Retirement and Proximity to "Teaching Hospitals"

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netrammgc
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Retirement and Proximity to "Teaching Hospitals"

Post by netrammgc » Sun May 17, 2015 4:28 pm

Respected and reveered Bogle heads,

Is there any truth to proximity to teaching hospitals vs good regular hospitals as one ages? From what I gather a good hospital is a good hospital, regardless if it trains residents.

My wise and healthy mother will not fathom moving to a town that doesnt have a "teaching hospital".

I gather it comes from the fact that she worked for a teaching hospital for over 40+ years. Quite an accomplishment if you ask me.

I ask this out of curiosity and don't plan on moving her away from this comfort at any point.

Browser
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Re: Retirement and Proximity to "Teaching Hospitals"

Post by Browser » Sun May 17, 2015 4:39 pm

I live close to a "teaching hospital" aka a University Hospital and medical school. There is certainly an abundance of medical care and a long list of specialists available there. And you can assume these professionals are up-to-date on the most current information. One thing to note, however, is that you might be a lab object being seen and treated by residents and young medical staff rather than the senior, experienced staff. So, you need to be somewhat skillful in navigating your way through that to assure you are actually getting access to the best treatment available there.
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netrammgc
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Re: Retirement and Proximity to "Teaching Hospitals"

Post by netrammgc » Sun May 17, 2015 5:06 pm

Browser wrote:One thing to note, however, is that you might be a lab object being seen and treated by residents and young medical staff rather than the senior, experienced staff. So, you need to be somewhat skillful in navigating your way through that to assure you are actually getting access to the best treatment available there.
Thanks Browser. It is true there are a lot of specialists and doctors in the area. How much emphasis do you put on this? Would one discredit a small community with a good community hospital a few hours away from a teaching hospital?

One thing she says is to never get sick and go to a teaching hospital in July. That's apparently when all the new residents start.

But that's a different comment/question.

mhalley
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Re: Retirement and Proximity to "Teaching Hospitals"

Post by mhalley » Sun May 17, 2015 5:36 pm

There are plusses and minuses to this as in all things. 90% of all illnesses can be cared for by a local community hospital. Certainly if you have a rare condition, then a referral center is a good idea, or a surgery that is not that common, you want someone that does a lot of them. OTOH, you don't know at the start if your illness is rare or not, it will take a while for the rareness to assert itself. So at a referral center there is always the chance of getting unneccessary tests because they are looking for the zebras.
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Re: Retirement and Proximity to "Teaching Hospitals"

Post by 2comma » Sun May 17, 2015 5:52 pm

I'm a regular listener to the podcast "The Skeptics Guide To The Universe" hosted by Dr. Steven Novella, an academic neurosurgeon in Boston (he also writes a blog "Science Based Medicine". They were talking about a survey conducted of doctors (a true study with controls not a Bogleheads poll) to see if they would prefer an academic hospital to care for themselves and their family. The results were that for complicated disease and issues involving the use of cutting-edge therapies they would go to an academic hospital. For more routine diseases and procedures they preferred non-academic hospitals. I believe one of the reasons mentioned was the probability of a greater variety of drug resistant hospital-acquired infections (superbugs) are more likely in the academic hospitals because they presumably deal with more serious conditions.

This really shouldn't be an issue because the causes and the remedy for dealing with hospital acquired infections are well known but not always well followed. A great deal of effort is being put into this problem. Hospitals are being required to report on the number of cases, Medicare and several insurance providers are no longer paying hospitals to treat these infections (they are being forced to pay for their own mistakes), and there are a set of "best practices" that if followed virtually eliminate these infections. Guess which health care workers are the worst at following these protocols? Yep, doctors!
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Browser
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Re: Retirement and Proximity to "Teaching Hospitals"

