Education
Is Washington falling behind on medical education and care?
Is the quality of medical education in Washington worse than in other metropolitan areas? Looking at the rankings of our medical schools compared to other regions, it seems that we're behind.
Photo by Poppy Wright on Flickr.
According to a number of people in the medical profession, the general consensus in the field is that DC has fewer very experienced doctors in many specialties. Primary care physicians also generally seem harder to get to see, and fewer take insurance.
The US News rankings for the top medical, law, business, and engineering graduate schools for each of the top 11 metropolitan areas are below. When another school was close behind, the table includes those schools as well.
| # | Metro area | Pop | Top med. school | Top law school | Top bus. school | Top eng. school |
|---|---|---|---|---|---|---|
| 1 | New York | 19.0 | 8. Columbia 16. Cornell | 4. Columbia 6. NYU | 8. Columbia 11. NYU | 15. Columbia |
| 2 | Los Angeles | 12.9 | 13. UCLA | 15. UCLA 18. USC | 15. UCLA | 5. Caltech 12. USC |
| 3 | Chicago | 9.5 | 10. U Chicago 18. Northwestern | 5. U Chicago 12. Northwestern | 4. Northwestern 4. U Chicago | 19. Northwestern |
| 4 | Dallas | 6.5 | 20. UT SWestern | 51. S Methodist | 39. UT Dallas | 121. S Methodist |
| 5 | Houston | 6.0 | 21. Baylor | 57. U Houston | 25. Rice | 31. Rice |
| 6 | Philadelphia | 6.0 | 3. U Penn | 7. U Penn | 3. U Penn | 23. U Penn |
| 7 | Washington | 5.7 | 48. Georgetown 55. GWU | 13. G'town, 20. GWU 39. GMU, 49. AU | 24. Georgetown 44. UMD | 18. UMD |
| 8 | Miami | 5.7 | 53. U Miami | 69. U Miami | 70. U Miami | 121. U Miami |
| 9 | Atlanta | 5.4 | 21. Emory | 24. Emory | 19. Emory | 4. GA Tech |
| 10 | Boston | 4.6 | 1. Harvard | 3. Harvard 26. BU, 29. BC | 1. Harvard 4. MIT | 1. MIT 19. Harvard |
| 11 | San Francisco | 4.4* | 4. Stanford* 5. UCSF | 2. Stanford* 7. UC Berkeley | 1. Stanford* 7. UC Berkeley | 2. Stanford* 3. UC Berkeley |
* Stanford is technically just outside the San Francisco-Oakland-Fremont Metropolitan Statistical Area, in the adjacent San Jose-Sunnyvale-Santa Clara MSA (#31, with 1.9 million people). Both are part of the larger San Jose-San Francisco-Oakland Combined Statistical Area (7.5 million), but also, Stanford borders the county line and the edge of the San Francisco MSA. Berkeley, meanwhile, is unquestionably in the San Francisco MSA.
The Washington area is near the top of the pack for most of the graduate programs. In law, perhaps not surprisingly, we've got four top-50 schools. But in medicine, Washington's best are ranked farther down; we're more comparable to Miami, a city in a state which places very little emphasis on quality education.
The number two medical school in the nation is, of course, not far at all. Baltimore is even part of the same Combined Statistical Area as Washington. UVA's is number 25, but it's far enough away as not to be part of the Washington region.
Does this matter? The link between medical education and medical care
Who cares if our medical schools aren't the best in the nation, especially with Johns Hopkins around?
Doctors have the ability to live in many parts of the country, and residency already takes them to areas they might not otherwise have lived in. When choosing a long-term place to live, many want to either work where they can get the most interesting cases, or make the most money.
Specialists who have the most knowledge often want to work in the best academic or research hospitals. Patients needing the most unusual and expert care will go to those hospitals, making the work more interesting for doctors. Plus, a doctor's reputation comes partly from the quality of the school and hospital where he or she works. That draws many of the best doctors to want to work at the best schools and their hospitals.
