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Best medical schools? Profession mixed on fairness, merits of U.S. News rankings

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Alex Westerfelt, PhD, aims to sway osteopathic medical school administrators to stop participating in U.S. News & World Report’s surveys for ranking medical schools. The formula used to rank schools on primary care is flawed, he says. Dr. Westerfelt directs institutional assessment and planning for the Ohio University Heritage College of Osteopathic Medicine in Athens. (Photo courtesy of OU-HCOM)

A few osteopathic medical schools fare well in the latest U.S. News & World Report rankings of “Best Medical Schools.” In primary care, which is considered one of the two major ranking categories, the Michigan State University College of Osteopathic Medicine in East Lansing stands at No. 14 and the University of North Texas Health Science Center Texas College of Osteopathic Medicine (UNTHSC/TCOM) in Fort Worth at No. 20. In addition, the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg ranks 9th in rural medicine and 12th in family medicine.

What’s more, three osteopathic medical schools make the Top 20 in geriatrics. UNTHSC/TCOM ranks 16th, while the University of Medicine and Dentistry-School of Osteopathic Medicine (UMDNJ-SOM) in Stratford ties for 19th place with the University of New England College of Osteopathic Medicine in Biddeford, Maine.

Many other osteopathic medical schools, however, are poorly ranked or unranked, and medical school rankings can vary mysteriously from year to year.

A number of osteopathic medical school representatives agree that the U.S. News ranking methodology is flawed, but they differ as to what should be done as a consequence. School administrators have varying views on whether the ranking system is a challenge to surmount or a travesty to shun.

Compounding the problem, U.S. News rankings are sometimes taken out of context by organizations that adapt the statistics for their own purposes. The popular physician rating site Vitals.com, for example, draws from the rankings to assign a quality score to medical schools. Vitals gives the vast majority of osteopathic medical schools just one out of four stars.

Call to boycott?

Joining five other osteopathic medical schools, the Ohio University Heritage College of Osteopathic Medicine (OU-HCOM) in Athens opted out last year from participating in U.S. News’ annual data and opinion surveys, which form the basis of the med school rankings. OU-HCOM’s director of institutional assessment and planning, Alex Westerfelt, PhD, hopes to spur other colleges in the profession to discontinue participation in the U.S. News ranking system, which he asserts is subjective, unscientific and strongly biased against osteopathic medical education, despite the high rankings of a handful of DO schools.

“The rankings are a very successful marketing effort but are not a valid research effort,” Dr. Westerfelt contends. “We have to stop letting a business venture define quality in medical schools.”

Dr. Westerfelt takes particular issue with the primary care rankings, for which, he insists, U.S. News “uses inferior methodology that no peer-reviewed journal would ever consider.” Given their strength in producing primary care physicians, osteopathic medical schools have been woefully underrepresented among the top-ranked institutions, he says.

Misuse of U.S. News rankings can harm profession’s image

While osteopathic medical school deans are all too familiar with the U.S. News & World Report ranking system, many are unaware that the popular physician rating site Vitals.com assigns a quality score to medical schools based primarily on the U.S. News rankings.

A number of DOs interviewed for The DO’s series on online physician rating services, such as AOA Trustee Norman E. Vinn, DO, and Al Turner, DO, a Portland, Ore., osteopathic manipulative medicine specialist, express dismay that Vitals.com predominantly gives osteopathic medical schools just one out of four stars. “What gives this website the authority to rate our schools?” questions Dr. Vinn.

Robert J. Morse, the director of data research for U.S. News & World Report, notes that Vitals.com is “misappropriating U.S. News data.” The oversimplified quality scores do not reflect the many variables U.S. News uses in its rankings, he says.

The U.S. News ranking system gives each medical school a composite score of up to 100 points based on four broad components:

  • Quality assessment, weighted at 40%.
  • Proportion of graduates entering primary care, 30%.
  • Ratio of full-time faculty members to students, 15%.
  • Selectivity of admissions, 15%.

To come up with its quality assessment, U.S. News sends a survey to medical school deans, associate deans for academic affairs, and heads of internal medicine departments, asking them to rate each of approximately 160 allopathic and osteopathic medical schools on a scale of 1 (marginal) to 5 (outstanding), with “don’t know” also available as an option. In addition, the publisher sends a similar survey to a sample of MD residency directors in internal medicine, family medicine and pediatrics. Because osteopathic medical schools are much fewer in number and less well-known than allopathic medical schools, especially in regions of the country that do not have an osteopathic medical college or many practicing DOs, osteopathic medical education faces an unfair disadvantage in these opinion surveys, Dr. Westerfelt says.