Post by Browser » Sun May 17, 2015 6:16 pm

The university hospital is indeed much more "institutional". You don't have the feeling that you have a personal doctor-patient relationship and you can get lost in the shuffle. For that reason, lots of people prefer a smaller hospital and doctors affiliated with that smaller hospital. Where I live, there are both. My mother was hospitalized for 3 days in the smaller community hospital and the setting was supportive, non-hurried, attentive. I'd much prefer to be in such a hospital if I had the choice. I've been in the "teaching hospital" for serious illness. It was impersonal, staff was inattentive, I was generally miserable because I was very ill. However, I had teams of some of the best specialists around who I'm sure saved my life. Big trade-off. I now continue to go to the University Hospital for the reason that there are scores of specialists at my fingertips, some of whom are top in their fields. On balance, with my medical history, I've been willing to deal with the institutional maze and have not made the leap to a private practice physician. Generally the private practice physicians in the area are affiliated with either the university hospital or the smaller hospital. I'm sure a good PPP would be able to handle most of my medical needs and be able to refer me to specialists at the teaching hospital if necessary. However, since I'm familiar with the drill at the teaching hospital and am on the patient roster in multiple specialty areas: orthopedics, urology, opthamology, dermatology, I just continue there. What I'm really missing though is a good GP or family doc as a primary care doctor I can see for the daily aches and pains.
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Re: Retirement and Proximity to "Teaching Hospitals"

Post by jlawrence01 » Sun May 17, 2015 7:15 pm

2comma wrote:I'm a regular listener to the podcast "The Skeptics Guide To The Universe" hosted by Dr. Steven Novella, an academic neurosurgeon in Boston (he also writes a blog "Science Based Medicine". They were talking about a survey conducted of doctors (a true study with controls not a Bogleheads poll) to see if they would prefer an academic hospital to care for themselves and their family. The results were that for complicated disease and issues involving the use of cutting-edge therapies they would go to an academic hospital. For more routine diseases and procedures they preferred non-academic hospitals. I believe one of the reasons mentioned was the probability of a greater variety of drug resistant hospital-acquired infections (superbugs) are more likely in the academic hospitals because they presumably deal with more serious conditions.

That sounds pretty reasonable.

Personally, I have worked in both types of hospitals and I prefer local community hospitals where I see my PCP and specialists that I have been treating with throughout the year. I get very tired of 45 minute medical histories done by physicians I have not seen before (and will likely not see again).

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blueblock
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Re: Retirement and Proximity to "Teaching Hospitals"

Post by blueblock » Sun May 17, 2015 7:56 pm

Interesting question. I've been with the Northwestern Medical Faculty Foundation in Chicago for 20+ years. I've always felt like the care I receive there is first rate, to include PCPs--I've been through two--who know who I am, and occasional referrals to specialists who really know their stuff.

I just retired and moved from IL to WI. For now, I'm using COBRA to extend my Aetna coverage at NMFF. That's an hour away from where I live, but I'm pretty healthy, and I've had only one medical emergency in all those years, so I'm not too worried.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by netrammgc » Mon May 18, 2015 12:53 am

blueblock wrote:Interesting question. I've been with the Northwestern Medical Faculty Foundation in Chicago for 20+ years. I've always felt like the care I receive there is first rate, to include PCPs--I've been through two--who know who I am, and occasional referrals to specialists who really know their stuff.

I just retired and moved from IL to WI. For now, I'm using COBRA to extend my Aetna coverage at NMFF. That's an hour away from where I live, but I'm pretty healthy, and I've had only one medical emergency in all those years, so I'm not too worried.
Thanks blueblock,

I appreciate the response. I eventually would like to retire in some communities that are approximately 2-3hrs from the nearest teaching hospital (see my location). They have a good community hospitals, they are small college towns, but nothing but the standard ole' acute care and critical access hospitals.

Would one stick to this plan of retiring to a small community until you are in need of specialty care? Then possibly move/relocate or commute to a city? Would one be hesitant to move that remote?

ks289
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Re: Retirement and Proximity to "Teaching Hospitals"

Post by ks289 » Mon May 18, 2015 3:38 am

In retirement I feel it is important to have access to a tertiary care hospital (many but not all teaching hospitals would qualify) for complicated medical issues if they should arise.
Living within a short commute may suffice since many tertiary care hospitals are urban and not in the most desirable retirement communities. If none are located near your, you may end up being hospitalized (transferred) and getting follow up care hours away from your home and support structure.

