Do Physicians From Higher Ranking Medical Schools Get Better Patient Outcomes?

Here is another fascinating paper deriving its data from Medicare services.[1] The authors took a random sample of nearly 1,000,000 patients age 65 or over who had been admitted to hospital as an emergency. They looked to see whether physicians from higher ranking medical schools achieved better mortalities, lower spending or lower rates of readmission. There were no differences whatsoever in mortality, despite the very high precision afforded by a study of nearly 1,000,000 patients. Spending per patient was slightly lower among the physicians from high ranking medical schools than among their colleagues from lower ranking schools. Two different rankings were used – for one of these the alumni of higher ranking schools had lower readmission rates, whereas there was no difference when the other ranking system was used.

It is known that there is quite a large variation in practice between doctors, but the variation between doctors would seem to be much greater than the variation between the graduates of different medical schools. Of course, the outcome as measured here might not be highly sensitive to a physician quality. It is likely that process measures would be a more sensitive reflection of performance than summary measures such as mortality and readmission rates. In fact, this is born out when propensity to write opioid prescriptions are compared, showing that graduates from lower ranking schools are more likely to overprescribe.

— Richard Lilford, CLAHRC WM Director

Reference:

1. Tsugawa Y, Blumenthal DM, Jha AK, Li KT, Orav EJ, Jena AB, Newhouse RL. Association between physician US News & World Report medical school ranking and patient outcomes and costs of care: observational study. BMJ. 2018; 362: k3640.