med schools - prestige or economics?

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Jerilynn
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Re: med schools - prestige or economics?

Post by Jerilynn »

frugalhen wrote:
EmergDoc wrote:Cheapest. If he's a Kentucky resident it's an easy decision. Nobody cares where you go to medical school so long as it is in the US. $200K difference? That's a no-brainer. As far as good jobs it's all about residency. No one cares about undergrad and almost no one cares about med school. In fact, my patients don't even care about my residency.

Med school loans are mostly ~ 6.8%. An extra 200K at 6.8% is a whole lotta money. Subsidized loans are going away too.

A couple Docs in my family from "Good" Schools. They tell me they have seen great docs who went to caribbean schools, they just did not test well. As long as they are board certified. Residency is key. If you want to super specialize in the most competitive areas, then the Harvard degree may help. Otherwise, save your money is their comment.

I live around Philly and we have a lot of DO's. Our primary care doc is a DO and is great.
Interesting comment about DOs. I was just discussing this with my mom. Back in the old days, the only people who became DOs were the ones that couldn't get accepted into a MD program. Is that still the case?

I'm assuming that the DO schools aren't 'big name prestige places', hence according to the OP no DO's will be Dermatologists. True?
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lightheir
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Re: med schools - prestige or economics?

Post by lightheir »

Jerilynn wrote:
frugalhen wrote:
EmergDoc wrote:Cheapest. If he's a Kentucky resident it's an easy decision. Nobody cares where you go to medical school so long as it is in the US. $200K difference? That's a no-brainer. As far as good jobs it's all about residency. No one cares about undergrad and almost no one cares about med school. In fact, my patients don't even care about my residency.

Med school loans are mostly ~ 6.8%. An extra 200K at 6.8% is a whole lotta money. Subsidized loans are going away too.

A couple Docs in my family from "Good" Schools. They tell me they have seen great docs who went to caribbean schools, they just did not test well. As long as they are board certified. Residency is key. If you want to super specialize in the most competitive areas, then the Harvard degree may help. Otherwise, save your money is their comment.

I live around Philly and we have a lot of DO's. Our primary care doc is a DO and is great.
Interesting comment about DOs. I was just discussing this with my mom. Back in the old days, the only people who became DOs were the ones that couldn't get accepted into a MD program. Is that still the case?

I'm assuming that the DO schools aren't 'big name prestige places', hence according to the OP no DO's will be Dermatologists. True?
I have had the pleasure to work with some outstanding DOs in my internship (it's common for people who have matched in top-tier residencies to choose an 'easy' internship in fields that allow it, such as dermatology, optho, radiology, etc.) While their test scores werent' quite as high as the top tier candidates, I would have no problem with them being my doctor. I'd categorize them more as 'late-bloomers' - those who may have decided to commit to the MD route much later in their career, and thus may not have built up as fancy a resume as required to go the normal MD route. It's still competitive for them though, and they fill the ranks of underserved primary care areas (and do a great job.)

In general, yes, DOs were the ones who couldn't get into an MD program. Not always true, but probably the most common situation.

There are zero DOs being accepted in derm, and even radiology through the standard match (there used to be some in radiology, but zero in the past few years) as all slots are filling with US medical school grads. Foreign grads face a similar steep uphill battle for those specialties, despite being even more qualified than the US grads in many cases. If you choose to go the DO route, odds are highest that you will be going primary care.

Again, I've been impressed with nearly all the DOs I've had the privilege to work with, in multiple settings. It just happens that there are far more qualified MD candidates than spots available, so even people who do a great job in a doctor role are excluded from medical school due to the competition.
hardworker
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Re: med schools - prestige or economics?

Post by hardworker »

Here's an opinion from someone who's been through this dilemma before:

Until recently, I was a dental student at a prestigious state school, but a state school nonetheless. I had also been accepted to Harvard dental school and turned it down in favor of a prestigious scholarship that was worth quite a bit, when combined with the in-state tuition I was receiving. Well, due to personal reasons that had nothing to do with which school I was attending (I would have been equally as miserable pursuing dentistry at Harvard as I was at my state school, if not more), I walked away from D-school with $40K @ 6.8% interest in student loans and no job. Why? Because I want to pursue medicine.

You may think that, given my experience with the burden of student debt, I would choose similarly again if (when??) I get into med school. But if I am ever so lucky as to get into Harvard again (unlikely, but still...) or any other top med school (Stanford, Johns Hopkins, Princeton, etc), you BET I will pick it over my state school, even though some of the state schools I will apply to are quite respected in their own right. This is because, even though dentistry doesn't *require* a residency per se, many students at my school wanted to apply for big $$ residencies like ortho and oral surgery and were actively "gunning" against one another. We didn't have an uber posh name to back up our applications with, so the competition was cutthroat. Additionally, I interacted with students from "Ivy League" dental schools this summer at a prestigious internship, and I was shocked to discover that some of these students were much less qualified than myself but appeared to have gotten in based on their "name brand" alone. Regardless of what degree you pursue -- medicine, dentistry, law, business, etc -- do yourself a favor and make sure your degree is from the best possible school that you can get into. I'm still young (22), which is what gave me the courage to walk away from dental school itself, and I'm not going to make the same mistakes I did when I was even younger (20). This time around, I'm choosing the name-brand school, regardless of how much it costs. Even though I think right now that I want to go into primary care (just due to my personality), I'm going to protect my future self just in case I want to get into a competitive specialty later on. The irony of the situation is that I may have already blown my one shot at getting a prestigious degree, but at least if opportunity knocks next time around, you KNOW I will take it.

Morals of this story:
(1) Student loan debt is bad, but don't let a measly $40k stop you from pursuing your dreams. Especially if you're as miserable as I once was.
(2) Go to the best school that you can, if for no other reason than to "protect" your future self.
(3) At the end of the day, you'll be a high-earning professional. It doesn't matter if you have an extra $100k in debt. You'll pay it off and you'll be glad that you got the best degree that you could.
pochax
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Re: med schools - prestige or economics?

