Wednesday, March 14, 2012

How Do You Rate Your Doctor?--Part Two

In keeping with the theme of ratings, US News and World Report just released its annual rankings of "Best US Medical Schools". Shock of shocks, Harvard University ranks at the top--at least in the "research schools" category. For best schools specializing in primary care the list is utterly different: the University of Washington occupies the top spot, and only one school, UCSF, makes both top-10 lists.

I wouldn't call these lists "nonsense" but my sentiments aren't too far off that mark. I see two major problems here. The first is that the concept of ranking one-through-whatever seems dubious at best: does putting the University of Nebraska (#6 in primary care) above UMass (#7, a school near and dear to the heart of the Billy Rubin Blog) or for that matter University of North Texas (#35) really mean that a Cornhusker grad who's now a doc in primary care is qualitatively better than a Minuteman or a Texan doc? I'm thinking not. Or does it really mean something to the average medical student that Harvard is a better research school than, say, Baylor (#21) if there's essentially no difference in the number of research opportunities at Baylor?

At best--at absolute best, if you're trying to put a happy spin on these lists--you might reasonably break these rankings out into "tiers" where you acknowledge that it's meaningless to rank one school above another within a given rank, but that you can make some broad statements about how groups of schools compare to one another. The difference between Duke (#9 research) and Vandy (#14) doesn't really exist, but I'd be willing to believe that there's a real qualitative difference, however small, between either of those schools and, say, University of Missouri (#74).

The second problem is that the criteria by which these schools are judged play to the strengths of schools with fancy pedigrees. As this page helpfully explains, there are several criteria that USN&WR take into account, but one of the most important factors is a school's reputation. In other words, a huge chunk of where you find your spot on this list is determined not by truly objective criteria, but simply by what other people think about you. So Harvard gets an A+ for being, well, Harvard--even slackers from the hills of Idaho have heard that Harvard is a good school, despite knowing nothing about how Harvard actually functions in the real world.

Thus, one of the major reasons why a given school lands where it does is essentially the equivalent of lunch room gossip: the popular kids are popular because, well, they're popular! There are objective portions to the score, to be sure: they factor in how much research money comes flowing in (Harvard really is a mammoth institution in this regard), what percentage of med school grads go into primary care, the average GPA and MCAT scores of the students, and so on.

Although with all of that, I still don't think it will tell you anything about the quality of the doctors being produced from those institutions. The University of North Dakota (#77 in primary care) is a school built for students who were, for the most part, born in the Upper Midwest and want to stay there. There's no particular reason to suppose that their training is any more or less better than pretty much anywhere else. Plus there are some weird discrepancies in the list: Cornell, a school with a very high reputation, is not surprisingly ranked as #16 in research but is #57 in primary care. Does that mean that New York-based prospective students interested in primary care should drop Cornell and head to the University of Rochester (#15)? Maybe yes, maybe no. Either way, they're likely to become pretty much the same kind of doc no matter which they choose.

US News is in the business of selling copy, and they seem to make an honest--though per above, I believe seriously flawed--effort at honestly assessing these institutions. The bone I have to pick is that people read these numbers without really understanding what they mean or where they come from, and suddenly attach great importance to them--and they just ain't that important. But mark my words, the haughty attitudes that get ingrained into many of these students once they get accepted to such-and-such a high-ranked school (or for that matter, the chips on the shoulders of those that get into the lower-ranked ones...though I'm not sure what a Cornell medical student should think) invariably will find their way into how they approach their colleagues, or much more importantly, their patients, in the years to come.

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