Is attendance at a “pedigreed” top-tier medical school necessary for me to get into a good residency?

Whether attending a top-tier medical school is a big deal is a hotly debated topic in student circles, and even among the people in the know. Some answer with an emphatic “yes!” while others point to a long list of factors in the residency selection process such as Step 1 scores, your chosen specialty, your school’s reputation for putting out good doctors, and even personal connections.Top-tier med school

Considerations for a medical residency match

There’s no way around it. Your choice of school and its ranking are factors that play into your ability to snag the best residency. There is an argument that a top-tier medical school will guarantee you a good spot. However, if you rely on that factor alone, you’re likely to end up with a residency match that’s less than you bargained for. So what matters most?

Step 1 Scores

Your scores on Step 1 testing (“the Boards”), taken at the end of the 2nd year of medical school after your basic science classes are finished, are a significant “omen” in predicting your success in landing a good residency. It’s a first look at your ability to show a command of the basic science curriculum and understand its relationship to medicinal practice. Whether you simply “pass” the test, or excel, has real implications for your future. Since it’s the only standardized measure that applies to all applicants, it lays down a helpful marker. A score of 188 means you passed the test, while the national mean is 229.

Your School

A top-tier medical school can carry some weight….assuming that your school is known for churning out good doctors. That’s usually the case, but not a given. Your school’s reputation in this area will be critical, and traditional wisdom can come back to bite you here. PD’s are looking for the best residentsfor their program, period. So how do they gauge a good fit? Based on past residents, of course! If your school has provided good residents in the past, that’s a plug in your favor. On the other hand, if your school’s sent up a couple of residents that disappointed, then you could pay a price for that. These are factors beyond your control.

Is there a possibility that an Ivy League education could play against an ideal medical residency placement? Yep. Some PDs will assume students from certain schools come with a sense of entitlement, and refuse applications from those schools. But all things being equal, I’d say top-tier status for your school is a net plus.

Competitive specialties?

School choice increases as a factor with more competitive specialties and prestigious hospitals. If there are two applicants, all things being equal, vying for a highly competitive spot at a prestigious hospital, and the hospital’s had no negative experiences with the residents from either of the schools the applicants hail from, I’d give a hair to the student from the top-tier medical school or medium-tier medical school over a lower-tier one.

That said, I’d recommend some serious research before you decide your first, second and third choice schools for residencies. It’s common for students to request more well-known schools, and completely gloss over some top notch schools known for their expertise in certain specialties. Yes, Harvard and Johns Hopkins have top-rated EM programs, but schools like Chapel Hill and University of Colorado have comparable rankings. And sometimes your education at these non-elite schools will come at half the cost! Don’t discount a school you haven’t heard of. There are some gems out there that are considered major players in your chosen specialty! Find out where they are.


This is more important than you think. If you have a friend of a friend of a friend with a contact at the hospital where you want a residency, it can elevate your prospects above and beyond where they might otherwise be. Also, PD’s at different programs are in contact, and do talk. They can push an applicant into a program, in spite of disappointing Step 1 scores or a less than stellar medical school program. It doesn’t hurt to talk to your friends-of-friends, your contacts at other schools, a colleague’s contacts at the hospital of your choice. We’ve all heard of students from lower-tier programs whose mentors worked the phones with their colleagues to place the student in a stellar residence. It happens!

Regional saturation

If you’re living in a region where there are one or more top-tier medical schools, and you’re thinking of attending a bottom- or middle-tier school, you’ll be up against stiff competition. So the region of the country where you plan to go to school plays in here too. You’d be advised to try to get into a top-tier or at least middle-tier school with a good reputation in your state/region if your area is flooded with top-tier medical schools. That’s not to say that a lesser school choice will deflate your chances, but you will need to come to the table with other pluses to increase your viability in getting a good residency match.

Other recommendations

From the National Resident Matching Program (NRMP) and AAMC’s “Charting Outcomes” 2011 report of which applicants matched their preferred specialty, here are some recommendations for getting a successful residency match:

—Rank all the programs you really want, without regard to your chances

—Include a mix of competitive and less competitive programs within your preferred specialty

—Include all of the programs where they have expressed an interest in you and you would accept a position

—If you’re applying to a competitive specialty, also rank your most preferred programs in an alternate specialty

—Include all of your qualifications in your application

You can check out the latest medical residency match stats at the NRMP site.

Foreign Schools

Schools outside the U.S. have a decided disadvantage. For international medical graduates looking to be licensed to practice in the U.S., the preferred path is to complete a residency program at a U.S. hospital. International students must have an ECFMG (Educational Commission for Foreign Medical Graduates) certification to be considered. This certification relies on completion of USMLE Step 1, Step 2 Clinical Knowledge and Step 2 Clinical Skills, plus a diploma from a university registered in the International Medical Education Directory (IMED). This requirement for having a medical diploma creates a potential gap of at least six months between the time international graduates finish and the time they can begin residency. So needless to say, if you’re applying for a medical residency from a program outside the U.S., you will need to come with your best game. See our posts here and here on attending international medical schools.

Cost differential: What will a top-tier medical school education get you in the end, and is it worth what you’ll have to pay?

An Ivy League or Top Ten medical program will cost you for sure. What  you’re asking is, “Is it worth what you’ll have to pay?” The answer is a big question mark! There’s no definitive answer. I have given you some valuable input from some PDs, past students, med school administrators, and admissions committee folks. In the end, if graduating with a top name school behind your name is important to you, then you’ll probably answer “yes,” no matter the cost.

On the list of “10 Most Affordable Public Medical Schools for In-State Students” developed by U.S. News & World Report,  you’ll find some respectable contenders for good ratings. Instead of paying an average of $28,812 (at a public school) to $45,870 (going private), you can keep your tuition-per-year at a low of $16,432 (Texas A&M) or $22,291 (East Caroline University-Brody), or even $19,233 (University of New Mexico). In a strictly financial sense, there are plenty of schools that don’t rank in the “Who’s Who?” and aren’t given top-tier status, yet their research and primary school care programs rank in the top 75 among U.S. schools. And many are able to command top-notch residency matches.


In the end, if you want to know what part your medical school choice plays in the quality of your residency match, I’d honestly say it matters. Going to a top-tier medical school will open more doors for you, though it won’t ensure you the match you want. The other factors I’ve mentioned here will have an impact as well, and depending on your specific circumstances, could have as much weight as school choice. So I’d suggest going to the best school you can afford as your best option, and working the other levers that will help you get the medical residency you deserve!