Post by pochax »

hardworker wrote: Morals of this story:
(1) Student loan debt is bad, but don't let a measly $40k stop you from pursuing your dreams. Especially if you're as miserable as I once was.
(2) Go to the best school that you can, if for no other reason than to "protect" your future self.
(3) At the end of the day, you'll be a high-earning professional. It doesn't matter if you have an extra $100k in debt. You'll pay it off and you'll be glad that you got the best degree that you could.
There is no guarantee that you won't be just as miserable, if not more, in med school - i had friends who definitely had their share of personal difficulties both directly and indirectly related to the workload and competition. also, top notch med schools also have a degree of competitiveness - it really depends on the people in the class - remember that those who get into brand-name med schools got there because they have a competitive-edge (or are just flat-out brilliant).

regarding (2) - i don't think going to the best school "protects"/guarantees your future. although i do agree that being "mediocre" is slightly better than being mediocre at a non-brand-name.

regarding (3) - an extra $100k in debt compounded with interest is quite a bit. especially for primary care where the reimbursement/hours-worked ratio is not as great as the procedural specialities. i would underestimate that - at 22 years old, i am not fully sure you see the value of $100k. at least personally at that age, i didn't.
Radman
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Re: med schools - prestige or economics?

Post by Radman »

I am currently a resident and was in this exact situation a few years ago. I had a chance to go to state school and leave with 60K of debt or better regarded private for 240k. I decided to go to the private school because I thought I would have a better chance at more competitive residencies and I didn't know what I wanted to go into. I thought I would go into Emergency medicine and I ended up choosing Radiology.

Agree with comment that if you know for absolute certain you want to do private practice then go the cheapest medical school you can. That being said, people end up choosing different fields than they had imagined, such as myself.

I don't feel this an absolute situation. It is not absolutely worth it or absolutely not worth it. In the end going to a private well regarded medical school for more debt will give you an additional edge in residency applications all things being equal. He will have an edge coming from Johns Hopkins verses Kentucky state school. It is also true that even without that edge he may still be able to match highly competitive specialties coming from the state school.

However, will he need that edge is a different question. He can't know that right now. But it could be the difference between matching into a competitive specialty (like derm) or marching at a desired program (prestigious surgery program verses average program in location he doesn't want to live at).

I understand others points about the potential difference in cost being up to 300k taking into account interest and lost opportunity to invest. However, if that extra edge is the difference between say matching neurosurgery (income 500k +) verses general surgery (300k) that 200k difference could also add up.

It is essentially a 200k choice on if you will need that edge to match in your desired specialty, desired location for residency/career, and future income. In the end, personally I feel going to the private school helped. I feel that I was more competitive for matching radiology coming from private school verses state and ended up at the program I wanted. It was an extra bump that I paid an extra 180k plus 7.2% interest. Do I regret it? No. I look back and I would have regretted not going to the private school more than the extra debt. Its a personal choice.
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Jerilynn
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Re: med schools - prestige or economics?

Post by Jerilynn »

hardworker wrote:Here's an opinion from someone who's been through this dilemma before:

Until recently, I was a dental student at a prestigious state school, but a state school nonetheless. I had also been accepted to Harvard dental school and turned it down in favor of a prestigious scholarship that was worth quite a bit, when combined with the in-state tuition I was receiving. Well, due to personal reasons that had nothing to do with which school I was attending (I would have been equally as miserable pursuing dentistry at Harvard as I was at my state school, if not more), I walked away from D-school with $40K @ 6.8% interest in student loans and no job. Why? Because I want to pursue medicine.

You may think that, given my experience with the burden of student debt, I would choose similarly again if (when??) I get into med school. But if I am ever so lucky as to get into Harvard again (unlikely, but still...) or any other top med school (Stanford, Johns Hopkins, Princeton, etc), you BET I will pick it over my state school, even though some of the state schools I will apply to are quite respected in their own right. This is because, even though dentistry doesn't *require* a residency per se, many students at my school wanted to apply for big $$ residencies like ortho and oral surgery and were actively "gunning" against one another. We didn't have an uber posh name to back up our applications with, so the competition was cutthroat. Additionally, I interacted with students from "Ivy League" dental schools this summer at a prestigious internship, and I was shocked to discover that some of these students were much less qualified than myself but appeared to have gotten in based on their "name brand" alone. Regardless of what degree you pursue -- medicine, dentistry, law, business, etc -- do yourself a favor and make sure your degree is from the best possible school that you can get into. I'm still young (22), which is what gave me the courage to walk away from dental school itself, and I'm not going to make the same mistakes I did when I was even younger (20). This time around, I'm choosing the name-brand school, regardless of how much it costs. Even though I think right now that I want to go into primary care (just due to my personality), I'm going to protect my future self just in case I want to get into a competitive specialty later on. The irony of the situation is that I may have already blown my one shot at getting a prestigious degree, but at least if opportunity knocks next time around, you KNOW I will take it.

Morals of this story:
(1) Student loan debt is bad, but don't let a measly $40k stop you from pursuing your dreams. Especially if you're as miserable as I once was.
(2) Go to the best school that you can, if for no other reason than to "protect" your future self.
(3) At the end of the day, you'll be a high-earning professional. It doesn't matter if you have an extra $100k in debt. You'll pay it off and you'll be glad that you got the best degree that you could.
I'm sorry dentistry didn't work out for you. It's a wonderful profession for the right person. Seems like you made the right choice to leave.
I do not agree with you that attending a prestigious, high-priced school is worth it, but to each his own.
I'm not sure if your morals are valid. First of all, it will cost you more than a measly $40k in all probably. I also wouldn't bet a pizza that at the end of the day (med school) you will be a high-earning professional. Sure, it's possible with the right situation, but I wouldn't count on it. Things can and probably will change. I have several friends that are physicians and they all tell me that their net income has gradually gone down every year for the past few years. I think this a trend that will continue.
Cordially, Jeri . . . 100% all natural asset allocation. (no supernatural methods used)
mt
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Re: med schools - prestige or economics?

Post by mt »

I can comment on military scholarships, since that is how I handled the expensive cost of attending a private medical school.

The Army, Navy, and Air Force all have a Health Professional Scholarship Program (HPSP), which is like ROTC for med students but with less hassle. The only activities during schoool are Officer Basic Course during the first summer, then doing one clerkship/year at a military hospital. They pay tuition/books/fees and provide a decent sized monthly stipend. In general, you in turn owe one year of active duty (after residency) for each scholarship year. I did my internship/residency in the Army, then received a deferment to obtain fellowship training at a civilian hospital. My brother went to the same med school and also received an Army scholarship (he is currently stationed in Hawaii).