For routine primary care and uncomplicated specialty care, most community practitioners and hospitals will be adequate and deliver the care in a more convenient and comfortable setting. At times, it may be unclear when a condition or procedure/surgery warrants a higher level of care, but hopefully your providers will know.

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fandango
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Re: Retirement and Proximity to "Teaching Hospitals"

Post by fandango » Mon May 18, 2015 5:43 am

I think that the ideal situation would be to have an excellent primary care provider and local hospital and proximity to a large "teaching hospital".
During the aging process, most of us find ourselves going more frequently to the PCP and rarely to a teaching hospital.

Our nearest teaching hospitals are Emory and the Medical College of Georgia. Both are good, but you should be prepared for long waits to get an appointment and not so personalized care. I have friends who have gone to both only to have appointments cancelled after they drive all the way to the hospital and poor coordination of treatment due to high demand and turnover of personnel. So, in my view teaching hospitals are not necessarily the best. You may need one some day but don't expect ideal care.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by Levett » Mon May 18, 2015 5:51 am

I'm sure we all have stories of many kinds, but here's two that go to your mother's point.

Several years ago I was walking in a northern Michigan resort town with a friend. He suddenly grabbed my arm and said he had fierce pain shooting up his left arm (years before he had been treated for a heart attack). I immediately rushed him to a fine northern Michigan hospital just minutes away. He was taken to the cath lab. He was stabilized but the obstruction was too tricky for their cath lab. Lesson: a good hospital knows its own limitations and knows where better service will exist. My friend was sent to Cleveland Clinic, and he's soon to celebrate his 80th birthday.

There's good, and there's better.

Second story (a family member). Local diagnosis at a teaching hospital was generally accurate. However, the physician (to his credit) was not satisfied with the path report, on which much depended. Despite some subsequent clarification, we sought a second opinion at a major university hospital 60 miles away. The local path report was rejected. The new path report was the basis for the appropriate treatment protocol. It has made a big difference.

Speaking as a retiree, I want easy access to the best possible medical care.

I wouldn't dare presume to speak the TRUTH. I'm just speaking to my experience of the "truth" with respect to medical care.

Lev

P.S. There is a downside to proximity to fine hospitals. It's been my personal experience that sometimes the personnel are just a bit too eager to run just one more test. As one doc friend said to me, "If you look hard enough you will likely find something, even if it's not threatening." The problem, as I see it (with the help of some recent writers), is one of overdiagnosis.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by netrammgc » Mon May 18, 2015 10:54 am

Levett wrote:I'm sure we all have stories of many kinds, but here's two that go to your mother's point.

Several years ago I was walking in a northern Michigan resort town with a friend. He suddenly grabbed my arm and said he had fierce pain shooting up his left arm (years before he had been treated for a heart attack). I immediately rushed him to a fine northern Michigan hospital just minutes away. He was taken to the cath lab. He was stabilized but the obstruction was too tricky for their cath lab. Lesson: a good hospital knows its own limitations and knows where better service will exist. My friend was sent to Cleveland Clinic, and he's soon to celebrate his 80th birthday.

There's good, and there's better.

Second story (a family member). Local diagnosis at a teaching hospital was generally accurate. However, the physician (to his credit) was not satisfied with the path report, on which much depended. Despite some subsequent clarification, we sought a second opinion at a major university hospital 60 miles away. The local path report was rejected. The new path report was the basis for the appropriate treatment protocol. It has made a big difference.

Speaking as a retiree, I want easy access to the best possible medical care.

I wouldn't dare presume to speak the TRUTH. I'm just speaking to my experience of the "truth" with respect to medical care.

Lev

P.S. There is a downside to proximity to fine hospitals. It's been my personal experience that sometimes the personnel are just a bit too eager to run just one more test. As one doc friend said to me, "If you look hard enough you will likely find something, even if it's not threatening." The problem, as I see it (with the help of some recent writers), is one of overdiagnosis.
Thanks all. This has been very informative and helpful.There are some beautiful posts here. Thank you again for sharing your experiences and thought.

