Are Teaching Hospitals Safer and Better than Community Hospitals… or Less So?

A friend was recently diagnosed with an unusual form of leukemia. His prognosis is pretty good and the cancer center at our local hospital has an excellent reputation — but he’s decided to get treatment at a well-known academic medical center, even though he’ll have to travel more than 100 miles each way. He wants to be sure he’s doing “everything possible” to beat his cancer — and sometimes that means going outside the community to get access to new or cutting-edge treatment options. There are many factors to consider when deciding what hospital is best suited to your medical care needs, from the facility’s quality rating and cost to your own condition, needs and personal comfort. Teaching hospitals aren’t always tops in all those areas. I discussed the pros and cons of teaching hospitals with noted medical consumer advocate Charles B. Inlander, author of Take This Book to the Hospital with You: A Consumer Guide to Surviving Your Hospital Stay.

TEACHING HOSPITALS GET AN “A” FOR…

Also called academic medical centers, teaching hospitals often provide routine care, but are better known for innovative, sophisticated services, technologically advanced equipment and research laboratories that investigate cutting-edge, experimental treatments. Each teaching hospital is affiliated with a university medical school and staffed with residents from the school doing their clinical training, as well as the licensed attending physicians who supervise them. There are also “fellows,” which is what they call physicians pursuing advanced training beyond residency to learn a particular specialty. This range of personnel means that teaching hospitals, by their very nature, have more layers. The ratio of full-fledged doctors to residents varies from one teaching hospital to another, but generally speaking the benefit of academic medical centers is that patients have access to expertise plus the newest thinking and treatments.

In Inlander’s opinion, teaching hospitals offer a particular advantage for people with rare, complex or multiple medical conditions. Specialists are theoretically up to date on the latest research and treatment advances. A specialist’s extensive experience translates to more refined skills and a wider breadth of knowledge that is valuable in making obscure diagnoses and performing difficult or uncommon procedures — more so than at community hospitals where unusual cases truly are unusual. Since they have more patients with unique needs, both the specialists and the hospital staffs generally have much more experience in caring for people who are seriously ill. And certain teaching hospitals specialize at a very high level in the diagnosis and treatment of particular conditions, such as heart disease or cancer.

WHEN COMMUNITY HOSPITALS
ARE A BETTER CHOICE

Community hospitals may be easier to navigate, friendlier and more comfortable, while also providing high-quality care. In addition, Inlander is quick to note that there are some situations where community hospitals may be a better choice than teaching hospitals, especially for people visiting a hospital for more routine care (such as chemotherapy for common cancers or cardiovascular screening) or straightforward procedures — such as childbirth or a lumpectomy or stenting. Factors that may weigh against teaching hospitals include:

  • Higher cost. Since the cost of educating and supervising residents is high, the bill for a procedure may be larger at a teaching hospital than at a community one — and then you may need to add in travel costs as well. With consumers currently paying a higher percentage of medical costs out of pocket, this can be a serious consideration.
  • Higher infection risk. Simply being in a hospital can be hazardous to your health nowadays, given that hospital-acquired infections now kill more than 90,000 patients annually. Teaching hospitals have a greater number of severely ill patients who are therefore more vulnerable to hospital acquired infections… increasing risk to those around them as well. “A higher number of sicker people with more severely compromised immune systems can mean higher rates of infections,” Inlander warns.
  • There may be an “agenda.” The fact that teaching hospitals receive research funding from sponsoring drug companies or equipment manufacturers may translate directly into care recommendations.
  • Doctors who work longer hours make more errors. Though there has been systematic reform of the long hours required of medical residents, many routinely work longer days than is recommended. Ask your resident how long he/she has been on duty. A 2006 Harvard study reported that two-thirds of residents work 30-hour shifts, while other studies show that residents who work more than 20 consecutive hours are more prone to fatigue, lapses in concentration and medical errors. You always have the right to ask for a different doctor if you are concerned.

SAFETY CONSIDERATIONS IN THE HOSPITAL

Compare how your local community hospital stacks up against the nearest teaching hospital. You can research this kind of information about hospitals (such as standards of care, rates of medical errors and outcomes) at Web sites such as The Joint Commission at www.qualitycheck.org… the Hospital Quality Alliance at www.hospitalcompare.hhs.gov… and The Leapfrog Group at www.leapfroggroup.org. (For more on how to use online hospital comparison tools, see Daily Health News, May 5, 2008.)

Whatever hospital you go to, make sure to ask questions. Always know who is treating you. Be on guard at all times to make sure medical care is carried out safely (eg, that practitioners wash hands, that medications and dosages are correct, etc.). Patients in teaching hospitals should insist that an experienced physician — not just a resident in training — supervises care… and remember, you can opt not to have residents treat you, even at a teaching hospital. On the other hand, it’s not necessarily a bad thing to develop a relationship with the residents in addition to your doctor, since they are usually more accessible.

Source: Charles B. Inlander is a consumer advocate and health-care consultant based in Fogelsville, Pennsylvania. He was the founding president of the nonprofit People’s Medical Society, a consumer advocacy organization credited with key improvements in the quality of US health care in the 1980s and 1990s, and is author of 20 books, including Take This Book to the Hospital with You: A Consumer Guide to Surviving Your Hospital Stay (St. Martin’s).