Do Prestigious Residencies Mean Better Doctors?

Styles of practicing medicine vary from hospital to hospital, and they are transmitted to young residents through a "hidden curriculum." 

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Johns Hopkins Hospital  [AlaskaLoneWolf/Flickr]

Each fall, medical students in their fourth and final year select a medical specialty and apply to residency programs. Residency, which lasts anywhere from three to eight years, is run by teaching hospitals. It's when newly minted MDs learn the hands-on, practical skills of doctoring -- how to make diagnoses, perform surgeries, order and interpret tests, etc. They also learn how to deal with patients and families, and work with other caregivers.

Just like colleges and medical schools, residency programs vary in terms of reputation -- which naturally affects the number and caliber of the medical students who apply to get in. But does training at a prestigious hospital mean residents will become good doctors? Maybe not.

A report from the Dartmouth Institute for Health Policy and Clinical Practice offers medical students a glimpse of the kind of doctors they're likely to become, depending where they do their residency. It compares 23 of the country's "top" teaching hospitals on various aspects of patient care: How they treat patients in their last few months of life, how many surgical procedures they perform, and what the patient experience is like. As the report notes, "understanding variations in the way care is delivered by these institutions is important because it affects residency training and, thus, the way residents in a given program will practice as physicians."

For example, the most prestigious hospitals are not necessarily the ones teaching the most compassionate or even the safest care. Looking at how patients are treated in the last six months of life might seem like an odd way to compare hospitals, much less residency programs, but its actually a good measure of the kind of doctors residents will learn to be, and it speaks to broader aspects of the training program. Looking at these patterns of care can help medical students find the best residency programs for them -- even if they're not necessarily the "best" programs.

Whether they are on the path to becoming pediatricians or pediatric brain surgeons, residents absorb the habits and assumptions of the senior doctors around them. Those habits include things like whether or not to admit patients with chest pain to the hospital, how often to recommend elective surgeries like knee replacements, and what kind of treatment to recommend to patients reaching the end of life. 

Practice style varies from hospital to hospital, and gets transmitted to young residents through what's often called the "hidden curriculum." It's one of the most important differences between residency programs. As the Dartmouth report makes clear, there is huge variation in the intensity and complexity of care delivered to very sick patients, even among hospitals considered the best in the country. 

Presented by

Shannon Brownlee & Joe Colucci

Shannon Brownlee is the acting director of the health policy program at the New America Foundation and an instructor at the Dartmouth Institute for Health Policy and Clinical Practice. Her writing also appears in The New York Times Magazine and The New Republic. Joe Colucci is a program associate in the New America Foundation's Health Policy Program.

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