Comments on Is Washington falling behind on medical education and care? - Greater Greater Washington

Comment by Patrick Thornton

Tue, 14 Aug 2012 17:40:06 EDT

One of the core reasons I live in Silver Spring instead of The District is the lack of good public school options for adults. If you live in DC, you have to pay private school rates no matter where you go. UMD has the best overall graduate programs of the schools in the area (and by far the most comprehensive). If you're an adult who may want to go to graduate school, living just across the border makes a lot of sense.

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.

Comment by Richard Layman

Tue, 24 Jul 2012 12:57:21 EDT

andrew -- I've been to some presentations at Kaiser, and seen a demonstration of their integrated medical record system. It is a model, because they combine care + insurance, and so they are very motivated to reduce costs, through chronic care management, wellness, etc. (They are big on walking and I am trying to get them to be big on biking.) In this region, they don't have hospitals though, but everything else. As you know, Kaiser's efforts are a model for improving the way that health care services are delivered more generally.

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.

Comment by dcd

Tue, 24 Jul 2012 08:41:19 EDT

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.

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.

Comment by andrew

Tue, 24 Jul 2012 01:12:31 EDT

If we want to talk about basic primary care, you should all be looking really closely at Kaiser Permanente. They're putting a pretty massive investment into the DC area, and they do primary care very well, and keep their costs under control.

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.

Comment by Dizzy

Mon, 23 Jul 2012 23:34:06 EDT

@Vinnie

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.

Comment by Rich

Mon, 23 Jul 2012 23:07:21 EDT

The idea that US News & WR knows anything about med schools is your first problem. they don't. All of their rankings are filled with problems. Moreover, the gradataions between ranks are of varying importannce. having seen so much of this garbage and having been both an academic and someone who interacts with academics, I am a skeptic. The USN&WR rankings in my own field border on the laughable in many areas. [Deleted for violating the comment policy.]

Comment by Richard Layman

Mon, 23 Jul 2012 22:26:29 EDT

Tina -- I used to think I was awesome for suggesting an integrated wellness system including the management of chronic conditions (e.g., this blog entry from a few years ago: http://urbanplacesandspaces.blogspot.com/2008/02/dispuptive-innovation-once-again.html) but Christopher Alexander posited something not dissimilar in _Pattern Language_ which was published in 1979. (FWIW, a couple decades ago I worked for the Center for Science in the Public Interest, where I learned about health and wellness, focused on nutrition and alcohol policy primarily.)

Comment by Richard Layman

Mon, 23 Jul 2012 22:19:34 EDT

wrt dcdriver's point, I remember when advocating against the creation of a new HUH on Res. 13, that someone commented that many states and/or regions have only one Level 1 trauma center, but the residents in DC want one in every ward.

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.

Comment by Tom Coumaris

Mon, 23 Jul 2012 20:35:24 EDT

also, SF has both UC Boalt Hall law school as well as UC Berkley's and Stanford is as far from SF as Baltimore from DC.

It's time we start realizing we live in one metro area, in spite of what the census bureau says.

Comment by Tom Coumaris

Mon, 23 Jul 2012 20:29:44 EDT

Hopkins' international school is here (SAIS) as well I believe as it's business school. I'd certainly consider Hopkins' med school as part of greater DC.

But, of course it would be good to keep GU's med school.

Comment by Turnip

Mon, 23 Jul 2012 19:20:25 EDT

> Primary care physicians also generally seem harder
> 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!

Comment by dcdriver

Mon, 23 Jul 2012 18:37:25 EDT

@Tina

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.

Comment by JW

Mon, 23 Jul 2012 18:20:53 EDT

GW is good enough for the Secret Service to have Cheney's heart work done there, and good enough to go there if something happens to the president. As far as I'm concerned, that makes it good enough for me.

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.

Comment by Falls Church

Mon, 23 Jul 2012 18:16:13 EDT

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.

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.

Comment by JustMe

Mon, 23 Jul 2012 18:07:14 EDT

DC is never going to be all things to all people. Georgetown and GWU are never going to be "coveted" residency programs, but they are fairly solid as far as these things go.

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?

Comment by Tina

Mon, 23 Jul 2012 17:33:25 EDT

@dcdriver -By far the most common major medical condition that will affect all of us is cancer

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.

Comment by grumpy

Mon, 23 Jul 2012 17:22:07 EDT

As others have pointed out, Johns Hopkins is not that far away and we have several well-regarded hospitals in the area so I'm not too worried about DC being under-served in the area of medical care. That said, I do agree with David's eventual point that it is in DC's best interests to support medical institutions in and around DC, and I would much rather see the money DC just spent to subsidize Living Social instead go to an educational institution which would be investing in something which is both more valuable and permanent.

Comment by MJ

Mon, 23 Jul 2012 17:09:02 EDT

One look at the chart shows you that the real problem is that DC lacks a powerhouse university. We don't have a Stanford, Harvard, UChicago, Berkeley, Penn or Columbia. Why are we singling out medical education here? I'm having a hard time getting excited over this...

Comment by dcdriver

Mon, 23 Jul 2012 17:09:00 EDT

The good news:

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.

Comment by GWalum

Mon, 23 Jul 2012 17:03:19 EDT

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. And GW Hospital is the most up to date, state of the art teaching hospital in DC.

Comment by C. P. Zilliacus

Mon, 23 Jul 2012 16:59:15 EDT

andrew wrote:

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.

Comment by Tina

Mon, 23 Jul 2012 15:55:32 EDT

The NIH has a medical center that is filled with specialists that patients come to from all over the world; in addition it provides opportunities for participating in clinical trials that are not widely available in other geographic areas. Furthermore at its Bethesda campus NIH hosts some of the best academic research in the world (in addition to funding it at other places like UCLA). Also the WHC is both a teaching and research hospital, as is Childrens. And as pointed out, Hopkins is 35 miles away.

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...

Comment by spookiness

Mon, 23 Jul 2012 15:44:42 EDT

Bingo everything Andres said, especially with regards to adult education. I know that a decade+ ago I considered moving from NoVa to the district, but one of the factors that swayed my decision not to do it was the lack of continuing ed options that I knew I'd one day need.

Comment by Jasper

Mon, 23 Jul 2012 15:41:59 EDT

@ andrew:DC's problem isn't a lack of a good med school. It's a lack of a solid Higher Education system all around.

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.

Comment by andrew

Mon, 23 Jul 2012 15:26:00 EDT

Why isn't Hopkins included here? UCLA Medical Center is further from some points in LA than Hopkins is from most of DC, and Stanford is actually a bit further from downtown SF than Hopkins is to downtown DC.

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)

Comment by charlie

Mon, 23 Jul 2012 15:13:35 EDT

About the only correlationI I see is that teaching hospitals generally have better standards of care. Medical students are only a very marginal part of that.

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.

Comment by Vinnie

Mon, 23 Jul 2012 15:08:08 EDT

What Jasper said. Health is best maintained by having a large number of competent professionals (which means nurses, too, not just doctors) and access to care for as many as possible.

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.

Comment by Simon

Mon, 23 Jul 2012 14:57:06 EDT

If you're going to artificially add Stanford to San Fran, you might as well add Yale to NYC...

Comment by Jasper

Mon, 23 Jul 2012 14:51:35 EDT

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.

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.