The college ranking methodology takes into account a number of factors and weighs them in an arbitrary way. Gladwell feels that cost is not given enough emphasis as expensive private universities dominate the top of the list. When it comes to hospital rankings, U.S. News surveys only 250 physicians in each specialty and asks them to name the five best hospitals in their field. It is impossible for a hospital without an established national reputation to ever be ranked highly.
This whole charade is carried to an almost comical extreme by the folks at Castle Connolly, who bring you “America’s Top Doctors” and regional offshoots of the same concept. These ratings are eagerly awaited ever year and are the subject of lengthy articles in magazines. Advertising revenue is generated as hospitals tout their MDs who have been fortunate enough to have made the Castle Connolly list.
Here is a little secret. Castle Connolly sends questionnaires to hospital department chairs and asks them to name the best doctors in not only their fields but every medical specialty. No other criteria are used. Having been a department chairman for over 23 years, I can tell you that it is impossible for me to know anything about the quality of the work of any physician at another hospital or even sometimes another specialty in my own hospital. The vote is strictly by reputation. Many fine doctors make the list because reputations are very often correct. But not always. A surgeon can be well-known for research or involvement in organizations, but she may not necessarily be the best clinician around.
So what is a prospective patient to do? I’ve already blogged about the shortcomings of Healthgrades [here and here] and the CMS [Medicare] Physician Compare website is not ready for prime time. For now, I suggest you ask friends who may have had illnesses similar to yours for recommendations. Or you’ll have to trust the doctor who refers you to a specialist and your instincts when you meet her.