Little to No Association Found Between Physician Performance and Medical School Ranking
Researchers found a limited association between the ranking of a physician’s medical school and patient mortality or readmission rates.
Results from an observational study published in BMJ found little to no association between US News & World Report ranking of the medical school a physician attended and subsequent patient mortality or readmission rates.
Investigators selected a random sample of Medicare fee-for-service beneficiaries age 65 years or older who were treated by general internists following hospital admission for an emergency (n = 996,212). Researchers then obtained the US News & World Report ranking of the medical school attended by physicians who dispensed care (n = 30,322). As primary outcome measures, 30-day mortality and 30-day readmission rates were captured for the patients of each physician. Additionally, data on Medicare Part B spending per each physician was assessed, following adjustments for patient, physician, and facility characteristics.
Of the total physician cohort, 13.3% graduated from medical schools ranked among the top 20 for primary care and 13.4% graduated from medical schools ranked among the top 20 for research. Among all captured hospital admissions, 10.6% of patients died within 30 days of admissions. No association was found between US News & World Report primary care ranking of a physician's medical school and the physician's 30-day mortality rate for treated patients.
The overall 30-day readmission rate was 16.0%; following a multivariable adjustment, patients treated by physicians who graduated from medical schools with lower US News & World Report primary care rankings (≥50) had slightly higher readmission rates (16.1%) compared with those treated by physicians who graduated from top 10 schools (15.7%; P =.005). Additionally, physicians who graduated from top 10 ranked US News & World Report schools spent slightly less for each patient ($1029) compared with graduates from institutions with a ranking of 50 or higher ($1066; P <.001). No trends were observed between institution ranking and 30-day mortality.
According to nationally representative cohort data, little association was identified between the US News & World Report ranking of the medical school a physician attended and patient mortality or readmission rates. Researchers noted that although the US News & World Report rankings are an imperfect measure of education quality, they do capture a “wide array of factors” including peer assessments, student test scores, and faculty-student ratios. As such, these data indicate reliably that quality of care delivered is not necessarily a function of medical institution ranking.
Tsugawa Y, Blumenthal DM, Jha AK, Oray EJ, Jena AB. Association between physician US News & World Report medical school ranking and patient outcomes and costs of care: observational study. BMJ. 2018;362:k3640.