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Research

Association between physician US News & World Report medical school ranking and patient outcomes and costs of care: observational study

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3640 (Published 26 September 2018) Cite this as: BMJ 2018;362:k3640

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Re: Association between physician US News & World Report medical school ranking and patient outcomes and costs of care: observational study

Students who perform well academically tend to choose more prestigious and higher ranked medical schools thereby creating a potential bias. Hence it is somewhat surprising students from higher ranking schools didn't perform better with in-patient mortality or readmissions metrics. [1].

Medical students career choices are influenced by perceived prestige of a speciality. [2]. Debt burden of students can affect career choices.[3]. Did these factors affect the type of student who is working as a general internist?

In particular, did the brightest from the higher ranking schools choose high-prestige specialities rather than pursue a career as a general internist.

References:
1 Tsugawa Y, Blumenthal DM, Jha AK, et al. Association between physician US News & World Report medical school ranking and patient outcomes and costs of care: observational study. BMJ 2018;362:k3640. doi:10.1136/bmj.k3640

2 Compton MT, Frank E, Elon L, et al. Changes in U.S. Medical Students’ Specialty Interests over the Course of Medical School. J Gen Intern Med 2008;23:1095–100. doi:10.1007/s11606-008-0579-z

3 Jeffe DB, Whelan AJ, Andriole DA. Primary care specialty choices of United States medical graduates, 1997-2006. Acad Med J Assoc Am Med Coll 2010;85:947–58. doi:10.1097/ACM.0b013e3181dbe77d

Competing interests: No competing interests

30 September 2018
Santhanam Sundar
Consultant Oncologist
Nottingham City Hospital

Medical school ranking and patient outcomes: Just one problem

Dear Sir,

This study compares outcomes as well as healthcare costs of admitted patients based on general internist's medical school ranking.

Just one problem. The majority (It will be hard for me to quote the exact number but by anecdotal evidence it will be more than 90% as there are no such studies) of patients who are admitted under internist or hospitalists have "consults". If you walk around in any given hospital, it will be very hard to find a patient who has not been seen by a specialist.

To place responsibility on an internist for the decision making of a specialist is inappropriate. Internists are accountable for which specialty to call, its timing, but beyond that, they just follow "recommendations".

The focus of the study should be the medical school ranking of the specialists rather than internists.

Competing interests: No competing interests

26 September 2018
ramakant sharma
Intensivist
Chandler, Arizona
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