I am really glad that I chose the route I did. Not only did I finish training with very little debt, but found the experience of being a military physician to be very rewarding. I paid back my commitment and left to go into private practice, but some docs decide to stay and make a careeer of it.

The current estimated cost of a year at my med school is now $72,000.
Last edited by mt on Sat Oct 21, 2017 3:08 pm, edited 1 time in total.
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Jerilynn
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Re: med schools - prestige or economics?

Post by Jerilynn »

mt wrote:
The current estimated cost of a year at my med school (Northwestern) is now $72,000.
Ouch! No matter how you look at it, that's a lot of acne treatment and botox injections.
Cordially, Jeri . . . 100% all natural asset allocation. (no supernatural methods used)
etf
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Re: med schools - prestige or economics?

Post by etf »

i can almost guarantee that the top student in the UK class wouldn't match into harvard integrated plastics, or derm at stanford, or similarly competitive spots. there are certain specialities or at least certain programs where the door is essentially closed unless you are graduating from a top 5 med school. and no one knows 100% before med school what they will end up loving. why rule yourself out of certain choices, when going to harvard med would guarantee that you would be able to match into whatever field you desired?
etf
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Re: med schools - prestige or economics?

Post by etf »

EmergDoc wrote:
ezeiza wrote:
emp2b3 wrote:I somewhat dealt with this situation in the recent past and ended up going with the more expensive/name school. I am sure that I could've had great training at the other institution, but at that time I wasn't set on a primary care field. There are great arguments for both decisions, but going to the name school will keep doors open for him. Of course he could be the superstar at Kentucky and do great research etc., but for good or for bad the name still matters in my personal experience. As EmergDoc noted, patients won't care. But residency directors and even fellowship directors may. To be fair, in a 2009 study the medical school reputation was the 9th most important factor in a residency applicant's file for program directors. http://journals.lww.com/academicmedicin ... _a.24.aspx ; see Table 2 for the overall ranking and Table 3 for the ranking within subspecialties.

The way I look at is there are 8 other things that are weighted MORE heavily than what institution was attended. That hardly screams I'm worth 6 figures more in cost. Look at the list:
1. Grades
2. Scores
3. Grades
4. Grades
5. Scores
6. Scores
7. Class rank (harder at top school mind you)
8. AOA membership (also tougher at top school)
9. Med school reputation

Thanks, but I'll take my extra 200,000 or more (before loan interest is applied) and work a little harder on the other 8 things that matter more.
In my specialty, the objective factors that determine residency matching are:
1. Grade in EM rotation
2. Letters of recommendation
3. Board Scores
4. 3rd year Grades
5-10 or so other stuff
11. Medical school

Subjectively, it's all about whether or not they want to work with you. But the objective stuff gets you the interview.

The truth of the matter is that the stuff you learn in the first two years of medical school is mostly self-taught. The last two years it comes down to the residents and attendings you work with, and you have little to no control over that no matter where you go.
if one were trying to match into EM, then yes, school won't matter, because there are so many spots that the only real requirement is a mean-arterial pressure above 60.
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Re: med schools - prestige or economics?

Post by White Coat Investor »

nm......
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course
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Jerilynn
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Re: med schools - prestige or economics?

Post by Jerilynn »

etf wrote:i can almost guarantee that the top student in the UK class wouldn't match into harvard integrated plastics, or derm at stanford, or similarly competitive spots. there are certain specialities or at least certain programs where the door is essentially closed unless you are graduating from a top 5 med school. and no one knows 100% before med school what they will end up loving. why rule yourself out of certain choices, when going to harvard med would guarantee that you would be able to match into whatever field you desired?
Makes sense. So in essence, you are paying for flexibility. Still, that flexibility has a high price tag.

Why would someone want to go to Stanford Derm as opposed to [insert least expensive derm residency in the country]? Do they end up being better practitioners? Make more money? Get sued less? Get more money from Medicare or [insert insurance company] per procedure?
Cordially, Jeri . . . 100% all natural asset allocation. (no supernatural methods used)
cmarino
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Re: med schools - prestige or economics?

Post by cmarino »

ezeiza wrote:ECONOMICS! The only people who care about big name schools are the people who went to one. Out in the real world no one cares.
Again, Phd here, not MD. All depends on how you define "real world". If your real world is anything academic/research related, then there is a cursus honorum so to speak, and that is just how the game is played. When it comes to research the distribution of quality activity is extremely skewed, so if you are researching topic XYZ then chances are there are one, or maybe two places on the planet where all the action is happening followed by a few distant stragglers. I am sure there is another real world out there, possibly much larger, where no one gives a darn.
docderwood
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Re: med schools - prestige or economics?

Post by docderwood »

Radman wrote:I am currently a resident and was in this exact situation a few years ago. I had a chance to go to state school and leave with 60K of debt or better regarded private for 240k. I decided to go to the private school because I thought I would have a better chance at more competitive residencies and I didn't know what I wanted to go into. I thought I would go into Emergency medicine and I ended up choosing Radiology.

Agree with comment that if you know for absolute certain you want to do private practice then go the cheapest medical school you can. That being said, people end up choosing different fields than they had imagined, such as myself.

I don't feel this an absolute situation. It is not absolutely worth it or absolutely not worth it. In the end going to a private well regarded medical school for more debt will give you an additional edge in residency applications all things being equal. He will have an edge coming from Johns Hopkins verses Kentucky state school. It is also true that even without that edge he may still be able to match highly competitive specialties coming from the state school.

However, will he need that edge is a different question. He can't know that right now. But it could be the difference between matching into a competitive specialty (like derm) or marching at a desired program (prestigious surgery program verses average program in location he doesn't want to live at).

I understand others points about the potential difference in cost being up to 300k taking into account interest and lost opportunity to invest. However, if that extra edge is the difference between say matching neurosurgery (income 500k +) verses general surgery (300k) that 200k difference could also add up.

