Hospital Rankings: Can Docs Make the Process Less Stupid?

It’s that time of the year. As Halloween decorations give way to Thanksgiving and now Christmas ornamentation, I, like many other American academic physicians, am sent an array of end-of-the-year email reminders from hospital and medical school leadership about sundry matters ranging from holiday parties to Press Ganey Scores. However none of these notifications stands out quite like being urged to update my membership with Doximity and thereby ensure my good standing with the social media network.

And what lofty academic or clinical function is being served? None other than the academic medical community’s best effort to get out the faculty vote for Doximity’s upcoming and all-important hospital and departmental yearly reputation scoring – a number which ultimately feeds into the even more important, annual hospital rankings among the US News and World Report.

For years academics turned up their collective noses at the US News and World Report Hospital Rankings, laughing at the very idea that anyone other then themselves was capable of making such complex judgments. (That is, unless their own hospital was among the chosen.) Like it or not, the hospital annual ranking kept coming year after year, and these seemingly capricious judgments of laypeople, grated on the nerves of otherwise all-powerful and all-wise institutions. But much of this process changed with the arrival of social media and US News and World Report’s decision to enlist Doximity in its annual ritual.

Now it was possible to co-opt the academic community into their previous charade. What strikes me now is the gusto with which staid old academia has come to embrace this new media faculty call-to-arms. Wouldn’t it be nice if Doximity’s “next gen” form of polling, perhaps buttressed by indecipherable statistical analyses, has finally come to reveal the true and innate quality rankings among institutions, and this is why this process is now so avidly embraced among medical academia? Have I got some swampland for you! The shamelessness with which medical schools currently go around promoting this “reputation” measurement process among their clearly self-interested faculty reminds me of little more than an Instagram popularity test among high school classmates.

It seems to be in our nature as human societies to create hierarchies, no matter how flawed the underlying rationale. As a result I don’t entirely blame hospitals for engaging in the farce being perpetuated by US News and Doximity. Undoubtedly the results of these rankings carry great power among many a patient, resident applicant and perhaps even some insurers. But can anyone with a straight face truly assert that this new popularity/reputation based ranking system for hospitals is superior to the old?

After several decades of denying and then now engaging in a farcical ranking system, maybe it is time for medical academia to step up and give the public what it seems to want, our best shot at objectively ranking hospitals. However this time around maybe the ranking system can reflect our values. Clearly there are quality assessments that we might all agree on. Simple measures like safety, hospital-acquired infections and the thoroughness with which all subspecialties are represented might be easy places to start. Moreover in academia we uniquely tend to value peer-reviewed publications, funded research grants, Nobel laureates etc., all of which lend themselves to quantitative scoring and might also readily feed into a universal objective ranking. Such a process would more closely reflect the values that medical academicians tend to respect, excepting, that is, some of us contrarians.

Ultimately such a self-generated tool for judging our own institutions would be biased and far from perfect, but so too are the grades we routinely give our students and residents. Given the ceaseless public demand for a hospital ranking hierarchy, isn’t it the height of hypocrisy to not hold ourselves as academic institutions to the same standards we hold our students? Rather than let magazines and social media do the difficult job of ranking us, perhaps it is time for those of us inside leading academic hospitals to step up and do this dirty job ourselves; unless of course we are afraid of the answer. Excuse me now while I update my Doximity profile.

 

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