It’s a question that reverberates in the minds of premeds around the country.
If you have a choice between multiple medical schools, should you go to the cheapest medical school available, or should you go to the more prestigious, more expensive medical school?
M.D. vs. D.O. vs. Caribbean
I think it is worth the investment to go to a U.S. allopathic (M.D.) school if at all possible.
It’s an unfair bias, because every medical student should be judged on their own merits and not based on the name on their future medical school diploma or the letters after their last name.
However, many high-paying competitive specialties (neurosurgery, orthopedic surgery, dermatology, radiation oncology) take almost no D.O.’s, international medical graduates, or foreign medical graduates. Do I think there are qualified candidates from these schools? Absolutely! But residency programs do not see it the same way. I would not go to a D.O. or Caribbean school over an M.D. school, even if it were cheaper.
There are always anecdotal cases of medical students from D.O. programs going into radiation oncology or neurosurgery. I understand that there are D.O. programs in many specialties, including neurosurgery and dermatology. But there will soon be a merger between M.D. and D.O. residency accreditation organizations, allowing U.S. M.D. students to apply to D.O. residencies.
Further, residency programs won’t judge you differently because you got a full ride to a D.O. school or Caribbean medical school. You will be competing with every D.O. or Caribbean medical student to get the top grades and top USMLE scores in order to try to secure the handful of competitive residency spots that go to D.O.s each year. You can beat the odds, but why not tilt the odds in your favor by going to a more expensive U.S. M.D. school?
State School vs. Higher-Prestige Private School
There is no question that if you review match lists from prestigious medical schools, they are better than that of lower-ranked state schools. Your job prospects are improved if you go to a top residency program.
I understand that private schools (prestigious and non-prestigious) tend to have rank lists filled with more “prestigious” residencies because of the geographic bias of those who tend to go to state schools (i.e. people who attend state schools may value location and being closer to family compared to someone willing to travel across the country to go to a private medical school).
And more prestigious schools tend to enroll students with better medical school applications, which may correlate with factors important in residency application like Step 1 scores. A student who got into a top medical school may (or may not) thrive in a state school. There may be a correlation between GPA / MCAT and medical school performance, but the correlation is less strong than you might think.
“But I Went To State U. And Look Where I’m At Now!”
There are innumerable examples of people from state schools or lower-ranked private schools who match into prestigious residency programs. However, I think the odds of you getting into a competitive residency or residency program are much higher from a prestigious medical school. Whatever success you or someone you know achieved from a state school, it is possible that they could have had even greater success if they had gone to a more prestigious school.
I do believe that the decision is a continuum. Clearly, the difference between the #45 and #50 school on U.S. News rankings is negligible. But I do believe the difference between going to a top 10 school compared to the number 40 or 50 school may be enough to justify paying an extra $100,000-$150,000 in tuition.
I also understand that your salary potential is more dependent on non-academic factors, such as choosing to work in a rural location, working more hours/shifts, and working in private practice versus academics. If anything, graduates from prestigious residency programs are more likely to end up in academics and getting paid less. But if they do choose to maximize their income practicing medicine, they will be in the optimal position to do so.
Unfortunately, you cannot know in advance how well you will do in medical school. I don’t think that state schools are “easier” than prestigious private schools, such that you would have higher grades if you go to a state school. If you choose to go to the cheaper state school and end up in the middle of the class, you’ll wonder whether being in the middle of the class at a top-ranked school would have given you a better match outcome.
Is the difference in tuition that big of a deal in the long run?
The decision also depends on the scale of the difference in money we are talking about. If we are talking about a full ride versus paying $400,000, then yes, you should go to the school that is a full ride (provided it is an M.D. school). But if we are talking about a $50,000 or $100,000 difference, I would rather go to the better medical school.
When you see high-paying specialist couples being able to pay down $700,000 in student debt in 3-4 years, an extra $100,000 in debt can be blasted in just a few months if you are in a high-paying specialty. I’ve found that student loan debt burden ranks relatively low on the factors that will determine your long-term financial success.
Conclusion
I would not go to the cheapest medical school if there is a prestigious alternative. While you can match into any residency program in any specialty from any U.S. M.D. school, I believe that the odds are tilted against you if you go to a lower-ranked state school. The benefits of getting into a prestigious medical school help maximize the chance of getting into a top residency program or a competitive specialty, which will maximize your salary potential (which you may or may not actually achieve) down the road.
What do you think? Did you choose to go to the cheapest medical school you got into, or the most prestigious? Vote in the poll below!
I think it all depends on the difference, specialty choice, and goals.
For example, an extra 100k for the academic pediatrician is a lot of money. For the private practice spine surgeon, not so much.
Like you said, it is hard to know what you will go into, but I would hate to feel limited in your options because of debt. If your debt to income ratio is greater than 1… That starts to become painful.
By and large, I typically prefer less debt over prestige. Just my opinion.
TPP
I went state despite getting into private and easily saved a $100k. I had no regrets and would do it again.
Agree about going to a medical school, but for almost all specialties going to a good (!!!!) state
school if you perform well, you will be accepted into a good residency program. Certainly,
as mentioned, if you wish to practice in your home state, go to a state school. What is not
mentioned here is that about 1000 med students did not match into any residency this
year. These days debt is a huge factor for most residents finishing their training and needs
to be a big consideration.
My path was to take an academic scholarship at my state school. I borrowed living expenses only. I did residency at a Southern Ivy (Vanderbilt). I chose private practice in my home state. It worked well for me.
I thought this might make a difference when I was younger. I picked my home state school over a private school across the country because I thought I might find a wife in the next few years and I wanted her to be from my home state. Life is easier if both families live closer together. I did find my wife during medical school and our parents live 4 hours drive apart and we live in between them. Life has been very nice when it comes to visiting family.
Also good to note is almost never having a patient ask me where I trained. They don’t care. They just want to like you and have you do good work.
Dr. Cory S. Fawcett
Prescription for Financial Success
I’m one of those that went to an average State school (well below top-50) and matched in a top-20 residency in an medium-competitive specialty. I had competitive stats, but so did all my co-residents including those from big name schools. Med school classmates with similar stats as me also got into good programs, some in very competitive specialties. Maybe if I had gone to a prestigious med school I would’ve had a shot at a top program, but in the end it didn’t matter (maybe it would’ve more if I were in academics, which I’m not). I got to where I wanted in my career and working alongside those who went to big med schools or residency programs and they’re no better a doctor than myself (sometimes they are worse). I’m thankful though to have little debt after graduating as it seems like a serious burden on my colleagues who have much more debt.
I fully agree with the point that university should be chosen on basis of ranking. You should take admission in a prestigious medical university. If you talk about to study internal medicine in Caribbean medical schools then i would suggest to choose Windsor School of medicine. Their graduates are earning great salaries in America.
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