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?

MD vs. DO vs. Caribbean

I think it is worth the investment to go to a U.S. allopathic (MD) 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 DOs, 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 DO or Caribbean school over an MD school, even if it were cheaper.

There are always anecdotal cases of medical students from DO programs going into radiation oncology or neurosurgery. I understand that there are DO programs in many specialties, including neurosurgery and dermatology. But there will soon be a merger between MD and DO residency accreditation organizations, allowing U.S. MD students to apply to DO residencies.

Further, residency programs won’t judge you differently because you got a full ride to a DO school or Caribbean medical school. You will be competing with every DO 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 DOs each year. You can beat the odds, but why not tilt the odds in your favor by going to a more expensive U.S. MD 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 MD 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. MD 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.

“Wall Street Physician,” a former Wall Street derivatives trader , is a physician who blogs at his self-titled site, the Wall Street Physician.

Image credit: Shutterstock.com