primary care "ranks" not talked about and not understood

I think part of it is what percentage of the medical school's graduates go into primary care residencies.

 

Bingo. Its a huge factor (just as research is a huge factor for research rankings).

http://www.usnews.com/usnews/edu/grad/rankings/about/05med_meth_brief.php

 

Well, this explains how USNews ranks one school better at teaching primary care than another, but what factors really make a difference to us students?

 

None, thats the problem with US News. It tells you absolutely nothing about TEACHING or how a school affects students at all, since there is no output measure (ie, % getting top 3 residency or USMLE average)

 

Well, disregarding ranking methodology, if you look at OHSU (which, incidentally, is perenially ranked 2nd in primary care), they're very heavy on early clinical experience, with longitudinal preceptorships in ambulatory care, family practice clinics. Moreover, when it comes to rotations, they require 12 weeks of general internal medicine, 10 weeks of peds, 6 weeks of OB-GYN, 6 weeks of family medicine, and 6 weeks of a rural primary care rotation. I think that's about as primary care-intensive a clinical curriculum as you'll find anywhere, so if you're looking for a really strong background in primary care, a school like OHSU will help you a lot. On the other hand, if you're not sure whether or not you want to specialize or in what area, it doesn't leave you a whole lot of time to explore other fields. Of course, the rankings list only 44% of OHSU grads as going into primary care, so it's definitely not prohibitive by any means.

 

Fortunately, you can go to any school and take elective/selective rotations to supplement the required primary care rotations, so the fact that these are required at some schools doesn't necessarily make those schools better than others for those considering primary care. I guess that leaves early clinical exposure as one of the main factors determining how strong a school is in teaching primary care. Does that sound right?

Also, Gleevec pointed out something about the rankings that I hadn't really thought about, which is that they don't consider output factors like USMLE scores and top choice residency placements. That seems pretty ridiculous to me.

 

No one does. Because then all the "top ranked" schools would get exposed as not that different from the rest of the schools.

The truth would hurt the big-wigs too much.

 

Top choice residency placement doesn't really mean anything. This is because the top ranked program on a person's rank list might not necessarily be his/her "real" first choice. It is only his first choice among those who offered him interviews. For example, I might really want to go to MGH, Hopkins, and all those top places, but none of them granted me interviews, so I only got to interview at some very non-competitive community programs. As a result, I only get to rank these community programs. However, when I match at my number 1 choice, I am still counted in the school's statistics as getting my top residency choice when, in fact, I didn't even come anywhere close to getting any of the programs that I really want to go. In fact, nationally, something like 80% of all applicants get their top three choices. So, that's why those statistics won't mean anything. That's also an advice to all those applying for med schools, don't put too much weight into school's claims such as "90% getting top 3 choices." They only represent top 3 choices AFTER the interview cut.

 

Thanks for explaining the residency match system. I was actually a little confused about that. It's much like the Texas med school match system, and yeah, I guess those top 3 stats don't mean all that much.

 

It's useful to see not just # of people matching to competitive specialties, but WHERE they match to. Some people choose less competitive specialties to apply to b/c of interest, not neccessarily b/c of the strength of their application.

However, it does seem like people have a higher chance matching back at the hospitals affiliated with the med school they graduated from. So that's something to pay attention to. For example, many people from Northwestern match at McGaw (renamed as Northwestern Memorial), and many people from Columbia/Cornell match at NY Presbytarian.

 

just to get it out of the way... yes i'm biased towards U of Washington. but i think we can all agree that the rankings are controversal. still, i did want to point something out...

note the % each school scores compared to the top ranked school, who automatically gets 100%. in the research ranking harvard is 100, wash u is 96, jhu is 95 and the last of the top 10, yale and u of wash are 87.

now look at the primary care rankings. top ranked u of washington is 100%, while #2 ohsu is 80%. thats a huge difference!

i think its hard to argue that any controversy exisit with u of washington being recognized as the best place to train in primary care. i could throw in other specific details but that's what the schools website is for.

 

since primary care is an inherently non-competitive field, why do you need to go to a "top" program to gain a 'top" residency? Is that the benefit? Do MSU-DO students get better primary care residencies than say, Columbia med students since its ranked higher? I've never figured out how to interpret them.

 

My personal opinion is that a 'competitive primary-care' program is very relative in its terminology. However, I do believe there are a couple of things that correlate strongly with Strength of Pri. Care focus:

1) A school, or area that does not have a lot of interns or residents, i.e. you the student are in direct contact with the physician and get 'first-dibs' on clinical practice and exposure, almost on an intern like level. The residents aren't there to take away from your experience.

2) Early Preceptorships (i.e. from day 1) in a variety of primary care settings, allows the students to plan out years 3 and 4 of medical school to be able to ensure more ideallic matching.