There are many assumptions about both teaching hospitals and community hospitals. The latter are thought to have lesser quality physicians and medical staff, while the former have better educated and well-published experts. However, with teaching hospitals patients worry about medical interns or residents doing the actual medical work, while the attending physicians are in their ivory towers writing peer-reviewed articles to advance their academic careers. There are also the horror stories about the July 1 shift for new residents each year. Do you want your emergency intubation being done by a resident who just started his residency?
A recent study, published in the Journal of the American Medical Association, tries to measure the difference between the two kinds of hospital by looking at objective data. The study found that there are significant differences in outcome, and this generally reflects better care in teaching hospitals. The authors looked at 21 million hospitalization records from Medicare data. They were looking for risk-adjusted 30-day mortality. The study focused on 15 diagnosis groups and 6 common surgical procedures.
Except for stroke and sepsis, teaching hospital patients did better by every measure. For more complex procedures, like abdominal aortic aneurysm repairs, teaching hospitals had a mortality rate that was 5% lower than their community hospital counterparts. There was also a substantial gap — favoring teaching hospitals — for respiratory disease treatment. Since teaching hospitals often get referrals of patients who have more complex problems, the gap in favor of teaching hospitals may be even larger.
One of the reasons for this gap is probably that “practice makes perfect” — or at least better. As noted, major teaching hospitals are often the hospitals to which complex cases are referred, so the average doctor there may do similar procedures many more times than would a community hospital physician. There have been other studies that show that the more of a particular procedure, like aortic valve replacements, performed by an individual doctor, the fewer complications or bad outcomes.