Is there a database of tertiary hospitals or referral centers? I can only seem to obtain good data for teaching, critical care, and acute hospitals from the medicare website.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by Browser » Mon May 18, 2015 12:38 pm

I'm not exactly sure what "teaching hospitals" encompasses. I'm assuming that hospitals that are associated with university medical schools are included. The category must also include some of the larger hospitals, but what makes a hospital a "teaching hospital" exactly? As for university hospitals many of these are located in very attractive college towns and fare pretty well as retirement destinations by reason of the quality of life offered in these towns. Of course, many are also located in large metro areas that may or may not be appealing for retirement living.
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Re: Retirement and Proximity to "Teaching Hospitals"

Post by texasdiver » Mon May 18, 2015 1:49 pm

I don't think the key factor is whether a hospital is a teaching hospital or not. My wife is in a faculty position in a residency program affiliated with a teaching hospital and she has plenty of horror stories about inexperienced residents. The key is having access to a major medical center with a wide range of specialists and staff that are experienced in doing unusual or complicated procedures. Mostly those are going to be located on major urban areas just by default. I suspect that any of the top 30-40 urban areas in the country by population are going to have major medical centers that are perfectly good.

What is more unusual is to have major world class medical centers in smaller cities. The Mayo Clinic in Rochester MN for example is probably the best and most comprehensive hospital in the US that is in a city of 100,000. Most cities that size have decent hospitals but nothing like the Mayo Clinic. Spokane is another smaller city that has tremendous medical facilities but that is party geography as it is basically the only city of any size between Seattle and Minneapolis.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by Browser » Mon May 18, 2015 2:20 pm

texasdiver wrote:I don't think the key factor is whether a hospital is a teaching hospital or not. My wife is in a faculty position in a residency program affiliated with a teaching hospital and she has plenty of horror stories about inexperienced residents. The key is having access to a major medical center with a wide range of specialists and staff that are experienced in doing unusual or complicated procedures. Mostly those are going to be located on major urban areas just by default. I suspect that any of the top 30-40 urban areas in the country by population are going to have major medical centers that are perfectly good.

What is more unusual is to have major world class medical centers in smaller cities. The Mayo Clinic in Rochester MN for example is probably the best and most comprehensive hospital in the US that is in a city of 100,000. Most cities that size have decent hospitals but nothing like the Mayo Clinic. Spokane is another smaller city that has tremendous medical facilities but that is party geography as it is basically the only city of any size between Seattle and Minneapolis.
Good point. One thing I've heard that makes sense to me is that you would ideally like to be treated by physicians who have treated the largest number of patients with your condition. This might be particularly true for surgical procedures. At one unfortunate point in my life I needed a major liver resection, which I received at Memorial Sloan-Kettering in NYC. I remember the surgeon who talked with me prior to the surgery saying that I needed to know there was a 5% mortality risk for the surgery, but that the risk would be much higher at most other hospitals. As he explained, it's not so much that he was saying they were more talented people but that they had performed many more of these procedures than most other hospitals would ever perform. All other things equal, you want the guys that have had the most practice doing what they are going to do to you. That probably means a major hospital that sees a lot of patients, most likely in an urban location unless it's a regional hospital that many patients will travel to in order to be treated there.
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Re: Retirement and Proximity to "Teaching Hospitals"

Post by VictoriaF » Fri May 29, 2015 4:48 pm

When I moved to the Washington area I assumed that a teaching hospital is better than a regular one and chose my primary care physician at the GWU Medical Faculty Associates. My initial PCP has retired and passed me to another one. I like both of them as people but can´t judge their professional quality, because I have not had any serious diseases (yet). My PCP occassionally brings residents for my annual checkups. I always give a permission, because its good to have the second pair of eyes, and the PCP seems to pay more attention to me.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by HIinvestor » Sat May 30, 2015 12:52 pm

For "run of the mill" care and "normal" ailments, your regular primary care provider and specialists and community hospitals are fine, in our experience. If these hospitals have medical students, does that make them "teaching hospitals"? If that is the case, pretty much all the hospitals in our state are "teaching hospitals" because all of them have medical students learning at them with more experienced docs mentoring them.