It is essentially a 200k choice on if you will need that edge to match in your desired specialty, desired location for residency/career, and future income. In the end, personally I feel going to the private school helped. I feel that I was more competitive for matching radiology coming from private school verses state and ended up at the program I wanted. It was an extra bump that I paid an extra 180k plus 7.2% interest. Do I regret it? No. I look back and I would have regretted not going to the private school more than the extra debt. Its a personal choice.
In the end we all justify our choices: I went to a public, little known Medical School, worked hard and got to interview everywhere I applied. Ended up training @ a great program. I was very happy (and fortunate) to be free of student loan debt my first year in practice.
dhodson
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Re: med schools - prestige or economics?

Post by dhodson »

it is true we all rationalize our decisions in the end. the question becomes how do we give good advice going forward. while i think school matters some for the uber competitive fields like mine, it can be difficult for a medical student to really know their destiny. Sometimes on this site we get a little too focused on saving money.

In regards to the comment about just having a pulse/BP to get into ER, that wasnt called for. While it isnt currently in the uber class, it still is a competitive field.

as a side note, U of L in Kentucky has a very famous dept head in dermatology. He would certainly have influence.
lightheir
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Re: med schools - prestige or economics?

Post by lightheir »

Jerilynn wrote:
etf wrote:i can almost guarantee that the top student in the UK class wouldn't match into harvard integrated plastics, or derm at stanford, or similarly competitive spots. there are certain specialities or at least certain programs where the door is essentially closed unless you are graduating from a top 5 med school. and no one knows 100% before med school what they will end up loving. why rule yourself out of certain choices, when going to harvard med would guarantee that you would be able to match into whatever field you desired?
Makes sense. So in essence, you are paying for flexibility. Still, that flexibility has a high price tag.

Why would someone want to go to Stanford Derm as opposed to [insert least expensive derm residency in the country]? Do they end up being better practitioners? Make more money? Get sued less? Get more money from Medicare or [insert insurance company] per procedure?
Often, people go to these hi-powered places to live in the area. Silicon valley, where I live, is notoriously difficult to get a job regardless of specialty as an out-of-stater.

You still can get around this by doing a fellowship there, which is definitely an easier route, but being in the area for years counts for a lot, especially when you've got that big name on the resume. You also get a real edge on applying elsewhere in the country, and a big edge for academic positions.

Still, since most people go to private practice, a big name school residency doesn't add all that much once you're through the job door, and even in the interview process it won't add a huge amount especially compared to someone with an insider connection who will always get the first nod.

As said, the main reason to go that hi powered med school is not to match at the BEST residency, but to match at ONE residency in your field of choice, and preferentially in an area that's not completely out of your control. Even though that sounds like it should be pretty easy, it's much harder than it sounds - you really want every edge you can get if you're going for a competitive specialty. The moment you throw on a single geographic restriction (think spouse/sig other), or couples match, you really really want to have that edge.
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Re: med schools - prestige or economics?

Post by travellight »

+1 dhodson and lightheir.
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bandaidman
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Re: med schools - prestige or economics?

Post by bandaidman »

lightheir wrote:
beareconomy wrote:I just went to the cheapest med school I was able to get into. With decreasing reimbursement rates, there is no point in going into debt for 500k. Also, if he does well at UK, he'll have the same opportunities as from John Hopkins. All the med schools are the same as long as they are US.
The unfortunate truth is that for the competitive specialties, your med school likely influences your odds of getting in far more than any score you put up. Having seen many qualified applicants from top and mid-lower tier schools myself compete for ortho, derm, etc., I can say with absolute confidence that acing your board exams, getting across-the-board stellar clinical evals, and coming from a lower-tier school will yield zero guarantees for those competitive specialties, whereas a midrange candidate with middle-range board and clinical scores but coming from a top tier school with one strong recommendation is a near-lock on most of them (in terms of at least getting a residency spot.)

I agree with this to a point, top grads (high step1/2, AOA,etc) from anything but bottom tier allopathic US schools can and will get into competitive residencies. It is true that a better name will help, especially for "elite programs." What is also very important in applying to competitive residencies is letters of recommendation from well known figures in the field (meaning well known to the people deciding on whether or not to rank you). Not every top school has top programs in every field. Since a minority of people end up going into a field they consider as pre-med, that is a wild card. For instance, Hopkins' program in my specialty is not that highly regarded. Our experience with their students both on visiting rotations and as residents has been overall disappointing.

Back in my training days, I was initially going to a top 10 med school on a military scholarship. Day s before I finalized everything I received a scholarship from another good school (top 30 at the time). To have almost zero debt at graduation (I did not have parental help) was a huge blessing. It allowed me to pursue an academic career (less money, but more job satisfaction).

Interestingly, the students at the school I graduated form were held in much higher regard in regards to work ethic/practical skills....than the more elite school. That is still true today.

Expecting an elite name to guarantee success is foolish.

With an uncertain financial picture, I would be very hesitant recommending anyone assume 2-300k of debt.
bandaidman
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Re: med schools - prestige or economics?

Post by bandaidman »

BTW

No one cares what med school/residency you did once you finish.
bandaidman
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Re: med schools - prestige or economics?

Post by bandaidman »

ezeiza wrote:
emp2b3 wrote:I somewhat dealt with this situation in the recent past and ended up going with the more expensive/name school. I am sure that I could've had great training at the other institution, but at that time I wasn't set on a primary care field. There are great arguments for both decisions, but going to the name school will keep doors open for him. Of course he could be the superstar at Kentucky and do great research etc., but for good or for bad the name still matters in my personal experience. As EmergDoc noted, patients won't care. But residency directors and even fellowship directors may. To be fair, in a 2009 study the medical school reputation was the 9th most important factor in a residency applicant's file for program directors. http://journals.lww.com/academicmedicin ... _a.24.aspx ; see Table 2 for the overall ranking and Table 3 for the ranking within subspecialties.

The way I look at is there are 8 other things that are weighted MORE heavily than what institution was attended. That hardly screams I'm worth 6 figures more in cost. Look at the list:
1. Grades
2. Scores
3. Grades
4. Grades
5. Scores
6. Scores
7. Class rank (harder at top school mind you)
8. AOA membership (also tougher at top school)
9. Med school reputation

Thanks, but I'll take my extra 200,000 or more (before loan interest is applied) and work a little harder on the other 8 things that matter more.
Grades are important

However, with grade inflation, it is hard to tell what grades mean from some places. Scores are objective. Many places weigh them much more than they admit . LEtters mean a lot too, although they tend to look the same after a while. Doing an away rotation can have an impact, both negative and positive.
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semperlux
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Re: med schools - prestige or economics?

