See here and here:
http://health.usnews.com/best-hospitals/area/chicago-il
Last year, UChicago Med was at least in the top 4 in the city of Chicago - so it’s dropped.
How does it make up the gap and get back into the top 20, nationally?
Heck, when I started undergrad not that long ago they were #1 in Illinois. Something has gone very wrong at UCMC.
Some of this might be the effects of across-the-board budget cuts by the university last year and in 2015. The first round was 2% at academic departments and 5-6% everywhere else; the second round took an 8% bite out of academic budgets and an unspecified percentage in other departments. Even if you take what faculty/staff say with a grain of salt, it sounds like the second round of cuts trimmed less fat and more muscle.
https://www.insidehighered.com/news/2016/06/09/university-chicago-cost-cutting-draws-objections
I doubt this is the whole story, but the idea that anything can be cut by 10% without affecting results is only real in the minds of Dilbert bosses and Illinois politicians.
Without a very large donation to the hospital, its location, while not an excuse seems to hurt its ability to be self sufficient. After all, in my home state of Colorado the University of Colorado hospital was quite average until they got a $100 million donation and built a new hospital complex (100+ acres) in conjunction with the VA that makes UChicago look like a small town clinic. It now ranks #15 in the nation rising to heights never seen before.
DunBoyer – The budget cuts would not be reflected in rankings that quickly. CU123 UChicago just got its own $100 M donation to the med center. I don’t think it’s solely money, although that might be part of it.
Here’s some analysis:
From Crain’s Chicago: http://www.chicagobusiness.com/article/20170808/NEWS03/170809884/northwestern-medicine-only-illinois-name-on-u-s-news-best-hospital (UChicago fell because it was only ranked nationally in three specialties - compared to four last year)
Also, some more granular analysis:
In 2003, UChicago Med was ranked 14th in the NATION, and #1 in Illinois (http://www.chicagobusiness.com/article/20170808/NEWS03/170809884/northwestern-medicine-only-illinois-name-on-u-s-news-best-hospital)
It’s been in free fall since that point, as seen here and here (final pages of each doc):
http://www.rti.org/sites/default/files/resources/abhmethod_2010-11.pdf
https://www.usnews.com/pubfiles/BH2015-16MethodologyReport.pdf
As seen in the methodology reports, almost all of UChicago’s specialties have been declining.
For instance, in 2010, here are UChicago’s rankings for various specialties:
Cancer #11
Diabetes #18
Ear Nose Throat #38
Gastroenterology #6
Geriatrics #29
Gynecology #34
Neuro #26
Kidney #21
Pulmonology #21
Urology #28
In 2015, here are UChicago’s rankings:
Cancer #34 (down from #11 in 2010)
Diabetes - Not in Top 50 (down from #18 in 2010)
Ear Nose Throat - Not in Top 50 (down from #38 in 2010)
Gastroenterology #25 (down from #6 in 2010)
Gynecology - Not in Top 50 (down from #34 in 2010)
Neuro #43 (down from #26 in 2010)
Nephrology #50 (a bright spot! was unranked in 2010)
Kidney - Not in Top 50 (#21 in 2010)
Pulmonology - Not in Top 50 (#21 in 2010)
Urology - Not in Top 50 (down from #28 in 2010)
The free fall has been startling. UChicago’s standings in virtually all specialties have dropped.
What is going on?
Cue7 - There’s a methodology used in Japanese production systems called 5 why. You go down 5 levels of why to find the truth. I don’t have the time to do this, but it would be interesting to do a 5 why on a couple of the specialties. You might get to the truth.
I don’t think the info needed to do that would be made available to the public, @kaukauna …
I don’t know what the reason is for the plummeting national rankings, but the reason for the drop from #4 to #7 in the local rankings is clearly a number of comparatively minor methodology changes that tend to favor suburban non-teaching hospitals. It’s clear from the list that, based on its national ranking and its number of high-performance conditions, Chicago would have been #4 again.
It’s always about the money, with a few billion you could take any hospital and make it top rate, and the 100 million Colorado got was only part of the total, actually a small part.
@JHS - if UChicago was nationally ranked in one more specialty (as it was last year), it probably would still be in the top 4 in the city.
The larger - and more pressing - question - is the drop in specialty ranking across virtually all specialties. For instance, how does a hospital go from #11 in cancer in 2010 to #34 in 2015? How do you go from #18 in diabetes to out of the top 50 in just 5 years?
