Is Washington falling behind on medical education and care?
Photo by Poppy Wright on Flickr.
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.
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.