, it is you. if you are good, it doesn't matter where you are from...and if you suck, no pedigree or school will make you not suck.

p.s. if you really base your decision on what we all say, you are an idiot.

I think four weeks is enough for the vast majority of people. I personally took about 5-6 weeks and kept a relatively leisurely pace (i.e. worked out, saw movies, read books--had a real life). Without the hindrances of classes, I felt like I still had a great deal of time to study. I think I easily could have condensed it into four weeks. Actually, around week four I was starting to get a little burnt out (keep in mind that you will have recently finished studying for finals as well) and am not sure that my score was much better at week 6 then it would have been at week 4. Plus, your review for step 1 should hopefully be just that--a review--not an introduction to the material. Antedoctally, I believe the top three or four scorers in my class all took Step 1 after two or three weeks (disclaimer: they were also some of the best test takers in the class). The main disadvantage of only having a month off probably does not relate to your ability to study enough for the test to do well, but is instead the difficulty you may have recharging your batteries with some vacation time and much needed R&R between your 2nd and 3rd years. All that being said, if you like the medical school and think the curriculum is strong, my opinion would be to not let the four week issue hold you up too much.

I think that it is always easier to give advice to people when you have all the information. What schools are you talking about? I'm sure that you will get more accurate opinions if people know something specifically about the schools.

Med school is a hard time in life, so go where you are happy. Money is an important consideration, but it is not worth graduating with less debt if you had a horrible time during school. You need to be happy in order to do well in school. There are ways to get around the money, but someone mentioned earlier that you are not guaranteed to love ortho in 4 years. You may go into a much less lucrative specialty at which point the money becomes more of an issue.

You don't need a home ortho department, but it is helpful. You will have people you can talk to (face to face) and really plan out your career plans. They can serve as great mentors. As for having a hard time with research, you can do research in sport medicine or look for radiology research that is applicable to ortho.

Overall, go into school with an open mind. Don't limit yourself to ortho, but if it is a possibility you should work hard from the beginning. It makes application time much easier!

I've said enough.

First off I have to say that this is really a great site.

Ok now to add my 2 cents. I agree that money shouldnt be a big big factor in your decision on a school. I also feel that the school's name can be misleading to those who think that they may not have to work as hard as someone from a "lesser" name school...(if you will). I do not attend a school that has a high reputation for churning out Orthopods, but I have seen those who work hard at what they desire to become (orthopods included) match at some reputable programs. I have also seen individuals from Ivy league schools not match in Ortho and had to scramble. It was told to me personally from a chairman of Orthopaedics at a very reputable program recently, that they look at BOARDS..No. 1, grades etc. He emphasized on Boards...you have to produce or have Divine intervention otherwise.

I am taking Step 1 this June (atleast that is the plan) I can only hope that 1 month is enough time....because that is all the time I am given. But knowing there are students in the class ahead of me who had the same time I will..and they were able to kick ass on the boards then I have to imagine since they are human like me I have a chance to either do the same or better.....I pray to GOD not worst.

So I guess it is safe to say where ever you go you have to work hard period!

Oh yeah I liked the comment about being a big fish in a small pond I think they just might eat better and enjoy it in the process.