Post by semperlux »

One more thing to contribute.

For many (not all), but many people, they will probably go through several jobs before they settle into a permanent one long term. That prestigious school may have the most impact on your first job since you would not have any prior references. After that, your performance on the previous job and your connections will probably matter more than anything else for future jobs. Sure, that big name school may still give you a little more pull, but it probably won't weigh more than your previous job performance and who you know.

And like many others have already mentioned, if you're eventually going to set up your own shop, it really doesn't matter where you went to school, because you'll be your own boss. I would imagine someone who is looking into derm, plastics, or any of the sub-specialties will eventually set up shop to maximize their earnings potential....see where this is going? Also, like others have said, if you are in primary care type specialty, the demand is so high that where you're trained probably is not as important either.
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Re: med schools - prestige or economics?

Post by Jerilynn »

semperlux wrote:One more thing to contribute.

For many (not all), but many people, they will probably go through several jobs before they settle into a permanent one long term. That prestigious school may have the most impact on your first job since you would not have any prior references. After that, your performance on the previous job and your connections will probably matter more than anything else for future jobs. Sure, that big name school may still give you a little more pull, but it probably won't weigh more than your previous job performance and who you know.

And like many others have already mentioned, if you're eventually going to set up your own shop, it really doesn't matter where you went to school, because you'll be your own boss. I would imagine someone who is looking into derm, plastics, or any of the sub-specialties will eventually set up shop to maximize their earnings potential....see where this is going? Also, like others have said, if you are in primary care type specialty, the demand is so high that where you're trained probably is not as important either.
Supply and demand operates more with 'elective' medicine such as plastics and derm. If I were setting up a derm practice, I'd look for an area with high demand and very few if any dermatologists in the area. This way I can charge a higher fee and wouldn't have to 'participate' with insurances.
There was a classic study done which showed that if you increased your fees by 10%, you could make only 80% of your prior gross and have a higher NET income.
This is precisely what I did when I set up my practice way back when.
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Re: med schools - prestige or economics?

Post by metzgm »

If you intend to do primary care or ER, or if you're pretty certain that you will pursue private practice/hospital employee ship, then go to the less expensive school.
If your goal is academics, or to get into a high powered COMPETITIVE subspecialty (like interventional cardiology, NOT ID or endo) , then go to the prestigious school.
Do not idolize academia, as so many a med student are led to do, unless you are TRULY in your heart of hearts, interested in research (and can put up with the lower pay which will have to be augmented by speaking engagements for drug companies - though this too will dry up in the next 5-10 years).
Once you have completed your training, no one cares where you went to medical school (except if it is in the Carribean, because everyone knows you couldn't get into a real medical school) - only your last place of training (residency or fellowship) matters, and only perhaps for your first job. And in private practice or non-academic environments, no one really cares even about that. It becomes all about whether you do the work and get along without causing drama.

It is always wise to heed the 3 A's of successful practice - this applies to med school too:
Affability, availability, and ability (exactly in that order).
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Re: med schools - prestige or economics?

Post by semperlux »

Supply and demand operates more with 'elective' medicine such as plastics and derm. If I were setting up a derm practice, I'd look for an area with high demand and very few if any dermatologists in the area. This way I can charge a higher fee and wouldn't have to 'participate' with insurances.
There was a classic study done which showed that if you increased your fees by 10%, you could make only 80% of your prior gross and have a higher NET income.
This is precisely what I did when I set up my practice way back when.
I completely agree with you. Unfortunately, most (not all) areas of high demand is way over-saturated these days (eg Beverly Hills, Hollywood, Orange County, New York City, etc...), so unless one has been established for a long time, or took over a successful practice, it's hard for a new grad to break into the market.

I also agree with metzgm. Specialties like any radiology and its subspecialties, or cardiology and it's subspecialties will be affected more by your pedigree. But for the most part, I would venture to say that most medical specialties would not depend on pedigree that much in order to score a job.
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Re: med schools - prestige or economics?

Post by dhodson »

Jerilynn wrote:
semperlux wrote:One more thing to contribute.

For many (not all), but many people, they will probably go through several jobs before they settle into a permanent one long term. That prestigious school may have the most impact on your first job since you would not have any prior references. After that, your performance on the previous job and your connections will probably matter more than anything else for future jobs. Sure, that big name school may still give you a little more pull, but it probably won't weigh more than your previous job performance and who you know.

And like many others have already mentioned, if you're eventually going to set up your own shop, it really doesn't matter where you went to school, because you'll be your own boss. I would imagine someone who is looking into derm, plastics, or any of the sub-specialties will eventually set up shop to maximize their earnings potential....see where this is going? Also, like others have said, if you are in primary care type specialty, the demand is so high that where you're trained probably is not as important either.
Supply and demand operates more with 'elective' medicine such as plastics and derm. If I were setting up a derm practice, I'd look for an area with high demand and very few if any dermatologists in the area. This way I can charge a higher fee and wouldn't have to 'participate' with insurances.
There was a classic study done which showed that if you increased your fees by 10%, you could make only 80% of your prior gross and have a higher NET income.
This is precisely what I did when I set up my practice way back when.

this isnt so easy to do unless you are willing to live in a very unpopular area. There arent a ton of great locations with zero derms any more. Heck if you can name great places with sufficient volume that dont have any mohs surgeons, ill be interested to hear it.
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Re: med schools - prestige or economics?

Post by Jerilynn »

metzgm wrote:
It is always wise to heed the 3 A's of successful practice - this applies to med school too:
Affability, availability, and ability (exactly in that order).
You are absolutely correct. It's just too bad that ability isn't higher on the list. But, such is life.
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Re: med schools - prestige or economics?

