Advice for the lowly med school applicant

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.

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

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.

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. . . .

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.

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.