The Tyranny Of Rankings
It was recently announced in The New York Times that both Yale and Harvard Law Schools are withdrawing from the annual survey conducted by US News and World Report that ranks law schools. That is the same publication that ranks hospitals and medical schools and which has anointed MD Anderson as the number one place for cancer care in the United States.
I am not writing to quibble about the MD Anderson rankings. Yale Law School was actually number one yet its leadership is ending Yale’s participation in the survey because it “was unreliable and skewed educational priorities.” What I want to discuss is the whole notion of using outside agencies in a beauty contest to determine the quality of the education or patient care given in any institution.
Law schools, medical schools, and hospitals, as well as liberal arts colleges each have their own missions. It is the leadership of the institution that is responsible for the ability of the institution to fulfill its mission. Most of these institutions also have governing oversight boards responsible for the performance of the institution in its mission of education or patient care and for the performance of the leader.
I was always skeptical of the US News and World Report rankings of cancer care institutions because the free-standing cancer centers are quite different from those closely affiliated with a medical school—apples and oranges. At institutions like MD Anderson, the great mission is patient care. Research, education, and cancer prevention (academic pursuits) all count, but in the end, the major revenue stream and the major focus of MD Anderson is patient care. Furthermore, I seriously doubt any patient cares whether or not the 23,000-person work force is diverse and inclusive. They care about their care team’s interactions with them, whether their visits are efficient, and whether they are getting better. These things are best measured by the institution itself and the faculty within, not some external board to which the institution supplies the data the ranking agency determines to be important under the aegis of more consultants.
It is the job of the leadership of any academic institution, especially a cancer center, to know what’s important, articulate the mission and vision to accomplish what’s important, and to manage the finances and personnel to make good things happen.
I applaud Yale and Harvard Law School for telling US News and World Report to take a hike. The leadership of both schools takes responsibility for guiding the school to teaching excellence and equity in its class make-up and preparation for the real-world practice of law.
Similarly, the leadership of MD Anderson should not focus on external rankings or judgment by external boards as to whether or not the institution is fulfilling its mission. That’s the president’s job; he shouldn’t be farming it out to magazines or any other corporate entity.
The faculty of MD Anderson knows good patient care, clinical research, lab-based research, prevention, and teaching. If you want to know how you are doing Dr. Pisters, ask them not the division heads who will not speak truth to power.
A number of first-rate faculty have been harassed and fired of late, not to mention the ones leaving. A lot of this is based on the president’s concern for “professionalism” and diversity among the faculty. Here’s an idea. Ask the faculty about these people before you fire them and can’t find replacements that can even hold their white coats. Then ask their patients.
Some of those leaving or fired will be very hard to replace. That damages the ability of the institution to fulfill its mission, not to mention its effect on the bottom line from the absent faculty no longer billing. How smart is that, Dr. Pisters? You are cutting off your nose despite your face.
MD Anderson faculty are not interchangeable widgets. Replacing a senior faculty member and a world expert with a junior assistant professor just out of fellowship is no way to maintain MD Anderson excellence.
Worry less about what the ranking agencies think and more about what the faculty think—and the patients, the final arbiters of MD Anderson quality.