Doctors primarily concerned with money are attracted to areas with a lower cost of living and higher Medicare reimbursement rates, which vary by state. For a doctor in a hospital, like a surgeon, Medicare rates govern payments for many procedures and therefore strongly influence physician pay. Meanwhile, the cost of living also varies greatly, but often not in lockstep. A higher cost of living in the Washington area might deter doctors from choosing to practice here.
Certainly people in Washington can go to Baltimore for the occasional, very serious medical issue. But in a metropolitan area of almost 6 million people, shouldn't we want to have great specialists too? And while there are plenty of great primary care doctors in Washington, there often don't seem to be enough. If our medical schools were even better, it might attract even more of the best and brightest in the medical profession, just as the region attracts much of the best and brightest in the legal field.
Help medical schools thrive
Georgetown has expressed a long-term interest in moving its medical school, Washington's best ranked. DC should work hard to keep it here, and discourage it from moving to a distant exurban part of the region. It should also take an interest in helping the other medical schools grow and thrive.
Sometimes it seems DC takes its universities for granted. While certain officials entice sports teams to move here no matter what the cost, the District government is placing severe limitations on its universities. These limitations aim to satisfy residents who don't want to see an increase in undergraduate or graduate students or more institutional use of buildings in their neighborhoods.
DC won't collapse without better medical education or care, but as residents and leaders think about the future, we should consider helping DC and the Washington area be as competitive in medicine as it is in other fields.
 | David Alpert is the Founder and Editor-in-Chief of Greater Greater Washington and Greater Greater Education. He worked as a Product Manager for Google for six years and has lived in the Boston, San Francisco, and New York metro areas in addition to Washington, DC. He loves the area which is, in many ways, greater than those others, and wants to see it become even greater.   |
Comments
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In other words, access to medical care is more important than having top institutions. Most people do not need a specialist. They need a physician to get a physical, or a diabetes test.
Also, NIH does not fit within the confines of the study you mention, but it is the second largest and (second) best medical campus in the US. You can not ignore that when talking about care.
by Jasper on Jul 23, 2012 2:51 pm • link • report
by Simon on Jul 23, 2012 2:57 pm • link • report
Visits to the doctor really aren't like an episode of House. On the rare occasion where it might help to have the country's best specialists looking at something, its no big deal to drive an hour.
Conversely, exactly who's neighborhood is it OK to "revitalize" and/or "develop" in order to make room for more med school students? That's really not a population that's going to hunt around on craigslist -- their school is going to build them housing, displacing some local population.
by Vinnie on Jul 23, 2012 3:08 pm • link • report
Why doesn't DC have better hospitals? We need more sick old people. Ask Cleveland. Or Rochester.
Others have said that the mere precense of the Advisory Board drives away good physicans, but that is just silly correlations.
by charlie on Jul 23, 2012 3:13 pm • link • report
DC's problem isn't a lack of a good med school. It's a lack of a solid Higher Education system all around. DC has no good public university, Virginia's public university system is great (but far away, and declining rapidly), leaving UMD as really the only well-known public university in the area..and it's still pretty far outside of the city. GWU and GU seem content to remain small playgrounds for the rich at the undergraduate level, while having decent-but-limited programs at the graduate level.
None of our schools are on par with the Ivies or great research universities. Really, we don't have anything that even comes close. It's almost embarrassing that Lawyer City USA doesn't have a Top-10 Law School.
Live in DC and want to go to grad school? Currently, your best options are to pay full price, or move out of the district. I seriously think you'd be hard-pressed to find a locale in the US that has worse access to affordable adult education.
(Aside: These rankings are BS anyway)
by andrew on Jul 23, 2012 3:26 pm • link • report
That is true. However, it is worth to point out that DC is as much as scientific center as a political center. We have a bunch of great scientific institutions here, with the universities, NLR, NIH, NIST, the Smithsonian, etc. But all of those exist despite the DC government, not due to the DC government.