“Both pools of evaluators on average rate the quality of osteopathic medical schools lower than that of allopathic medical schools,” Dr. Westerfelt says. “Those opinions count for the bulk of a school’s score and subsequent ranking.”

To calculate the percentage of a medical school’s graduates going into primary care, U.S. News uses the number of graduates entering residencies in family medicine, internal medicine and pediatrics. Although U.S News reports in a separate list that the Top 5 producers of primary care residents are osteopathic medical schools, even this component of the ranking system doesn’t give osteopathic medical education its expected edge because the 30% weight is not sufficient to compensate for the more heavily weighted quality assessment, Dr. Westerfelt says.

Moreover, the primary care proportion fails to present an accurate picture of those graduates who will actually practice as primary care physicians after serving their residencies, according to Dr. Westerfelt. The ranking system does not take into account that many residents in internal medicine go on to subspecialize. The fact that far more MD graduates than DO graduates pursue internal medicine, as opposed to family medicine, residencies suggests that the U.S. News primary care percentages for leading allopathic medical schools are inflated, he points out.

The student selectivity component of the U.S. News primary care formula weights average scores on the Medical College Admission Test at 9.75%, mean grade point average at 4.5%, and average acceptance rate at 0.75%. Osteopathic medical schools have traditionally admitted students with somewhat lower MCAT scores and GPAs than do allopathic medical schools, so it is not surprising that DO schools lose further ground with this portion of the ranking formula, according to Dr. Westerfelt.

“Research has shown that the higher the MCAT scores, the more likely students will go into subspecialties,” notes Bruce D. Dubin, DO, JD, the dean of the Rocky Vista University College of Osteopathic Medicine in Parker, Colo. Osteopathic medical schools place more emphasis on candidates’ expressed commitment to primary care and to osteopathic principles and practice, Dr. Dubin says.

Osteopathic medical colleges also come up short on faculty-student ratio because DO schools use a higher proportion of part-time faculty members, who are not counted in this ratio.

By participating in this ranking system, “osteopathic medical schools have abdicated the right to define quality,” Dr. Westerfelt argues. “The U.S. News ratings are determined by uninformed opinions and by inputs, such as MCAT scores and GPAs, rather than by outputs—the quality and the number of our graduates who become primary care physicians.”

10 Responses

  1. Stephen Blythe, D.O. on July 1, 2011, 12:36 p.m.

    Since an internal medicine residency is often the gateway to a medicine subspecialty, the number of graduates entering an IM residency hardly reflects a colleges primary care orientation. As stated, looking at the percentage of graduates practicing in primary care would be far more valuable. And there is still the allopathic bias against medical education taking place at the community hospital level. My internship at a very busy community hospital put me at the front line of patient care and procedures. For example: While I saw no advanced limb salvage procedures during my ortho rotation, I spent the month working alongside three very busy orthopedists – as their only intern – examining knees, elbows, necks, and backs, reviewing x-rays, applying splints and casts – from morning to night. I would put my basic primary care orthopedics training up against any Mayo Clinic intern any day.

  2. Joe Baber, DO on July 2, 2011, 7:44 p.m.

    Osteopathic schools must take a careful look at the materials and methods used to make these assessements. Even if these results would not stand up against the same scrutinity that physicians use to critique primary literature, it should be openly discussed. While we know that NEJM publishes many industry sponsored studies infused with bias, they still generate national attention and turn the hands and pens of practicing and prescribing physicians. Instead of disregarding the data, the osteopathic profession should critique it in a way to formulate a self assessement for continued self-improvement. From my experience in a leadership position in an ACGME IM residency program, there remains a wide range of clinical skills proficiency amongst our osteopathic incoming residents. I have concerns that as the profession rapidly responds to meet the needs of the community in underserved areas with newer medical schools, the oversight and quality assurance of the clinical training years must be more closely assured so that all graduates will remain to be optimally equipped to enter any training specialty.