If you need more specialized care because your condition is more unusual, you may need to travel to a national or regional center that sees more unusual cases on a regular basis. That has been our experience for me and our kids. These national or regional facilities are where a lot of the cutting edge research is being done and your provider may well be one of those lead researchers.

Traveling for medical care isn't optimal for many reasons, but it is how I and my kids have gotten the care we need and still live in the state and area we prefer. It helps to live near a large airport and have your specialist near a good airport AND have great insurance and the finances for the travel and copays.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by tbradnc » Sat May 30, 2015 3:54 pm

I have close relative who has a medical issue her loved ones consider worthy enough to travel to Duke in NC, a teaching hospital with above average outcomes for this particular ailment.

According to the parents (patient is a minor) they request that "no students are involved" in the actual medical procedure as it is performed and feel like that is enough to ensure no one "learns" on their child.

Is this right/true/best? I have no idea, but they are satisfied.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by HIinvestor » Sat May 30, 2015 4:06 pm

Personally, I have flown from HNl to DEN for medical care 6 times over the past 15 years and feel it has been well worth the time, effort and money for the medical care I receive there. It is an effort. Though it is a teaching hospital and they do cutting edge research at National Jewish, the physicians who work on me and loved ones are not residents, researchers or med students (tho I have consented to having residents, researchers and med students observe).

If you have the ability and resources, you CAN find and get to specialty places if you need care that is above and beyond the expertise of where you live. It is more work, but it can be do-able.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by oncorhynchus » Sat May 30, 2015 4:32 pm

tbradnc wrote:According to the parents (patient is a minor) they request that "no students are involved" in the actual medical procedure as it is performed and feel like that is enough to ensure no one "learns" on their child.
Although understandable on one level, I find this attitude from those preferentially seeking care from an academic institution to be exceedingly selfish and myopic.

o
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Re: Retirement and Proximity to "Teaching Hospitals"

Post by tbradnc » Sat May 30, 2015 4:35 pm

Perhaps being their only child makes a difference. At any rate, I doubt they could care less what you think.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by oncorhynchus » Sat May 30, 2015 4:58 pm

tbradnc wrote:Perhaps being their only child makes a difference. At any rate, I doubt they could care less what you think.
I'm sure they don't care, and I suspect you don't either. But some might find the lack of future expertise to adequately treat their child, or any number of other equally deserving patients, worth caring about.

o
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Re: Retirement and Proximity to "Teaching Hospitals"

Post by obgraham » Sat May 30, 2015 9:40 pm

Minority view here:

Been in medicine for 45 years. Now that I am retired I have no intention of spending my final days/weeks/months undergoing complex medical treatment. No "teaching hospital" medicine for me.

When the time comes, it comes. Put me in the box and move on!

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by Naismith » Sat May 30, 2015 10:15 pm

Also, not every teaching hospital is going to have expertise in your particular ailment. Part of this is by design: federally funded centers are actually spaced out to give greater access to more people. I work at a University with an excellent academic health center that is highly rated for some things....but I went 6 hours away to have stomach surgery, and six hours in a different direction when I developed a funny spot in my eye. Since that was my reading eye, it was pretty devastating, but the local ophthalmologist mostly thought I was neurotic.

By being willing to travel that far, I was able to get in with one of the top people in the country, who used a machine that was not available at my local university hospital. It turns out that I am not crazy; there really is permanent damage to my retina. The neuro-ophthalmologist said that my report of symptoms was one of the best descriptions he had ever seen. He couldn't figure out why the local doctor blew me off.

There was nothing the local doc could have done anyway, but I get tired of being told that it is all in my head.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by ww340 » Sat May 30, 2015 11:00 pm

This is a timely post for me, as I am boarding an early morning flight for the Cleveland clinic tomorrow.

I live in a rural area that has very limited facilities. I initially went an hour away for care, then my condition required I travel almost 3 hours away which I have done for a year, but now I am being sent many hours away to the Cleveland clinic.

We don't want to leave our beautiful home and it's beautiful views, but health care is becoming a bigger issue for both of us.

We were in the Dallas ft worth area for a long time, and are looking at buying another home there, and we will likely split our time between the two as we did in the past.