Virginia's public university system is great (but far away
Euhm. GMU is VA's largest public school, and 20 miles is not that far...
GWU and GU seem content to remain small playgrounds for the rich at the undergraduate level, while having decent-but-limited programs at the graduate level.
They're not content as all, but there is no way for them to grow in DC.
None of our schools are on par with the Ivies or great research universities. Really, we don't have anything that even comes close.
True. However, I am not sure it's an achievable goal to create such an institution.
These rankings are BS anyway
A previous institution where I worked, had a deliberate policy of trying to game the ratings. They read their rating reports very carefully and consistently improved the easiest points. Very smart, and very effective. They also hung relevant prints from the ratings in public places, just like Five Guys does.
by Jasper on Jul 23, 2012 3:41 pm • link • report
by spookiness on Jul 23, 2012 3:44 pm • link • report
For an individual in need of unusual specialty care there is a lot in this area, along with plenty of opportunity for world ranked research.
However for the nations' health what we need are systems that support primary prevention. For that a better federal transportation bill and better educated state/local DOTs and planning commissions, along with reform of USDA farm subsidies will be more meaningful than a local medical school that's ranked #12 instead of #45...
by Tina on Jul 23, 2012 3:55 pm • link • report
DC's problem isn't a lack of a good med school. It's a lack of a solid Higher Education system all around. DC has no good public university, Virginia's public university system is great (but far away, and declining rapidly), leaving UMD as really the only well-known public university in the area..and it's still pretty far outside of the city.
I am a graduate of the University of Maryland at College Park (UMCP), and decline to express any opinion about higher education on the other side of the Potomac River (beyond stating that I root for the Terps when they play UVa and Virginia Tech).
But - I must take strong exception to your assertion that UMCP is "pretty far outside the city."
I don't think less than 9 miles (according to Google Maps) from the U.S. Capitol dome is far. And it is the University of Maryland, not the University of the District of Columbia.
Now it is unfortunate that the Metrorail Green Line stop for the campus is so far to the east of the center of the College Park campus (you can thank 1970's NIMBYs in Prince George's County, including the City of Hyattsville, for objecting to a Green Line routing that would have brought it almost straight north from Prince George's Plaza and through the center of campus for that), but it is possible to get to and from College Park by Metro.
Returning to the original subject of the thread, don't forget that the University of Maryland has a fine medical school as well - but it is at the University system's Baltimore City campus, a short walk from Camden Yards.
by C. P. Zilliacus on Jul 23, 2012 4:59 pm • link • report
by GWalum on Jul 23, 2012 5:03 pm • link • report
1. Very few people will ever have a medical condition so rare or complicated that it can only be treated at one specific hospital or by one specific doctor.
2. By far the most common major medical condition that will affect all of us is cancer and Georgetown is one of the 41 NCI designated comprehensive cancer centers.
3. Within the city limits of DC alone you have a dedicated children's hospital (which also operates the ER at UMC in Southeast), an NCI comprehensive cancer center, a Level 1 trauma center with helicopter access, a VA hospital, and a dedicated rehabilitation hospital. Not bad for a city of 600,000 people, and that's not counting all of the fine institutions outside of the city itself.
by dcdriver on Jul 23, 2012 5:09 pm • link • report
by MJ on Jul 23, 2012 5:09 pm • link • report
by grumpy on Jul 23, 2012 5:22 pm • link • report
CVD (Heart disease and stroke) are the leading cause of death for men & women.
http://www.cdc.gov/nchs/fastats/deaths.htm/
*note that type II diabetes is a leading contributor to CVD and kidney disease (nephropathy).
But 95% of type II diabetes, most CVD and most cancers, even alzheimers are chronic diseases that are preventable/delay-able with a primary prevention lifestyle approach - which to be supported, requires a system wide approach.
by Tina on Jul 23, 2012 5:33 pm • link • report
Be happy that NIH is here and that Johns Hopkins is such a prestigious place not too far away, and that for a city of our size, we have two decent med schools within our borders.
