Well, there are layers to it. Obviously, there is almost a 0% chance you get into like Massgen residency if you're not from Harvard or have an MD/PhD (effectively, the academically-focused residencies really care about prestige). But the reality is almost all of us premeds don't give a flying F about having research in our actual career and just want to practice in clinic/private practice.

In that realm, the residency you go to doesn't matter. An ortho trained at Ohio state will still be the same paying job as an ortho trained at Harvard, probably more than Harvard ortho because the more academic/research your job has the less money you make (clinic --> procedures = money).

But at the end of the day I would think that if you went to a T20 and applied with the same exact profile out of a rank 50 school, you'd probably be able to match the specialty you deisre (but a less 'prestigious' location). Obviously below like rank 100 schools or DO schools, it gets difficult, since some of those schools don't have home programs...

Honestly there's just so much information that people pull out of their ass, so it's hard to tell. I often see one-off stories about how Harvard derm/ortho applicants can get away with having average STEP scores but there is literally no data to support this. If you count the raw number of students from T5s, T10s, T20s, T40s, T60s into specialties, there is a steady decline but it's not anything to pick an entire school over imo unless its T5.

tl;dr we don't have enough data publicized to make a decision on it, but this goes both ways. What we have is that 25-35% of derm/ortho/plastics matches come from T20s which we can see from match lists. That means that ~70% come from elsewhere. This fluctuates per year.