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.