Wednesday, May 2, 2007
Hospitals and Physicians, Part 2
Picking The Top Academic Medical Centers and Top Academic Specialists
Academic health centers have long enjoyed positions of power and prestige in the health care system. We define an academic health center as one of the 125 institutions in the United States that consist of at least a medical school and an owned or closely affiliated clinical facility in which faculty instruct physicians-in-training. These centers classically conduct teaching, patient care and, in many cases, research. They may, and often do, contain additional components, including schools for other health professions (schools of nursing, pharmacy, dentistry, and the allied health professions) and other clinical entities (faculty group practices, community health centers, nursing homes, and increasingly, community-based networks of practitioners.
David Blumenthal, MD, Eric Campbell, PhD, and Joel Weissman, PhD,The Social Mission of Academic Medical Centers, New England Journal of Medicine, Volume 337, pages 1550-1553, November 20, 1997
“Top” doctor and hospital lists sell magazines, books, and websites. I was speaking to a good friend of mine, the senior editor of a prestigious website for the movers and shakers in health care, and he said, “ Sure, lists sell. Americans love lists, especially of top hospitals and doctors.”
No doubt this is true. Why else would U.S. News and World Report’s annual list of the top hospitals and top specialty centers, now more than 20 years old, be so popular?
When the annual list comes out, marketing departments of institutions making the “honor roll” scramble to issue press releases highlighting accomplishments of their particular medical center. Invariably academic medical centers and their specialty faculty dominate these lists.
Here’s this year’s “honor roll ”
#1 Johns Hopkins Hospital, Baltimore
#2 Mayo Clinic, Rochester, MN
#3 Cleveland Clinic, Cleveland
#4 Massachusetts General Hospital, Boston
#5 UCLA Medical Center, Los Angeles
#6 New York-Presbyterian Univ. Hosp. of Columbia and Cornell, New York City
#7 Duke University Medical Center, Durham, NC
#8 Barnes-Jewish Hospital/Washington University, St. Louis
#9 University of California, San Francisco Medical Center
#10 University of Washington Medical Center, Seattle
#11 Brigham and Women's Hospital, Boston
#12 University of Michigan Hospitals and Health System, Ann Arbor
#13 Stanford Hospital and Clinics, Stanford, CA
#14 University of Pittsburgh Medical Center , Pittsburgh
According to U.S. News and World Report, out of 5,189 hospitals, only 3 percent, 176, ranked in one or more of the 16 specialties in this year's "America's Best Hospitals." And of those, just 14 qualified for the Honor Roll by ranking at or near the top in at least six specialties—a demonstration of broad expertise.
In the interest of full disclosure, I’ve been on medical advisory board of America’s Top Doctors (A Castle Connolly Guide, fifth edition, 2005) and America’s Top Doctors for Cancer ( A Castle Connolly Guide, 2005) for 10 years.
Castle Connolly Ltd is a New York City publishing firm that publishes medical books, including, America’s Top Doctors, America’s Top Doctors for Cancer, Top Doctors: New York Metro Area, America’s Cosmetic Doctors and Dentists, Cancer Made Easy: New York Metro Area, The Buyers guide to Choosing the Best HealthCare, the ABCs of HMOs, The Best Senior Living & Eldercare Options, How to Find the Best Doctors: Florida.
America’s Top Doctors is updated annually. The basis for selecting the best doctors is peer nomination. They’ve surveyed more that 250,000 doctors to build their database of nominating doctors.. Over 25,000 doctors have been nominated through this process. The professional backgrounds of nominees are checked. Results of the final selections are printed in the book America’s Top Doctors. The top specialists are organized into 42 specialties and hundreds of subspecialties and by region of the U.S. – New England, Mid-Atlantic, Southwest, Midwest, Great Plains, Southwest, West Coast and Pacific,
The fifth Edition of America’s Top Doctors is 1274 pages. It contains the names of more than 3000 top specialists. Most practice in academic medical centers. Twenty seven major academic centers sponsor the book. Most academic medical center specialists are on salary and are part of “integrated health systems,” whereas 90% of doctors practice outside of academic medical center and earn their incomes through fee-for-service. Though they’re members of hospital medical staffs, they’re sometimes but generally not on hospital payrolls.
This sort of nomination process is useful and reliable for selecting specialists at top academic centers. But it’s not for everyone who wants to find the right doctor for themselves in their communities. After all, only 125 of America’s 5,189 hospitals are located at academic centers. Most Americans receive their care from local physicians and community hospitals.
Only about 10% of America’s physicians practice in academic settings. How to find the best among these nonacademic hospitals and doctors is beyond the scope of this blog entry, and I shall not venture there now, except to say number of websites and rating systems are evolving to identify and rate these hospitals and doctors..
There’s an underside to academic medical centers. Because of their social missions of training future doctors, nurses, and other health professionals, academic medical center costs are high. These high costs make competing with other hospitals and other medical specialists on the basis of financial considerations, convenience, and amenities difficult.
Many prestigious academic centers – such as Stanford, the University of Chicago – have undergone financial turnarounds. In addition, many of these centers were founded and grew in inner city locations and serve mainly the urban poor. Much of the care in these centers is delivered by medical students, interns, and residents in training. For these reasons, many patients prefer to specialists and health centers in upscale suburban settings.