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 the email – reprinted below – 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.



2 thoughts on “Residency Ratings

  1. Thanks Ira for highlighting this problem. There has been some unrest in the program director community, but not nearly enough in my opinion. This is purely a commercial endeavor on the part of Doximity and US News and World Report and does nothing to accurately inform the public or advance the quality of training programs.

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