My sense is, and @Poplicola has alluded to this - there are some managerial or administrative pressures that make practice at UChicago unfulfilling, and other schools with deep pockets and ambition (Northwestern, even Loyola) are poaching Chicago’s top docs.
I wish there was a way to see lateral movement - and to see which docs leave certain practices, and where they chose to go.
This doesn’t seem to be by chance - it looks like there’s an exodus of some sort from UChicago Medicine.
@Cue7 , if you read even the high-level methodology discussion for the USNWR rankings, you would see that they de-emphasized national specialty rankings for purposes of their local rankings in favor of outcome measures that systematically favor suburban hospitals, at least most of the time. It’s clear from the little data presented that Chicago has significantly more national rankings than the three hospitals ranked ##4-6, all of which I believe are satellites of other systems.
That doesn’t mean that all’s well at UChicago, but it does mean that the USNWR rankings may not really represent a fundamental shift in UChicago’s local standing, and that North Shore University - Evanston may not really be a contender in the academic medical world of Chicagoland
@JHS - true, the new regional ranking, which more heavily emphasizes “procedures/conditions” will favor (generally) suburban hospitals over urban ones.
This point aside, the much larger issue is the drop across so many specialty fields. Do you have any explanation for that? It’s a precipitous drop across so many fields - cancer, diabetes, gastroenterology, neuro, etc. It’s worrisome and puzzling, no?
This might be an oversimplification of the issue, but a few points:
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how is UChicago Med going to outrank a multi-billion dollar medical enterprise with the word “Cancer” in the title, and would it even be reasonable to do so?
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Cleveland, Mayo, UCSF - and, locally, Rush - are dedicated Health Sciences academic institutions, not part of a diverse private research university.
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Obviously NU, JHU,Duke and Stanford ARE diverse private research uni’s; however, with the exception of Stanford, all those med. centers are significantly larger than UChicago. Size matters.
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Looking at the affiliated medical schools of the above: all are larger than UChicago in terms of enrollees (nearly 500 compared to under 400). A 25% difference - but that might be enough to affect things like having a critical mass of faculty for specialized research, etc. which would obviously impact the rankings of the medical center.
Not saying there aren’t administrative problems with UChicago’s Health Sciences division and affiliated entities. Just thinking that those rankings are kind of comparing apples to oranges. Unlike college rankings, which at least separate the LAC’s from research universities (and then have separate sub-rankings for public vs. private), the hospital rankings are lumping very different entities all together. That can result in less meaningful comparisons. This point has also been made upthread.
But @JBStillFlying - your analysis doesn’t explain the precipitous drop over a short period of time. Remember, UChicago Med was ranked #14 nationally just 12 years ago - and it was about the same size then as it is now. Most of the other medical schools were the same size then as now, too. Further, the methodology for the national rankings hasn’t changed much - standing in specialties plays a big part in the rankings.
What happened in the interim to explain the drastic drop?
A relative drop in rankings can easily be explained without concluding that the division is slowly falling apart (I know you aren’t saying that but it IS a possible conclusion . . .). For instance, every entity has improved in terms patient outcomes, breakthrough treatments, and funding, but others have improved faster than UChicago due to the latter’s smaller size and less aggressive advertising. Other institutions may have grabbed onto specialty areas that they are known for but can’t provide the breadth of both academic and clinical experience that UChicago’s medical center can provide to both med students and residents. And so forth. Obviously you can’t truly compare UChicago (where the med school competes with the B and Law schools, among others, for funding) with Mayo or Rush. There are probably a host of similar factors.
Perhaps the most important one to consider is why does UChicago have a med center to begin with. After all, Harvard doesn’t, but rather farms its medical personnel out to the myriad excellent hospitals throughout the Boston area (excellent, in large part, to the existence of Harvard Med). UChicago also has partnerships with other health systems (including the one that Evanston Hospital is part of) - it’s curious that Evanston Hospital ranks higher than UChicago Medical when there are Pritzker faculty teaching at both. At any rate, because the med. center - and med school - are not running their own show but in fact are under the division of medicine and bio. sciences, it seems clear that the medical center doesn’t exist autonomously the way that the B-school and Law school do, but rather serves the particular needs of the division. That might be incompetent organizaton - or it might be a different philosophy about the purpose of having a hospital in the first place. After all, the division is named “Medicine and Biological Sciences” not “Health Sciences”. A nuanced difference, but a difference nonetheless.