  3. Pouya Bahrami DO on July 4, 2011, 1:38 a.m.

    Osteopathic Medical Schools need to be more independent minded and innovative. We have traditionally waited for “others” to define us before we fight back. I find it interesting that there is not a single “fair” proposal by Osteopathic institutions to rank medical schools. Why not create a fair methodology and rank all schools in the Osteopathic and Allopathic disciplines? Such a fair, and balanced ranking, published by the Osteopathic profession, could have subcategories that include primary care, specialty, or underserved champions. Once we, the Osteopaths, begin to rank schools in a methodology that most fair minded institutions and scientist would agree with, not only we attract the attention of the academia, but we also can fairly see how we are doing and what we should be doing better. We can lead by example and not worry about the US News. How about that for a change?

  4. Roselia Conrad, DO on July 4, 2011, 5:49 a.m.

    I agree with you Dr. Bahrami.

  5. Jake on July 8, 2011, 1:21 a.m.

    After reading this article, I feel terrible on choosing osteopathic school over allopathic school. I declined two allopathic acceptances to go to a osteopathic school that I truly loved, but after reading this article, I wish I hadnt declined my allopathic acceptances.

  6. Pouya Bahrami DO on July 20, 2011, 7:47 p.m.

    Jake you’ll be fine, you did the right thing if they were for the right reasons. Full steam ahead.

  7. Pouya Bahrami DO on July 20, 2011, 7:47 p.m.

    Thank you Dr. Conrad.

  8. Robert C. Bowman, M.D. on Sept. 23, 2011, 11:47 p.m.

    To “measure” primary care, specific primary care delivery measures are needed. Primary care rankings can be established that adjust for primary care retention, volume, years in a career, and % active. The Standard Primary Care Year (SPCYr) is such a measure – specific to class year of graduation and reflecting the future primary care delivery throughout a career.

    A perfect score of 35 SPCYrs per graduate is the result of 100% PC retention with 100% volume with 100% active for 35 years. Family medicine residency graduates contribute 22 – 28 SPCYrs during their careers mainly due to over 80% primary care retention.

    The most elite medical schools using US News Rankings, MCATs of matriculants, or NIH Research dollars trail with least primary care delivery per graduate at 1 – 3 SPCYrs per graduate – the same level as nurse practitioners not training in family practice.

    Osteopathic schools in the 1960s averaged 20 Standard Primary Care years per graduate due to over 65% of graduates in family practice but have decreased to about 8 on average (17% family practice) with a wide range from 6 to 13 SPCYrs per graduate.

    US MD is down to about 4 to 5 SPCYrs per grad or about the same as PA or NP or US MD internal medicine.

    Steady declines in primary care retention defeat primary care delivery in all of the flexible primary care training sources (IM, PD, MPD, NP, and PA). Steady departures from primary care during training, at graduation, and each year after graduation are the result of flexible designs impacted by US policy that neglects primary care (ever more evident with MedPAC recs, Medicare and Medicaid cuts).

    This results in primary care delivery for a school or school type or program more dependent upon the proportion entering family medicine – the remaining permanent PC source most resistant to aberrant US designs after graduation (but most vulnerable at the critical stage of medical student choice).

    US primary care delivery capacity involving 28,000 annual NP, IM, PA, MPD, PD, and FM graduates is limited due to declines to 7 SPCYrs per graduate as only 30% serve in primary care. This is down from 18 – 20 SPCYrs per graduate for the 1980 annual graduates that were half as many at 14,000 but provided 280,000 SPCYrs for the class entering the workforce in 1980 as compared to the more recent 210,000. Twice the annual graduates with one-third of the primary care delivery per graduate indicates failures in primary care training, failures in primary care policy, and the failure of generic expansion. Specific solutions are required with training, spending, and career choice to result in increases in primary care measurements and rankings.

    Bob Bowman ATSU SOMA

  9. Phlebotomy Guide on Dec. 27, 2011, 5:03 p.m.

    Good choice, i work in phlebotomy and it is really good pay place :-)

  10. Jaffer Dina on June 23, 2012, 11:09 p.m.

    Hi everyone,
    In order to preserve the accreditation/reputation of UMDNJ-SOM:

    1. Please sign the following petition to prevent a merger of UMDNJ-SOM with Rowan and to instead merge it with Rutgers.
    http://www.change.org/petitions/the-governor-of-nj-amend-senate-bill-s2063-to-merge-umdnj-som-with-rutgers

    2. If you are from NJ, please call your local legislators (and let em know that this merger is bad for SOM) and get other physicians involved as well.

    Thanking in anticipation,
    Jaffer Dina

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