Post by Jerilynn »

semperlux wrote:
Supply and demand operates more with 'elective' medicine such as plastics and derm. If I were setting up a derm practice, I'd look for an area with high demand and very few if any dermatologists in the area. This way I can charge a higher fee and wouldn't have to 'participate' with insurances.
There was a classic study done which showed that if you increased your fees by 10%, you could make only 80% of your prior gross and have a higher NET income.
This is precisely what I did when I set up my practice way back when.
I completely agree with you. Unfortunately, most (not all) areas of high demand is way over-saturated these days (eg Beverly Hills, Hollywood, Orange County, New York City, etc...), so unless one has been established for a long time, or took over a successful practice, it's hard for a new grad to break into the market.

I also agree with metzgm. Specialties like any radiology and its subspecialties, or cardiology and it's subspecialties will be affected more by your pedigree. But for the most part, I would venture to say that most medical specialties would not depend on pedigree that much in order to score a job.
The trick is to find an area of the country where there is need for you and you want to live.
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Re: med schools - prestige or economics?

Post by Jerilynn »

dhodson wrote:
Jerilynn wrote:
semperlux wrote:One more thing to contribute.

For many (not all), but many people, they will probably go through several jobs before they settle into a permanent one long term. That prestigious school may have the most impact on your first job since you would not have any prior references. After that, your performance on the previous job and your connections will probably matter more than anything else for future jobs. Sure, that big name school may still give you a little more pull, but it probably won't weigh more than your previous job performance and who you know.

And like many others have already mentioned, if you're eventually going to set up your own shop, it really doesn't matter where you went to school, because you'll be your own boss. I would imagine someone who is looking into derm, plastics, or any of the sub-specialties will eventually set up shop to maximize their earnings potential....see where this is going? Also, like others have said, if you are in primary care type specialty, the demand is so high that where you're trained probably is not as important either.
Supply and demand operates more with 'elective' medicine such as plastics and derm. If I were setting up a derm practice, I'd look for an area with high demand and very few if any dermatologists in the area. This way I can charge a higher fee and wouldn't have to 'participate' with insurances.
There was a classic study done which showed that if you increased your fees by 10%, you could make only 80% of your prior gross and have a higher NET income.
This is precisely what I did when I set up my practice way back when.



this isnt so easy to do unless you are willing to live in a very unpopular area. There arent a ton of great locations with zero derms any more. Heck if you can name great places with sufficient volume that dont have any mohs surgeons, ill be interested to hear it.
You don't need to go somewhere with zero derms. Just somewhere where the existing derms are booked up months in advance.
I'm not familiar with a mohs surgeon. What does it stand for.
As far as volume, you only need to be booked up 1 days in advance. Granted, it strokes your ego and makes one feel secure to be booked up 2 months in advance, but it doesn't affect the net income. You still can only treat X number of patients per day.
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Re: med schools - prestige or economics?

Post by dhodson »

i wasnt really expecting a location but just fyi its a fellowship within dermatology focusing on skin cancer.

i dont think 1 day is realistic. not possible to get the staff to balance things appropriately. i do agree the ego thing about 2 months is unnecessary though.
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Re: med schools - prestige or economics?

Post by Jerilynn »

dhodson wrote:i wasnt really expecting a location but just fyi its a fellowship within dermatology focusing on skin cancer.

i dont think 1 day is realistic. not possible to get the staff to balance things appropriately. i do agree the ego thing about 2 months is unnecessary though.
I was booked 1-3 days in advance for 20 years of my practice, so you can't say it's not possible. It was also real nice that if someone would call we would be able to see them the next day. (or even that day for emergencies because I would always leave some emergency time at the end of every day. If it wasn't used, we would just go home at 4:00PM.
I contend that this would be a viable practice methodology for a good specialist MD (for the right person).
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Re: med schools - prestige or economics?

Post by travellight »

Mohs is a micrographic technique usually done by dermatologists in excising skin cancer where the margins are read pathologically at the time of excision so that it is assured that margins are clear at the time of excision. It can take a couple of hours and patients may deal with the open wound which is closed within a couple of days. Some may be able to close them at the same time. It is usually reserved for complex areas on the face where it is important to preserve as much tissue as possible because it is difficult to close.
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Re: med schools - prestige or economics?

Post by dhodson »

Jerilynn wrote:
dhodson wrote:i wasnt really expecting a location but just fyi its a fellowship within dermatology focusing on skin cancer.

i dont think 1 day is realistic. not possible to get the staff to balance things appropriately. i do agree the ego thing about 2 months is unnecessary though.
I was booked 1-3 days in advance for 20 years of my practice, so you can't say it's not possible. It was also real nice that if someone would call we would be able to see them the next day. (or even that day for emergencies because I would always leave some emergency time at the end of every day. If it wasn't used, we would just go home at 4:00PM.
I contend that this would be a viable practice methodology for a good specialist MD (for the right person).

im going to assume you are not in a surgical field. harder to do with procedures especially given how patients need to arrange their own schedules post a procedure.

Leaving room for emergencies is a seperate issue. As you mentioned, you left time for that. I think that is a fine idea but that isnt related to how far you book out.
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Re: med schools - prestige or economics?

Post by Harold »

The thing I don't get about this discussion is that Harvard Med students are among the smartest people on the planet. Yeah, I know smart at age 20 (or any age) doesn't mean you have full understanding or are immune to allure of prestige. But it's as if we're saying they're all idiots because they don't realize they could get to the exact same place at less cost by going to the University of Nebraska -- I think there's a bit more to this story (and just possibly some folks are unaware of some opportunities given by the elite institutions).

I know nothing about the medical field, so maybe they are really all idiots -- but that just makes so little sense.
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Re: med schools - prestige or economics?

Post by Jerilynn »

dhodson wrote:
Jerilynn wrote:
dhodson wrote:i wasnt really expecting a location but just fyi its a fellowship within dermatology focusing on skin cancer.

i dont think 1 day is realistic. not possible to get the staff to balance things appropriately. i do agree the ego thing about 2 months is unnecessary though.
I was booked 1-3 days in advance for 20 years of my practice, so you can't say it's not possible. It was also real nice that if someone would call we would be able to see them the next day. (or even that day for emergencies because I would always leave some emergency time at the end of every day. If it wasn't used, we would just go home at 4:00PM.
I contend that this would be a viable practice methodology for a good specialist MD (for the right person).

im going to assume you are not in a surgical field. harder to do with procedures especially given how patients need to arrange their own schedules post a procedure.