So @JBStillFlying - what do you see is the reason here? What have other institutions done differently - in really the past 9 years (UChicago was ranked in the top 20 nationally as recently as 2008 or 2009, I believe) - that Chicago has not done?
What you’re saying makes sense over a longer time frame or if you look at certain specialties/areas. In Chicago’s case, however, almost every specialty has fallen precipitously over the past 5-10 years. Neuro, diabetes, gastro, etc. etc…
Further, what’s surprising is that the hospital rankings from 2003 to 2017 are remarkably consistent - the 2003 ranking had most of the same hospitals as the 2017 rankings. Moreover, schools that have fallen off the 2003 ranking (like Vanderbilt - a smaller medical system) are still quite close to where they were 12-15 years ago. So in 2003, Vandy was ranked at the bottom of the top 20, with 8 or 9 specialties with national standing, and in 2017, they had 7 specialties in national standing - not much of a difference.
Chicago went from having 10 or 11 specialties with national standing to 3 in a period of about 10 years. No other school I can see - big or small - endured such a loss. Further, smaller systems that did well 10 years ago (like Vandy) are still doing well now (they’re still #1 in TN, and are probably in the top 20-25 hospital systems in the country, a small drop of 3 places over 10 years).
“In Chicago’s case, however, almost every specialty has fallen precipitously over the past 5-10 years. Neuro, diabetes, gastro, etc. etc…”
- Rankings can change rapidly, as we've seen on the college scene and with the professional schools (Booth, to name one). Hospitals are no different once they find they are being ranked, especially if there is lots of money involved as a result of a change. The question is, should UChicago Med have held or even improved its rankings, would that have changed the funding? It's a good question. I simply don't recall much aggressive adverting on the part of UChicago Med. compared to other health systems (but I haven't lived in the area for awhile either - maybe things have changed?). Living in MN, I see a lot of advertising from UMN, from Abbott, from Mayo (Mayo has a national campaign!). The entire industry is one big marketing campaign. Is that happening with UChicago? We KNOW that the college has aggressively advertised and Booth was on a rankings campaign since year one (of the rankings - I was there. I remember). Certainly various parts of the place are quite capable of ratcheting up the advertising. The med center seems a bit sleepy by comparison. There's gotta be a reason for that.
“Further, what’s surprising is that the hospital rankings from 2003 to 2017 are remarkably consistent - the 2003 ranking had most of the same hospitals as the 2017 rankings. Moreover, schools that have fallen off the 2003 ranking (like Vanderbilt - a smaller medical system) are still quite close to where they were 12-15 years ago. So in 2003, Vandy was ranked at the bottom of the top 20, with 8 or 9 specialties with national standing, and in 2017, they had 7 specialties in national standing - not much of a difference.”
Vandy is not that small a medical center. Sure, the med school is about the same size as Pritzker’s. And the hospital has approximately the same # of docs. But it has 40% more beds and 30% additional nursing staff. It’s a larger stand-alone entity. Again, size is rewarded. Furthermore, who are Vandy’s hospital competitors? Most of them aren’t highly ranked in much of anything. Very different from a NU, or a Rush.
“Further, smaller systems that did well 10 years ago (like Vandy) are still doing well now (they’re still #1 in TN, and are probably in the top 20-25 hospital systems in the country, a small drop of 3 places over 10 years).”
- Chicago ain't Nashville, Knoxville or Chattanooga. Bigger market and a lot of hospital competition.
@JBStillFlying - do rankings change that quickly, and that steeply? If you go back 20 years, UChicago’s College was ranked #12 - now it’s ranked #3. That’s a nice increase. UPenn’s college was ranked #13, now it’s ranked #8, a nice change.
But in the med world. UChicago had specialties ranked in the top 10 or the top 20 6 years ago that have dropped 20, 30, 40 places or more.
Rankings for the top - for credibility purposes - seem to NOT change drastically over time, or year to year. You have some surprises every year, but at the top, it’s been quite consistent for a long period of time.
Could you point me to any other top, wealthy school that has seen a 40-spot drop in a period of 10 years?