Amazing how our priorities can change in a relatively short period of time.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by littlebird » Sat May 30, 2015 11:27 pm

Timely post for me too as I just kissed my spouse goodnight and left him in the emergency room of our very nearby community hospital. This is his 3rd visit in 5 months. He's going to be 89. If you live long enough, this is going to happen. We love the outdoors and considered retiring to a rural area where we could be "desert rats". But we compromised, 23 years ago, and decided we could "play" desert rat in the Sun Cities and have medical facilities close by (altho we were both very healthy then).

So glad we did. Many patients are helicoptered in from rural areas of the state and it's a huge strain on the "well" spouse (who may no be so well him/her self any more). I'll probably be there in the morning to see the doctors who pop in and I'll go home for lunch and a nap (I'm no so well anymore either) and return in the afternoon, hopefully to take him home late in the day, if experience is any guide. Personally, I prefer community hospitals to teaching ones, except in rare cases, but most of all, I love *proximity*!

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by HIinvestor » Sat May 30, 2015 11:32 pm

Yes, when I see older (>55 year) folks like myself buying very rural places that are distant from healthcare, I wonder if they have thought of possibly needing to be airlifted by helicopter or plane to a hospital and the delays that may entail which could affect their outcome, even if it would have been fairly simple and straight-forward if promptly treated. Living near a pretty good hospital and pretty good MDs works well enough for me (generally 30 minute drive with OK traffic). When I have to, I will travel as needed for more specialized care, as I and my kids have done in the past.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by jlawrence01 » Sun May 31, 2015 9:53 am

HIinvestor wrote:Yes, when I see older (>55 year) folks like myself buying very rural places that are distant from healthcare, I wonder if they have thought of possibly needing to be airlifted by helicopter or plane to a hospital and the delays that may entail which could affect their outcome, even if it would have been fairly simple and straight-forward if promptly treated. Living near a pretty good hospital and pretty good MDs works well enough for me (generally 30 minute drive with OK traffic). When I have to, I will travel as needed for more specialized care, as I and my kids have done in the past.
Agreed.

At least five of the twenty-five retirement locales we looked at for retirement were eliminated from the list solely due to a lack of available hospitals or the quality of the local hospitals.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by lumberingc » Sun May 31, 2015 10:39 am

texasdiver wrote:My wife is in a faculty position in a residency program affiliated with a teaching hospital and she has plenty of horror stories about inexperienced residents.
There are horror stories at every institution.

For instance, a toddler was fatally overdosed with morphine at John's Hopkins (http://nypost.com/1999/11/30/little-girl-lost-2/) which is a reputable institution.

What matters is not individual anecdotes but overall data. Various studies actually favor outcomes data in teaching hospitals

"Better overall process measures of quality and lower 30-day mortality in major teaching hospitals than in nonteaching hospitals."

http://www.ncbi.nlm.nih.gov/pubmed/1527880

"Lower in-hospital mortality in major teaching hospitals than in other hospitals."

http://www.ncbi.nlm.nih.gov/pubmed/8403950

"Lower rates of preventable adverse drug events in government-owned major teaching hospitals than in other hospitals; similar rates of preventable adverse events in general and related to procedures or diagnoses."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495442/

Of course, I am cherry-picking data...and some studies have found the opposite. The point is that teaching hospitals often have better outcomes not in spite of residents, fellows, and medical students but because of them. When there are groups of trained professionals working together, errors are often avoided, and there is an abundance of creative ideas. Besides, the residents/fells always have the benefit of someone more experienced if they need help.
tbradnc wrote:According to the parents (patient is a minor) they request that "no students are involved" in the actual medical procedure as it is performed and feel like that is enough to ensure no one "learns" on their child.

Is this right/true/best? I have no idea, but they are satisfied.
They are just being jerks. It will make no difference. what if everyone had this view?