Leaving room for emergencies is a seperate issue. As you mentioned, you left time for that. I think that is a fine idea but that isnt related to how far you book out.
The vast majority of my services were non-surgical. But, even the surgical stuff was done under oral sedation and local anesthetics. We did quite a bit of oral sedation with the non-surgical procedures.
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Re: med schools - prestige or economics?

Post by lightheir »

Harold wrote:The thing I don't get about this discussion is that Harvard Med students are among the smartest people on the planet. Yeah, I know smart at age 20 (or any age) doesn't mean you have full understanding or are immune to allure of prestige. But it's as if we're saying they're all idiots because they don't realize they could get to the exact same place at less cost by going to the University of Nebraska -- I think there's a bit more to this story (and just possibly some folks are unaware of some opportunities given by the elite institutions).

I know nothing about the medical field, so maybe they are really all idiots -- but that just makes so little sense.
Having met a lot of them (nearly 1/4 of my residency program is Harvard Med), I'd disagree that they are the 'smartest' people on the planet.

While compared to the general public, yes, MD candidates are considered "extremely smart", compared to high level scientists and other intellectual professionals, MDs are not particularly noteworthy. Genius-level intellect is absolutely not required nor selected for in any way in the admissions process. Top level mathematicians, physicists, economists, humanities professors are pretty easily arguable smarter than high level MDs, as typical MD work doesn't require the touch of creative genius required in those fields.

What the high-level candidates usually bring is not just the required baseline academic excellence, but also a host of intangible factors that suggest they would be leaders in ways that would advance medicine, whether it be the community, politics, or scientific research. Which is why I stand by my previous comment that getting "top scores" doesn't do much for helping your cause at any stage in the MD process - above a 'high' level of around 85% of national norms, added points don't contribute nearly anything at all. Your scores are really used as a minimal cut-off in the competitive programs - they then use the intangibles to select their candidates without a real emphasis on scores. (Scores count for more in less competitive programs since they won't have across the board stellar numbers in their applicants.)

If you met most of these top-level candidates in person, you'd be surprised - they come across as bright, but fairly typical individuals that you'd meet in the supermarket in your local neighborhood. Then you see their resume and your jaw drops at all the stuff they have done. It's actually pretty impressive that people work so hard and accomplish so much but be completely approachable and accessible.

The typical applicant to Harvard or other elite academic equivalent isn't remotely interested in saving $200k by going elsewhere. To be good enough to apply to these programs, you've already dedicated years of your life to research, community service, or other equivalent activities with great success, and having the big-name degree helps a lot in furthering those causes as well as keeping maximum doors open for future options. (Despite the reality that the vast majority of these folks still go into private practice.)
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Re: med schools - prestige or economics?

Post by Jerilynn »

lightheir wrote:
Harold wrote: The typical applicant to Harvard or other elite academic equivalent isn't remotely interested in saving $200k by going elsewhere.
I dunno, it still seems foolish to me. Saving $200k is nothing to sneeze at.
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Re: med schools - prestige or economics?

Post by travellight »

lightheir

+1
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Re: med schools - prestige or economics?

Post by travellight »

If my son got into Harvard or Hopkins or Stanford, any of the top ten really, I would not hesitate to spend the money to send him there.
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Re: med schools - prestige or economics?

Post by Jerilynn »

ncounty wrote:If my son got into Harvard or Hopkins or Stanford, any of the top ten really, I would not hesitate to spend the money to send him there.
Where is the list of the top ten (etc)?
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Re: med schools - prestige or economics?

Post by Harold »

Jerilynn wrote:
lightheir wrote:
Harold wrote: The typical applicant to Harvard or other elite academic equivalent isn't remotely interested in saving $200k by going elsewhere.
I dunno, it still seems foolish to me. Saving $200k is nothing to sneeze at.
I didn't write that. Might want to fix your quote.

And lightheir's comments, while appreciated, kind of missed my point. I didn't say they were the smartest people on the planet -- I said they were "among" them, i.e. among an elite tier of accomplished people who are smart enough to have an awareness of what they are involved in at the highest level. Hard to believe that they're not remotely interested in saving $200K if the experience is of equivalent use in their career. Just seems obvious that there must be some value there -- whether it's $200K worth is debatable, but many posts seem to say there's no value whatsoever.
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Re: med schools - prestige or economics?

Post by Jerilynn »

Harold wrote:
Jerilynn wrote:
lightheir wrote:
Harold wrote: The typical applicant to Harvard or other elite academic equivalent isn't remotely interested in saving $200k by going elsewhere.
I dunno, it still seems foolish to me. Saving $200k is nothing to sneeze at.
I didn't write that. Might want to fix your quote.

And lightheir's comments, while appreciated, kind of missed my point. I didn't say they were the smartest people on the planet -- I said they were "among" them, i.e. among an elite tier of accomplished people who are smart enough to have an awareness of what they are involved in at the highest level. Hard to believe that they're not remotely interested in saving $200K if the experience is of equivalent use in their career. Just seems obvious that there must be some value there -- whether it's $200K worth is debatable, but many posts seem to say there's no value whatsoever.
Opps, I'm still trying to learn the forum.
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Re: med schools - prestige or economics?

Post by dwade1109 »

Always economics.

I attended an in-state school and got nearly a full scholarship. Chose it over leaving for the Ivies. Graduated and over a year later I am debt free. I have no regrets; I matched at the top program in a competitive specialty.

To the person who said that the top ranked applicant from Kentucky has no chance at a big-time program think again. Our school was not top 50 but has matched people into integrated plastics at Hopkins and UCSF, Derm at Harvard and Columbia, etc.
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Re: med schools - prestige or economics?

Post by lightheir »

I'm speculating here, but I would not be surprised if you took a medical student who was unable to match at their desired specialty of choice, be it derm, ortho, or ophtho, and thus had to go into a field they weren't as thrilled about such as internal medicine, and made them an offer that they could 'trade up' to a bottom-tier derm/ortho/ophtho (competitive) program for $200k (or even $500k), they'd gladly pay it and still think it was one of the best $200k investments they've ever spent in their entire lives.

