tiers for residency programs

Tiers are person-dependent in almost all cases. Many of these on here are word-of-mouth combined with US News and World rankings, and I wouldn't put much stock into them unless you trust someone or have heard it over and over again. Plenty of people would rank a program like Indy over Hopkins or MGH, though others would argue for the opposite. Totally depends on what you're looking for, as some programs are great at research, but you don't operate much at all. Others let you operate a ton but have hardly any research (Penn, for example). Nothing I read on here about "tiers" helped in the actual match process when making my list, as there are so many factors to consider. All programs have strengths and weaknesses, with things like location, experience, cost of living, reserach, fellowship opportunities, etc. all coming into play. Obviously places like Columbia, Sinai, Lahey, MGH, Brigham, Hopkins, Penn, etc. have the "name recognition," but I had a few places ranked 8 or 9 on my list that other people put #1, and vice versa for the reasons listed above. Good luck and know that there are almost no "bad" programs out there and all will get you to where you want to go. Seeing a program on a Sub-I or an interview/second look is the best way to figure out if it's what you're looking for, and that's often how you'll optimize the changes of matching there. 

This is pretty controversial, but just to give you a sense of what people refer to as top tier, they are probably talking about (in no particular order) places like: UCLA, UCSF, Hopkins, Mayo, Northwestern, Duke, Emory, Vanderbilt, Cleveland Clinic, MGH, Cornell, Michigan, Penn, Indiana.This is by no means a complete list, and I'm sure I've missed some of the top tier programs. But, in choosing programs for residency, it's probably more important to look at programs for qualities attractive to you. For example: does the program have a community hospital/VA (where residents usually have more autonomy)? Is the location good for you? Is the call schedule good? Are there a lot of fellows that will take your cases away from you? Do they have a good case mix?Residency is a little different from applying to medical school, where many people care about the ranking of the school. With residency, you should be comfortably with the people you work with, be confident that you will be trained well as a urologist, and have a decent quality of life while training.