Should you schlepp to Boston?

Another year, another list of US News and World Report rankings.  This year’s Best Children’s Hospitals rankings are out, and it’s a Boston kvell-o-rama.

I find these rankings very amusing.  The people for whom they are most useful are the people who work in the PR departments of the hospitals at the top of the rankings.  For them, these lists are very important.  For everyone else, not so much.

I’ve had clinical experience at two children’s hospitals since entering medical school.  One of them is on this year’s “honor roll” and one is not.  Both were/are staffed by excellent pediatricians, nurses and clinical support staff, and deliver fantastic care to their patients.  I am confident that the overwhelming majority of patients would do just as well at either hospital.

Perhaps unsurprisingly, I will almost always recommend a children’s hospital over a general hospital (excepting truly superlative general hospitals with excellent and comprehensive pediatric departments).  Hospitals that are dedicated to the care of children will reliably deliver better treatment than those that are not.  A fantastic family practitioner is better than a lousy pediatrician, but all else being equal I’d want my patients (and certainly my own child) treated by someone who’s specialized in the medical management of children.  However, once you reach a certain threshold of competence and expertise, then there’s not much more that an “honor roll” children’s hospital will provide that you wouldn’t find at any good pediatric medical center.  Most childhood ailments should be managed well at almost any of them.

The patients who are most likely to benefit from care at one of the highest-ranked hospitals are the ones whose illnesses are most complicated, particularly if they are obscure.  Children’s Hospital Boston or Cincinnati Children’s is more likely to have an expert in rarer or more severe illnesses than a smaller children’s hospital.  These rankings are based on ten sub-specialties, and reflect the excellence of these hospitals in these more narrow clinical areas.  (Am I bitter that my own sub-specialty isn’t one of the ten listed?  NOT AT ALL!!)  There are even downsides to receiving care at hospitals that tend to deal with more complicated patients all the time (a post for a different day), and patients who don’t need to be seen by the world’s foremost authority on biliary atresia (to choose a diagnosis at random) don’t really benefit from being at one of the “best of the best.”

Is it nice if your child can receive care at Children’s Hospital of Philadelphia?  Sure.  It’s a world-class institution.  But almost all pediatric patients will do just fine somewhere else.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. Crap! I knew my kid was getting substandard care. Whom can I sue?

    Let me just say, if they were ranking departments of parking lot attendants, Children’s National would win the number one spot hands down! The loveliest guys, who remember and adore my kid.

  2. Everything you’ve said makes perfect sense. I’d be happy to take one of my sons – who is a healthy little guy – to any decent pediatric hospital.

    His brother has biliary atresia. We gratefully schlepp to Children’s Hospital of Philadelphia for his care. They rock.

    • Thanks for commenting, Jen. Your son’s case is obviously one in which it pays to go to one of the institutions at the very top of the list (of which, undeniably, Children’s Hospital of Philadelphia is one). If my son had a complicated illness like biliary atresia (which I chose because I happened to attend a noon conference about it relatively recently), and there was someone who could help in Sri Lanka, we’d schlepp to Sri Lanka.

      I hope your son is doing well, and I’m glad to hear that they’re taking good care of him at CHOP. While I’ve never worked there, I’ve heard uniformly wonderful things about it.

      • HELP!! Is there a doctor in the house? These black holes are creating a sense of extreme, unendurable claustrophobia.

      • My dear E.D. Kain, my very deepest thanks and gratitude, sir.

        I will behave. Promise!

        Now about this Bach fellow, Dr. Saunders…could anything be more representative of the greatness, nobility, beauty, intelligence of humanity than Herr Bach’s creative masterpieces. A true veritable treasure and fountain of and for the nourishment of the soul as has ever existed.

        (Thanks again ED–heartfelt thanks–the below is from Sir Thomas Brown–“Religio Medici.”

        “There is something in it of Divinity more than the ear discovers: it is an Hieroglyphical and shadowed lesson of the whole World, and creatures of God; such a melody to the ear, as the whole World, well understood, would afford the understanding. In brief, it is a sensible fit of that harmony which intellectually sounds in the ears of God.”

        “There is surely a piece of divinity within us, something that was before the elements and owes no homage unto the sun.”

          • Damn. Forgive the drifting of my thoughts, Dr. Saunders.

            Believe it or not, I had intended to discuss the perception of color. I’m not entirely sure where Bach, Divinity, and Religio Medici intersect insofar as ophthalmology is concerned.

            Ah, ok, a connection! Bach was totally blind the last few years of his life and (miraculously?) regained his eyesight the day he died, July 28, 1750. I wish I had more information to provide you–would love to hear your thoughts on this.

            I’ll get back to you soon. Thanks, Doctor.

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