And while it is true that yes, you can potentially match into top programs from nearly any medical school , you have to be realistic about how hard it is. You'll have to be prepared to be in the at least top 20%, if not the top 5% of your class to even have a shot of getting through the first cut. Then you'll need a host of strong additional factors like research, community service, and known recommenders. Solid academic performance alone will not get you there if you're not from a strong med school.

I'll also attest to how difficult it is to be in the top % of your class in med school. The clinical evals are completely subjective, and if you have bad luck and land with someone you don't mesh well with, or just happen to have a much more likeable or better classmate in your evaluation pool, your shot at an honors evaluation are slim. The national board examinations are actually the easiest to 'ace' - I've scored 95-99% consistently on every national-level medical board exam I've ever taken, but as said before, this has little/no impact on your competitiveness as a candidate - it's just used to weed low-performers out, not to reward high performers. I was an honors/AOA medical student but if I had to repeat the experience even at 'lesser' institutions, the variability of the subjective grading would give me little faith that I could reliably repeat this performance. (The national-type board scores are easily repeatable, in contrast - not subjective.)

And again, if you want just numbers, look at the match lists for residency classes from somewhere like Harvard/MGH, Stanford, UCLA, etc. vs other places and count the number of people matching in the uber-competitive specialties (of which there are NEVER a shortage of interested applicants.) I've seen near-ridiculous derm match numbers from Stanford/UCLA like 10-12% of their graduating class successfully matching, vs the typical number of 0-2%. It's not even close.
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Re: med schools - prestige or economics?

Post by 64415 »

if one were trying to match into EM, then yes, school won't matter, because there are so many spots that the only real requirement is a mean-arterial pressure above 60.[/quote]

This behavior is why I would never practice in an academic environment. The egos are insufferable. It isn't a function of attending a prestigious medical school or residency or fellowship, most of my colleagues attended the "fancy" institutions, but in private practice if you disrespected a competent colleague with a horse sh.t comment like this you will be shunned. You have to get along well with others in a private practice environment.
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Re: med schools - prestige or economics?

Post by Liquid »

Lightheir is absolutely correct medicine does not require remarkable creative intelligence vs research, theoretical physics, entrepreneurship, etc. Medicine requires dedication, work ethic, and the ability to suffer.

Medicine is also notably chock full of people who are blissfully unaware of their inability to (inherently) undersand basic finance.

-200k + interest is devastating to early accumulation. The discussion here is not whether sacrificing part of the one year salary of a 40yo MD is "worth it," rather the proper question is whether a retirement is worth the sacrifice. :greedy
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Re: med schools - prestige or economics?

Post by hicabob »

Well - this certainly was interesting - although a bit inconclusive. Thanks - it shall be passed on.
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Re: med schools - prestige or economics?

Post by metzgm »

You can't buy a shiny new house or car with prestige, at least not as a doctor.
95% of med school graduates, even at top tier schools, will end up in private practice (totally made of stat, but probably spot on). We have a MD/PhD Radiologist from Harvard leaving our non-prestigous community hospital, to leave for a smaller, less prestigious community in a hospital in Georgia. Can you guess why?
Why kill yourself sucking up to insufferable self- inflators of academia, cut throat classmates, AND spend an extra 200K, when you'll likely end up making tons more working in private practice. Unless of course, you are an insufferable self-inflator. Just joking, if you are REALLY into research (and not into the prestigious idea of research), go for the less expensive school. Also, keep in mind, that most academics do clinical research, something anyone can do in a hospital of sufficient size/volume.
Go to the prestigious school to keep options open, only if you think you would actually exercise options.
The future of medicine is grim - salaries of the past won't last! Be pragmatic.
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Re: med schools - prestige or economics?

Post by Jerilynn »

hicabob wrote:Well - this certainly was interesting - although a bit inconclusive. Thanks - it shall be passed on.
Indeed. It seems like those who attended the expensive schools, have deluded themselves into rationalizing that it was 'worth it'. Whereas, those who were wise enough to attend a state school are able to see the big picture and didn't waste their money on an overpriced school. ;)
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Re: med schools - prestige or economics?

Post by lightheir »

To make it clear - nobody defending spending the $200k has mentioned 'prestige' as a reason to do it. Prestige for self-satisfaction has nothing to do with it.

It's about keeping your options open. If you're confident enough in your future and ability that you can go it without the pricey school, then great - you just avoided spending an extra $200k. But if you're not sure what you're going to go into, would still like a geographic locale somewhat under your control, and also have a slightly easier road landing a job down the road, it's a $200k investment for that. Again, this is not like a typical just find a job situation - MDs go through a computerized, rigorous match process, and if you don't match in your specialty of choice, it's usually extremely difficult to do it on the second try.

I personally would advise nearly everyone who is even slightly unsure of their future options to go to the better school - that $200k, while a sizeable sum, pales in comparison to the number of work hours and opportunities lost both in terms of family life and alternative work options when you choose to do the grueling 4year med school + 3-4 year residency + 1-3 year fellowship commitment. Prestige has nothing to do with this recommendation.

Honestly, to me, if you're worrying about saving that $200k compared to a definite acceptance to a substantially higher ranked/more prestigious medical school, you might want to re-evaluate your reasons for going to medical school, as you'll be giving up way more than $200k with those training hours and responsibilities and also foregoing a lot of well paying jobs that are much easier and don't land you in debt for someone of comparable talent and intelligence.
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Re: med schools - prestige or economics?

Post by etf »

64415 wrote:if one were trying to match into EM, then yes, school won't matter, because there are so many spots that the only real requirement is a mean-arterial pressure above 60.
This behavior is why I would never practice in an academic environment. The egos are insufferable. It isn't a function of attending a prestigious medical school or residency or fellowship, most of my colleagues attended the "fancy" institutions, but in private practice if you disrespected a competent colleague with a horse sh.t comment like this you will be shunned. You have to get along well with others in a private practice environment.[/quote]

i'm sorry to have offended anyone...my intent was certainly not to say that going into EM meant that someone was a less competent physician by any means. what i meant to say was that there are so many spots in fields like EM, peds, family, etc that any medical student in the U.S. will be able to match SOMEWHERE, whereas in a field like derm the spots are so limited that most applicants would be lucky to match anywhere.
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