Teaching Hospitals v Other

[Brat]

As we age health care decisions abound.

I am contemplating surgery and trying to figure out what would be best for me. My surgery is a quality of life issue, not life threatening but something that really does need to be done right. This is not cookie-cutter surgery, very patient specific. Work to be done by a specialist.

Locally there are three surgeons at a university hospital with lots of letters after the MD. I know that they have Residents in their department.

The only other surgeon with similar credentials works for Kaiser.

There are surgeons in that specialty (likely graduates from the university hospital or Stanford) who practice at a highly regarded local hospital but they don't have a string of letters after their MD. My primary care provider does not know the university surgeons but says that he knows two of these who do good work.

The other factor is that only the university has a department dedicated to the specialty which may impact surgical resources.

If I were to choose the university physicians there is a good chance that my work will be done at least in part by a Resident, my issue isn't really complicated (to the best of my knowledge).

Which route would you go and why?

 

[Ed_The_Gypsy]

Brat,

Is it practical to find out what the statistical outcome profiles are for the doctors you are considering? Sometimes it is available and sometimes it isn't.

If you are thinking about Pill Hill, I have an irrational positive feeling about them based on nothing except growing up in Portland and bicycling past the school a hundred times.

 

[jclarksnakes]

Look for data on outcomes for the surgeons who do surgery at the teaching hospital and pick one of them based on the data. In most instances the teaching hospital will have more high tech equipment available and experience using it. Those surgeons with all the letters after their names will also in most instances have much more experience doing your surgery. In the teaching hospital there are much more likely going to be experienced residents in the hospital after hours and having them readily available can help if something goes wrong.

 

[ERhoosier]

Research the individual surgeons & (if poss) their outcome stats for similar procedures. Some sources might inc healthgrades.com, hospital web sites (should give their med school & post-grad training programs), even just doing basic web search might be helpful.
Sometimes insurance plans have info/impact on these decisions.

Good luck in your quest.

 

[Meadbh]

I agree with previous posters. Teaching hospitals have residents, yes, and of course they are less experienced, but they are often more thorough and less likely to prejudge the situation. Good hospitals have multidisciplinary teams that build on everyone's strengths. As we age, our bodies are more likely to react poorly to "insults" such as surgery and we are more likely to develop complications. Teaching hospitals are more likely to have the moitoring and resiurces to be prepared for this. Do ask about outcomes. Also ask about processes and complication rates.

Questions to ask include:
1. How many of these procedures do you do every year?
2. What is your average success rate for the procedure?
3. What complications have followed this procedure in your hospital in the past 5 years?
4. What is the incidence of hospital acquired infection in your hospital?
5. What is the average length of stay for this procedure?
6. What safety measures do you employ? They should volunteer that they do the surgical checklist prior to every surgical procedure, that they use a DVT (deep vein thrombosis) prevention protocol, and that medications are always double checked.

Here is one review from the literature tat you might find helpful.

Teaching hospitals and quality of care: a review o... [Milbank Q. 2002] - PubMed - NCBI

Good luck in making your decision!

 

[Ed_The_Gypsy]

Wow! What great responses in only 5 posts!

 

[palomalou]

I've had major surgeries in teaching hospitals and in local (that, not by choice). On that basis, I'd take the teaching hospital any day and twice on Sunday. But all the questions are great--ask them. And hoping that all goes swimmingly for you.

 

[tinlizzy]

If it were me, I'd pick an outpatient surgery center (if possible) to hopefully reduce the chance of getting a nasty infection. My son tore his ACL his junior yr in high school, playing football. One of his teammates tore his MCL. I chose a local surgeon and outpatient surgery center and my son's teammate went with the coach's brother, an orthopedic surgeon at a tertiary hospital. My son had no complications and his teammate spent a little over a month in the hospital with a post-op staph infection.

The microscopic organisms are much scarier than the resident surgeons IMO.

I found this for you Oregon Health Policy and Research Oregon Healthcare Acquired Infections Report

 

[MichaelB]

For the same reasons already mentioned I would choose the teaching hospital. The primary reason to choose a surgery center or another hospital would be if the situation were life threatening and the surgeon was accomplished and much more experienced.

 

[Richard4444]

I am a Boston transplant now living in Florida. I had a few surgeries during my Boston days (Boston is only teaching hospitals with Harvard, BU, and Tufts being present along with the high quality residency programs). As a retired dentist, I certainly appreciated the slow and methodical procedures as the attending physicians taught the residents who did most of the procedures. IMO, this is highly preferred as the peer review is going on during the procedure.

 

[ERhoosier]

Personally would NOT make decision solely on "teaching" vs "non-teaching" hospital. There are good and bad in both categories so researching outcomes is critical. In many areas some of the very best hospitals are staffed by EX-teaching staff docs (& nurses, etc) who left 'academics' to deliver the top-notch care they refined over the years (& maybe make some decent $$ prior to retirement ).

 

[Brat]

Where there is a center of excellence in a particular specialty if you need that care that is the place to go. In Portland metro there is one noted for cardiac surgery, if I needed heart surgery that is my go-to place.

Two of our hospitals are trauma centers, they get more acute care patients than others in the area. One of the two is also a burn center. Those patients come in 'dirty', infection control is a nightmare. I always factor that in when I look at hospital acquired infections, particularly ICUs.

Thanks for the link!! After a look at the HCAIA report the three hospitals I have on my short list have better stats than both national and state data, one had no occurrences, for a procedure that would be indicative for my care.

 

[frank2009]

I unfortunately had the recent pleasure of spending 4 days in a teaching hospital. Overall the experience was positive. I do plan to remain with the hospital for post op care. Once I got over the fact that the residents were so young, I found that they were all thorough and courteous. I also liked the fact that a more experienced doctor reviewed their work.

On the negative side, I found that residents were constantly during business hours, giving me the same cursory examination and asking the same questions. I just wanted to sleep and feel sorry for myself.

Overall, I'd agree with ERhoosier. I don't think that teaching or non teaching should be the sole factor when making your decision.