By Carolyn Crist
Where a doctor went to medical school in the U.S. doesn’t predict how well that doctor’s patients will do, a new study suggests
Researchers who looked at outcomes of nearly one million hospitalizations managed by more than 30,000 physicians found no difference in patients’ risks of death or hospital readmission according to where their doctor’s medical school fell in the U.S. News & World Report medical school rankings, according to the report in The BMJ.
U.S. News & World Report has published medical school rankings since 1983. The rankings take into account the school’s reputation, research activity, and acceptance rate. Rankings also depend on peer scoring by school deans and residency directors, as well as student grade point average and admission test scores.
“There are ample anecdotes suggesting that both patients and physicians may use the ranking of the medical school a physician graduated from as a signal of provider quality,” said lead study author Dr. Yusuke Tsugawa of the University of California, Los Angeles David Geffen School of Medicine.
But “although these rankings take into account many aspects of medical schools, the performance of graduates, including patient mortality, which arguably is what patients care about most, is not included in the calculation,” Tsugawa told Reuters Health by phone.
Tsugawa and colleagues studied 996,000 patients over age 65 with Medicare, the government insurance for the elderly and disabled, who were admitted to hospital emergency departments and treated by general internists in 2011-2015. They linked the Medicare data to a Doximity database with information about doctors’ medical school training, credentials, specialties and board certifications.
Overall, nearly 11 percent of patients died within 30 days after admission. The research team found no links between the ranking of a doctor’s medical school and patients’ 30-day mortality rates.
The overall 30-day readmission rate was less than half a percent lower for doctors who went to the higher-ranked schools (15.7 percent for top 10 schools versus 16.1 percent for top 50 schools overall).
Medicare spending was also roughly $36 lower when doctors had graduated from the highest-ranked schools
“We don’t think patients need to pick a doctor based on that $30-$40 difference,” Tsugawa said.
“What we do every day as doctors isn’t what we learned in medical school, which is the foundation. What we practice daily is what we learned during residency years,” said Dr. Mario Guadino of Weill Cornell Medicine in New York City. Guadino, who wasn’t involved with this study, has researched the characteristics of cardiothoracic surgeons practicing at top-ranked U.S. medical institutions.
“Overall, this study gives a reassuring message,” he told Reuters Health by phone. “There’s not a lot of fragility in the level of care you will get, and you don’t need to be concerned about your doctor’s medical school education when you go to the hospital.”
Patients should look beyond the U.S. News & World Report rankings to better understand costs and quality care, said Daniel Tancredi of the University of California, Davis School of Medicine in Sacramento.
“These rankings are meant to inform students about where they should go for medical school,” he told Reuters Health by phone. “That’s a different question than determining the best medical school for patients.”
SOURCE: The BMJ, online September 26, 2018
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