I’m also confused by your statement of size being rewarded. Vandy’s med plant is bigger than Chicago’s, but Chicago was ranked ahead of Vandy as recently as 8 years ago. I apologize for bringing this up again, but what happened, as the methodology has stayed quite consistent? Are you attributing this mainly to lax advertising? What’s the reason for that? I mean if everyone else is achieving success thru advertising, why fall 8 years behind on this?
“do rankings change that quickly, and that steeply? If you go back 20 years, UChicago’s College was ranked #12 - now it’s ranked #3. That’s a nice increase. UPenn’s college was ranked #13, now it’s ranked #8, a nice change.”
- Yes. Take a look at schools that aggressively pursue the rankings game. It helps if you are coming from a relatively lower starting point.
“But in the med world. UChicago had specialties ranked in the top 10 or the top 20 6 years ago that have dropped 20, 30, 40 places or more.”
- totally concerning, no doubt. It's not clear what the answer is.
“Could you point me to any other top, wealthy school that has seen a 40-spot drop in a period of 10 years?”
- Can certainly point to a few that have had significant increases. In the world of healthcare there has been rapid change within the past 10 - 20 years so while a 40 point drop in some ranking system may be pointing to a fundamental problem, it may not be all that surprising.
The question, again, is whether anything’s changed about UChicago Hospitals or the affiliated Med school. For instance - 10 years ago if a UChicago faculty member contracted a form of cancer, was he more likely to receive treatment at UChicago than today? And if so, why? People I know who worked in the ICU know that Billings would get a heck of a lot more desperate cases than Northwestern - oftentimes they were turned away from those places and ended up at Billings. So it’s quite possible that certain factors that are deemed important today simply aren’t present at UChicago and so the ranking isn’t high.
“I’m also confused by your statement of size being rewarded. Vandy’s med plant is bigger than Chicago’s, but Chicago was ranked ahead of Vandy as recently as 8 years ago. I apologize for bringing this up again, but what happened, as the methodology has stayed quite consistent?”
- could be wrong here, but Vandy specifically has had significant expansion and renovation in the past 10 or so years and of course Nashville has had nice growth as well. Has Chicago had the same? HP and the surrounding area were certainly gentrifying over the past several years and hopefully that is continuing (not sure of the pace). Those factors absolutely matter. Something as simple as being able to attract faculty to your facilities and to your area of the city is a huge deal. This is where Northwestern has a definite advantage - while Chicago itself is shrinking, the gentrifying of the neighborhoods to the north of the loop, as well as the continued affluence in the surrounding burbs, puts it at a distinct advantage to UChicago monetarily. Now, why Rush is ahead of UChicago is a different story. Just connected with a relative who graduated from Rush nursing and spent time working at UChicago hospitals and she doesn't believe those ranking at all (except for the part about NMS being #1). Nevertheless, even if unreliable and easily manipulated, Rush is still doing something that UChicago isn't.
“Are you attributing this mainly to lax advertising? What’s the reason for that? I mean if everyone else is achieving success thru advertising, why fall 8 years behind on this?”
- My point about advertising is that the healthcare industry has rapidly moved into a very competitive one over the past 20 or so years. Those who don't get with the program (either merging with other hospitals to form a system, investing in new and better physical plant, etc.) are left behind. As mentioned, I'm not up with what UChicago has done to improve it's medical facilities over the past 10 or so years but I understand they've done some things with more in the works (including the level one trauma center). I do know that cash is limited, there's a real dearth of decent healthcare on the south side, and the the surrounding community depends very heavily on the hospitals. Those factors certainly present an opportunity but they may also hinder expansion exactly the way that the university sees fit. It is beyond excellent in terms of being a community hospital but it just doesn't have the modern visibility as a state of the art research facilitiy. It's not in an area where the average working Chicagoan desiring state of the art care tends to go or think of going and it's not located near the loop (where thousands upon thousands work every day). I'm not sure that it's attracted a national or even international patient base the way that MD Anderson, or Mayo, and similar have done. Someone coming in from another country is more than likely to land at O'Hare and get to Northwestern than to go to the south side. It's a harsh assessment, I realize, but the location might be a real disadvantage w/o either rapid changes in perceptions about the south side as a place to live and work or the hospitals' ability to provide some specialized niche care that one can only get in Hyde Park. That's why advertising is so important - but it has to be backed up with substance, of course.