Can a top medical school open the door to a top residency program?

Last week, US News and World Report released their list of the 2014 Best Medical Schools (designed for applicants to the Class of 2014). Their rankings are not at all surprising – in primary care, nine of the top 10 are still holding strong, with only the University of Alabama Birmingham rising from last year’s #12 rank (replacing UCLA); the top 12 programs for research stayed the same, with a bit of shuffling in the ranks.

Not that these lists of so-called “best” medical schools are ever surprising. Based on such factors as admission statistics, research dollars, and students entering primary care fields (see their full ranking methodology), the rankings are to a large extent self-perpetuating. Highly ranked schools attract more applications, therefore boosting their selectivity by decreasing the ratio of “accepted” applicants while raising MCAT and GPA scores. Likewise, established research programs are more likely to receive continued funding, which feeds into higher research rankings.

Further, the data is highly suspect, as medical deans have pointed out. For instance, one of USNWR’s measures is based on residency program directors’ impressions of each medical school, but historically the majority of directors have declined to participate; last year only 17% participated in the USNWR survey. In fact, the AAMC still refers applicants to a 2001 critique of the USNWR rankings, which concludes that they “have no practical value and fail to meet standards of journalistic ethics.”

So what, if anything, do these rankings mean to the medical school hopeful? Besides the bragging rights a medical school gets for a top slot, is the medical education they offer any better? And is a med student’s shot at a top residency significantly improved by attending a “top 10” school?

In business and law schools, career success – and commensurate salaries – is reflected in large part by school rankings. A Harvard MBA opens doors to Fortune 100 companies that are closed to graduates of lesser known programs. Medical education does not work like this, no matter how hard U.S. News and World Report tries to shove it into the same mold. The future of a medical student’s career depends on the choice of specialty and residency. An orthopedic surgeon with a degree from Podunk School of Medicine will probably make significantly more than a GP from Harvard.

Can a top medical school open the door to a top residency program? Opinions vary – and naturally, it’s the top programs who claim it does, while lower-tier programs claim it makes no difference. Fortunately we have hard data to settle this dispute. Each year, the NRMP publishes the NRMP Program Director Survey Results and asks what factors influence the decision to interview a particular candidate. The reputation of the medical school always ranks around 50%; in the latest report, it was the 23rd most important consideration, far below the top three factors: the Step 1 score, letters of recommendation from within the specialty, and the applicant’s personal statement.

So in the end, does a top ranking or a program’s reputation never matter? Of course not. Residency selection is subjective and program directors often trust their alma maters or networks to supply candidates. But the question is whether rankings like this one from USNWR are something you need to worry about as you apply to medical school.

The “best” medical schools, in my opinion, are those that are accredited, that offer the clinical and research opportunities you want, and that produce competitive residents who match. No matter what USNWR says, if you can win a seat at one of the many outstanding allopathic or osteopathic programs in the U.S., your future in medicine is bright.

By Cydney Foote, Accepted consultant and author of Write Your Way to Medical School, who has helped future physicians craft winning applications since 2001.