This conversation reminds me about how DC can become more of a center for "tech companies." I mean, why should it? If you wanted to start a tech company, you'd live elsewhere, not in DC, so why are we trying to compete with SF and Seattle, anyway?
by JustMe on Jul 23, 2012 6:07 pm • link • report
Really? As someone with family members who have needed to see a variety of top notch specialists over the years, and who have been willing to travel to other cities if needed (but they didn't need to), I've found that Greater DC has a decent number of highly regarded specialists given the size of our population. We have G'town/GWU research hospitals, NIH, and three top notch general hospitals in Sibley, Suburban, and INOVA Fairfax, all of which are affiliated with many top notch specialists.
That said, I agree that DC should beef up it's medical education facilities, along with other areas of STEM, as those are the fields of the future.
Having top medical institutions is all fine, however, if large chucks of the population do not have access to those top institutions, they're useless to most.
The vast majority of these top specialists take insurance and with Obamacare, in 2014 anyone who really wants insurance will have it.
On the rare occasion where it might help to have the country's best specialists looking at something, its no big deal to drive an hour.
Virtually anyone who lives to a ripe age will need those specialists many times before they die. We all die of something and whatever we die of usually requires lots of care from specialists.
by Falls Church on Jul 23, 2012 6:16 pm • link • report
And the lack of specialists really isn't that big a deal. Like people above said, if you really need and can get in to see a top specialist, you can drive to Hopkins.
It's almost embarrassing that Lawyer City USA doesn't have a Top-10 Law School.
The top 14 schools in the US News rankings have never changed. Ever. There's a huge amount of inertia there, plus the higher-ranked schools generally have more money to play with. But GU and GW are both excellent law schools, good enough that the difference in education you get there versus at NYU or U of Chicago is negligible.
by JW on Jul 23, 2012 6:20 pm • link • report
You are absolutely correct.
Dick Cheney and his wife donated a bunch of money to GW for their cardiac program. Both Georgetown and WHC are transplant centers (as is Inova Fairfax), so I wouldn't worry about cardie-vascular care.
Primary and preventative care is certainly about access, but I know people with Mediciad who get treatment from GW's faculty group practice, so excellent care is available.
Cancer, however, shouldn't be discounted in this discussion. The lifetime probability for males is 44% and 38% for females. Probability of death is about 1 in 5 for both genders. http://www.cancer.org/Cancer/CancerBasics/lifetime-probability-of-developing-or-dying-from-cancer
At some point US News appears to have gotten out of the news-reporting business and into the ranking business. Thousands of pages have been written on the problems with these rankings, so much so that from time to time some schools refuse to participate in them. Other schools openly try to game the system by, for example, over counting actual teaching faculty to appear to have lower faculty-student ratios.
Besides, it is a myth, perpetuated by TV shows like "House" and ranking outlets like US News, that people who die would otherwise be alive if only they could have been treated by some sort of "super doctor." Medicine rarely works that way.
DC has a perfectly fine set of medical schools and hospitals for its population, and if you include the resources of the region, we are doing better than fine.
by dcdriver on Jul 23, 2012 6:37 pm • link • report
> to get to see,
My impression of that changed drastically when I switched insurance plans. Wrong plan - "Can you come in a week from next Tuesday?" Right plan - "Tomorrow at ten?"
> and fewer take insurance.
Maybe it has more to do with the insurance dynamics in the various cities, than with the doctors!
by Turnip on Jul 23, 2012 7:20 pm • link • report
But, of course it would be good to keep GU's med school.
by Tom Coumaris on Jul 23, 2012 8:29 pm • link • report
It's time we start realizing we live in one metro area, in spite of what the census bureau says.
by Tom Coumaris on Jul 23, 2012 8:35 pm • link • report
DC has 3 Level 1 Trauma Centers + the Pediatric Level 1 at Children's Hospital. The State of Maryland has 1 + a Pediatric + the Shock Trauma Center in Baltimore.
