Blog | Monday, January 12, 2015

Residency ratings


I have been a big proponent of seeking the feedback of our patients regarding their experiences with our care, and of pushing our organization to be more transparent about the results. I believe that sharing performance motivates everyone to raise his game, and that we should embrace valid ratings on specific measures. On the other hand, I have always thought that global “rankings” divorced from specific performance measures make little sense.

As Malcolm Gladwell pointed out in the New Yorker a few years ago rankings of complex, multidimensional things like cars or colleges are inevitably flawed, because they don't account for the fact that different people will value various attributes in different ways. There is no “best car” since I may value handling and acceleration, and you may value styling and safety. Likewise, there is no “best college” because one student may value class size or athletic facilities while another values research opportunities and proximity to a large city.

That is why I was appalled when I got an e-mail from the current director of my old medical residency. Here is what is wrong with this, in no particular order.

Like cars and colleges, residency programs have too many dimensions to reduce to a simple comparative rank. Doing so ignores of host of questions that may be important to a graduating medical student, such as: Is this in a city where you would like to settle? Does the institution have strength in a particular subspecialty that you may want to pursue? Will you be required to travel to satellite training sites? If so, would you consider that an asset or a deficiency?

Technically, I am not an “alum” of the BIDMC training program. I am proud to say I did my medicine residency at Boston's Beth Israel Hospital, which no longer exists. The BIDMC was created years later through the merger of the BI and the New England Deaconess Hospital.

Even if the old BI did exist, what could I possibly contribute to developing an accurate assessment of the current program, given that I was an intern 30 years ago?

This has nothing to do with seeking meaningful feedback to drive improvement. It has everything to do with soliciting votes for a beauty contest.

In the end, this is pretty sad. I think my residency program was very good. I cared for a wide range of patients, I had excellent role models, and I developed skills and habits that provided an excellent foundation for my professional growth and development. I also developed a deep affection for the hospital where I trained; it is not only where I trained, but where I later met my wife, and where our children were born. And yet all of that is, in the end, completely irrelevant. So I won't be “voting” for this program on Doximity, and I hope no one else will either.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.