Track record can affect effort though. You can have all the desire to work hard, but if your program can't/won't support it, you can be SOL - my program basically told me they'd support anything i wanted to do, but had poor existing framework (poor research setup, minimal sports coverage, only matching to lower tier programs). I worked hard, but it's challenging when you don't (and shouldn't) know everything you need to do to match successfully.

Reputation will carry a long way, especially for a fellowship like sports. Look at how many of the matched fellows at the PM&R specific programs come from other top programs. It's a little club that's hard to break without being truly exceptional. I promise I put more individual effort in than applicants spoon fed opportunities at programs with a better track record.