The programs of Massachusetts General Hospital in Boston, Johns Hopkins University in Baltimore and Boston's Brigham and Women's Hospital each received at least 600 nominations in the U.S. News-initiated survey. The University of California, San Francisco Medical Center got nearly that number.
Twenty other internal medicine residencies each got between 100 and 300 nominations out of more than 9,000 submitted. Some 300 other programs were named by 70 survey respondents or fewer.
By next Friday, February 26, senior medical students must identify and rank internal medicine residency programs in which they are interested. This type of residency can be a gateway to general practice or a subspecialty such as cardiology and gastroenterology. Most of the students will be matched to a residency based partly on their rank-order list and partly on each program's own ranked list of candidates. On March 21 ‒ "Match Day" ‒ the National Resident Matching Program, the nonprofit organization that runs the match process, will inform the students of their residency assignments.
Survey recipients were invited to name up to five programs they believe to offer the best clinical training in internal medicine. Doximity, an online network with more than 250,000 physician members, conducted the survey through a combination of web notifications and emails sent to 18,695 members who have completed a U.S. residency in internal medicine. The response rate was 18.2 percent. A total of 9,174 nominations were submitted by 3,410 internists, or 2.7 on average per respondent. The survey ran from the middle of last December to February 10.
U.S. News ranks hospitals and medical schools, but it neither ranks nor evaluates residency programs. The physician sample for the residency survey was not nationally representative, and the results should not be construed as a ranking. (The Best Hospitals and Best Children's Hospitals rankings use primarily objective data and secondarily results from nationally representative physician surveys.)
Its limitations notwithstanding, the new survey appears to be the first major effort to measure doctors' views on a formative part of medical training. In all, 2.2 percent of U.S. internists completed the survey. As a group, survey participants provide care at 1,300 hospitals and represent every state except Alaska and Wyoming. Doximity provided raw survey results and related data to U.S. News and assisted in analysis. Separately, the two organizations have a data-sharing collaboration that supports the U.S. News Doctor Finder.
Results and discussion. The survey's results show that a number of programs enjoy a substantial positive reputation. The 24 programs named the most frequently are listed in Table 1 in order of total nominations received. Results for two subgroups of respondents are also shown.
|Nominations (total)||Nominations from general internists||Nominations from program directors|
|Massachusetts General Hospital, Boston||732||179||25|
|Johns Hopkins University, Baltimore||696||162||36|
|Brigham and Women's Hospital, Boston||600||147||21|
|University of California, San Francisco||579||201||31|
|Mayo Clinic, Rochester, Minn.||297||67||8|
|Duke University Hospital, Durham, N.C.||283||50||17|
|Washington University/Barnes-Jewish Hospital, St. Louis, Mo.||249||46||10|
|University of Pennsylvania, Philadelphia||248||54||14|
|New York Presbyterian Hospital (Columbia Campus), New York||215||41||8|
|McGaw Medical Center of Northwestern University, Chicago||201||63||8|
|University of Michigan, Ann Arbor||183||57||7|
|University of Washington, Seattle||183||71||12|
|University of Texas Southwestern Medical School, Dallas||177||43||4|
|Cleveland Clinic Foundation, Cleveland, Ohio||165||53||8|
|Icahn School of Medicine at Mount Sinai, New York||161||44||9|
|Stanford University, Stanford, Calif.||155||38||5|
|Vanderbilt University, Nashville, Tenn.||150||38||7|
|New York Presbyterian Hospital (Cornell Campus), New York||149||41||6|
|University of Chicago||144||50||7|
|Emory University, Atlanta||134||44||2|
|UCLA Medical Center, Los Angeles||131||44||6|
|Beth Israel Deaconess Medical Center, Boston||130||42||1|
|Yale-New Haven Medical Center, Conn.||120||34||8|
|New York University School of Medicine, New York||115||31||3|
Doximity data also hints at a connection between a program's perceived success in training doctors to practice as internists and the residents' future career paths. Compared to internists who are currently in practice and trained elsewhere, a larger proportion of UCSF's former residents now practice as internists rather than subspecialists, according to Doximity (36% vs. a range of 18% to 34% for other programs, as shown in Table 2).
In the past few years, an even larger proportion of residents from UCSF's program has gone into general internal medicine, including general practice and hospital medicine, says Hollander. Perhaps only half have pursued subspecialty fellowships, he says. "That is probably lower than some of our peer programs and reflects the fact that we have two primary care tracks," one focused on underserved populations. Indeed, at least three-quarters of former residents from the programs at MGH, Johns Hopkins and Brigham & Women's are now practicing as subspecialists, according to Doximity (see Table 2).
