Does Medical School Prestige Impact Match Rates in Competitive Specialties? A Retrospective Analysis

Matching into a competitive specialty has historically required extensive research, leadership, and extracurricular activities. Since the United States Medical Licensing Examination (USMLE) Step 1 exam has changed to a pass-fail grading system, it has been questioned whether medical school ranking will become a significant factor in matching into competitive medical specialties. To our knowledge, this is among the first studies to examine competitive specialty match trends following the transition to pass/fail Step 1 scoring. High-tier and low-tier medical schools were determined using the U.S. News and World Report 2024 Medical School Rankings list, and the 20 highest- and 20 lowest-ranked US-based allopathic medical schools were selected. Medical school competitiveness was determined using the mean USMLE Step 2 clinical knowledge (CK) score, mean number of research abstracts, publications, and presentations, percent of applicants that matched into said specialty, and percent of matched students that were Alpha Omega Alpha (AOA) honors society members. The most competitive specialties were determined to be dermatology, neurological surgery, plastic surgery, orthopedic surgery, and otolaryngology. Match rates into competitive specialties were compared at high- and low-tier medical schools. Secondary analysis eliminated schools that did not have an affiliated residency program, termed a "home program", to examine this as a potential confounder. High-tier medical schools demonstrated statistically greater match rates into dermatology (p=0.046), neurological surgery (p=0.008), otolaryngology (p=0.008), and competitive specialties overall (p=0.006) when compared to low-tier medical schools. A difference was not noted for plastic surgery (p=0.308) and orthopedic surgery (p=0.809) match rates. However, when accounting for whether schools had affiliated residency programs, these differences were no longer statistically significant, highlighting the potential importance of home programs over school prestige alone. Higher-tier medical schools placed more students into competitive specialties, specifically dermatology, neurosurgery, and otolaryngology, when compared to lower-tier medical schools. Thus, attending a highly ranked allopathic medical school may serve as a significant benefit when applying to some competitive specialties. However, after eliminating high- and low-tier medical schools without an affiliated residency program, no statistical significance was observed for dermatology, neurosurgery, plastic surgery, orthopedic surgery, otolaryngology, or overall. Thus, medical school ranking may be less important than attending a school with a home program when applying for one of the five competitive specialties examined.