Too bad I didn't get around to it, but for the last couple weeks I had been thinking about writing an entry proposing the equivalent of an MHO -- metropolitan health organization like the metropolitan planning organization -- for metropolitan areas that cross state lines.
E.g., one of the reasons that PG's health system is f*ed up is because of the cross-jurisdictional and poverty issues that are also tied up with DC, and the issues with UMC and HUH. FWIW, I have made that point constantly for years, that PG-DC-MoCo health and wellness planning should be more closely coordinated and planned.
by Richard Layman on Jul 23, 2012 10:19 pm • link • report
by Richard Layman on Jul 23, 2012 10:26 pm • link • report
by Rich on Jul 23, 2012 11:07 pm • link • report
Conversely, exactly who's neighborhood is it OK to "revitalize" and/or "develop" in order to make room for more med school students? That's really not a population that's going to hunt around on craigslist -- their school is going to build them housing, displacing some local population.
Huh? Georgetown offers zero housing for its med students. GW offers a couple of options like HOVA and Columbia Plaza, but almost all GW med students do, in fact, hunt around on craigslist.
@andrew
GWU and GU seem content to remain small playgrounds for the rich at the undergraduate level, while having decent-but-limited programs at the graduate level.
None of our schools are on par with the Ivies or great research universities.
Over half of GU students receive financial aid, so it is not quite the "playground for the rich" that it may have been in the past. Certainly my experiences there have borne out a pretty wide range of SES among the student body, although the polos & pearls set remains noticeable.
As for research, for what it's worth, there are 108 RU/VH (Research University / Very High research activity level) universities as categorized by Carnegie (the former R1 classification). Georgetown and GW are both on that list.
@GWAlum
Don't put too much stock in these media-driven surveys and rankings. The George Washington University School of Medicine was the most competitive med school nationally in admissions last year.
Pretty good for a school that is only a couple of years removed from being put on accreditation probation! Sorry, couldn't resist a little ribbing ;)
@DAlpert
In addition to the NIH omission, you probably should have mentioned, at least in passing, the Uniformed Services University of the Health Sciences.
by Dizzy on Jul 23, 2012 11:34 pm • link • report
This is getting derail-y into the general healthcare policy debate, but if we're talking about care on the lowest levels (and all signs are pointing that we could solve a lot of problems and save a lot of money with more cheap primary care), we shouldn't be talking about building a world-class med school. We should be talking about building primary care institutions that are suited to serve a large and diverse urban population. Kaiser are the only ones that I've seen do that effectively.
by andrew on Jul 24, 2012 1:12 am • link • report
There are so many wiggle words and qualifications in this statement that it's meaningless. And it serves as the basis for the entire column.
by dcd on Jul 24, 2012 8:41 am • link • report
Interestingly, DC's program of creating community clinics is at the level of national best practice. And I have suggested that they could work with Kaiser to implement a similar kind of medical records system. There isn't a combined, unified program across the clinics, and they aren't really used to deliver the kind of wellness services and chronic care management protocols as suggested in my above-cited blog entry.
But there is no reason that they can't move in that direction.
It's not in their financial interest to do so, but I've long thought that Kaiser could get involved with United Medical Center or the pre-involvement of UMMS in the PG Hospital issue, and take over and fix those institutions as part of their building the next level of their health care network in the DC region.
by Richard Layman on Jul 24, 2012 12:57 pm • link • report
I don't know if DC needs better medical schools, but it does deserve a good public university with strong graduate programs. These research universities can bring a lot of innovation to an area.
It is unfortunate that UMD is so hard to get to from DC, or even Silver Spring, but that's something that could be remedied. The Purple Line could largely solve this issue, and leaders in the area should be working to connect the regions tier 1 research university better to its biggest city.
by Patrick Thornton on Aug 14, 2012 5:40 pm • link • report
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