Directors of postgraduate training programs also differed from the rest of the survey sample in how they responded. Among the 143 respondents identified by Doximity as directors of residency or fellowship programs, Johns Hopkins and UCSF received more nominations than either MGH or the Brigham. The residency at Duke University Hospital in Durham, N.C., was a close fifth in this subgroup of respondents, though it got considerably fewer nominations in the survey as a whole.
Physicians tended to nominate residencies near their practices. Among northeastern respondents, for example, residencies located in New York, Philadelphia and New Haven, Conn., rounded out the top 10. Residencies at Duke and at Vanderbilt University in Nashville were among the five programs named most frequently by respondents from the South. Midwestern physicians favored programs in Chicago; Rochester, Minn.; St. Louis; Ann Arbor, Mich., and Cleveland. And doctors in the West disproportionately nominated residencies in California, Washington and Colorado.
Responses also varied by the age of the physician. While MGH and Johns Hopkins received similar numbers of nominations among those older than 40, for example, MGH had an edge among younger doctors.
Limitations. What should medical students feverishly working on their match lists conclude from this survey? Its insight into programs' reputations could inform their preferences, particularly if they are concerned about how future colleagues might judge their medical pedigree. But the survey findings aren't authoritative.
Statistical biases may produce a distorted reflection of the opinions of all medical practitioners. For example, Doximity members might consider certain programs stronger than nonmembers do. We think this is possible but unlikely to have a large effect; Doximity's membership includes approximately one in three U.S. physicians and broadly mirrors the makeup of the U.S. physician corps on attributes such as specialty and location of practice, mitigating the risk of such sample bias.
Another uncertainty is whether respondents' nominations differed from those that might have been submitted by nonrespondents. Respondents tended to be subspecialists (68% of respondents vs. 57% of all U.S. internists), younger than 50 (54% vs. 44%) and practicing in the Midwest (31% vs 22%) or Northeast (29% vs 24%). Internists in the South (24% of respondents vs. 31% of all internists) and West (17% vs. 23%) were underrepresented.
All residency programs listed in Table 1 received the vast majority of their nominations from physicians who completed their own residency elsewhere. None of the four most-frequently-nominated programs got more than 6 percent of their nominations from their own graduates. Nevertheless, larger residencies programs and those whose graduates disproportionately participated in the survey may have benefited from being more familiar to respondents.
Statistical limitations asides, no survey can objectively measure what many doctors prize most about their residency experience: rigorous, hands-on clinical training. Established metrics on this crucial dimension are nonexistent. Until now, graduating medical students have had little more to go on than word of mouth and the impressions they gleaned from their visits and interviews.
Table 2. Research Productivity and Subspecialization of Tracked Graduates of Selected Internal Medicine Residency Programs
|Residency program||NIH grants per graduate||Publications per graduate||Clinical trials per graduate||Graduates who subspecialize|
|Beth Israel Deaconess Medical Center, Boston||0.33||11||0.15||74%|
|Brigham and Women's Hospital, Boston||0.79||15||0.25||79%|
|Cleveland Clinic Foundation, Cleveland, Ohio||0.06||6||0.07||75%|
|Duke University Hospital, Durham, N.C.||0.43||13||0.15||82%|
|Emory University, Atlanta||0.09||5||0.06||67%|
|Icahn School of Medicine at Mount Sinai, New York||0.09||5||0.05||66%|
|Johns Hopkins University, Baltimore||0.49||14||0.19||75%|
|Massachusetts General Hospital, Boston||0.89||20||0.18||79%|
|Mayo Clinic, Rochester, Minn.||0.13||9||0.10||76%|
|McGaw Medical Center of Northwestern University, Chicago||0.09||5||0.08||68%|
|New York Presbyterian Hospital (Columbia Campus), New York||0.48||10||0.23||84%|
|New York Presbyterian Hospital (Cornell Campus), New York||0.49||11||0.17||81%|
|New York University School of Medicine, New York||0.20||9||0.10||72%|
|Stanford University, Stanford, Calif.||0.49||12||0.15||73%|
|UCLA Medical Center, Los Angeles||0.30||11||0.10||72%|
|University of California, San Francisco||0.46||13||0.12||64%|
|University of Chicago||0.41||13||0.14||79%|
|University of Michigan, Ann Arbor||0.24||6||0.14||75%|
|University of Pennsylvania, Philadelphia||0.34||11||0.14||75%|
|University of Texas Southwestern Medical School, Dallas||0.17||7||0.07||75%|
|University of Washington, Seattle||0.23||8||0.09||67%|
|Vanderbilt University, Nashville, Tenn.||0.13||6||0.12||72%|
|Washington University/Barnes-Jewish Hospital, St. Louis, Mo.||0.34||10||0.10||78%|
|Yale-New Haven Medical Center, Conn.||0.18||7||0.07||73%|