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by mlipps » Sun May 31, 2015 10:54 am

HIinvestor wrote:Yes, when I see older (>55 year) folks like myself buying very rural places that are distant from healthcare, I wonder if they have thought of possibly needing to be airlifted by helicopter or plane to a hospital and the delays that may entail which could affect their outcome, even if it would have been fairly simple and straight-forward if promptly treated. Living near a pretty good hospital and pretty good MDs works well enough for me (generally 30 minute drive with OK traffic). When I have to, I will travel as needed for more specialized care, as I and my kids have done in the past.
Following this thread to see more opinions. My parents live in a very rural area (20 minutes from the community hospital and only volunteer EMT's to take you there) and travel 2 hours every 6-12 months for him to see a specialist at Ohio State. Last year, he was sick for 6 months in our community hospital's care before they sent him by squad to OSU, where he recovered in a week because they finally properly treated his condition & diagnosed some underlying issues that had been previously misunderstood. On the other hand, he has been seeing the same PCP for 30 years. There is some value to that, but I assume the PCP will retire eventually. He has just retired & they are considering moving, so I am interested in all the good perspectives in this thread!

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by mlipps » Sun May 31, 2015 10:56 am

Oh, and one resource you all may or may not know of is HospitalCompare.gov. There, you can see the quantitative answers to your points about Hospital Acquired Infections, Patient Experience (those touchy feelys that many of you say are missing at the teaching hospital), and overall quality on some objective standards. It's not the only piece of info I would use to make these kinds of decisions, but it is a good source to consider.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by ilovedogs » Sun May 31, 2015 11:49 am

obgraham wrote:Minority view here:

Been in medicine for 45 years. Now that I am retired I have no intention of spending my final days/weeks/months undergoing complex medical treatment. No "teaching hospital" medicine for me.

When the time comes, it comes. Put me in the box and move on!
Thanks for saying this. I got to wondering about a lot of what I read here. There are no physicians in my family history; instead, there is a respect for physicians but a deep family view that there's rarely a need to see one. My father, in his 80's, went to an urgent care clinic (a stand alone place near a big garden center) when he woke up unable to breathe easily after a few days of sensing something, because he could not reach his primary care doctor. As soon as the physician saw him walk in to the facility, he called an ambulance. Dad spent about six days in the hospital with a diagnosis of pneumonia and was sent home. After what he experienced in the local hospital (keeping the story short), he decided it's all about the physicians and local care. He switched primary care docs to the physician who runs the urgent care facility less than half a mile away.

I just want to add that I understand the need for expert specialists, and that's different. Find your expert, whatever building she or he is in.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by baw703916 » Sun May 31, 2015 12:12 pm

obgraham,

I agree that throwing lots of technology at a patient when it's unlikely to significantly extend their life or improve its quality may not be worth it. But I would say that in the case of a very rare condition which persists over many years and has a large impact on quality of life the calculus is different--then it's much more important to be in contact with one of the few doctors who understands said condition (who are likely to all be at an academic medical center). It all depends on how unique one's health issues are.
Most of my posts assume no behavioral errors.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by obgraham » Sun May 31, 2015 5:04 pm

I don't really disagree with you, BAW. But what we are really talking about here in the majority of cases, boils down to cancer in old people. And we have developed a huge industry largely devoted to placating patients and their families' desires for a miracle cure.

I saw an article not long ago titled "How Doctors Die". Most of us do not want the treatments we recommend to our patients.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by Watty » Sun May 31, 2015 5:46 pm

netrammgc wrote: I appreciate the response. I eventually would like to retire in some communities that are approximately 2-3hrs from the nearest teaching hospital (see my location). They have a good community hospitals, they are small college towns, but nothing but the standard ole' acute care and critical access hospitals.

Would one stick to this plan of retiring to a small community until you are in need of specialty care? Then possibly move/relocate or commute to a city? Would one be hesitant to move that remote?
A problem with this is the lack of specialist in areas with small towns and community hospitals. Even in areas where they are not as accessible you are still likely to be referred to a specialist pretty often.

My bother in law retired on the Oregon coast in an area that had good doctors and a good community hospital but what they found was that when they had anything that was not routine they might have to drive a couple of hours to see a specialist, return home, sometimes drive back the next day to get some test like an MRI (which was not as common then), then drive home, then drive back to see the specialist for a followup appointment. Being a two hour drive away can really add up when there are multiple visits.

They were only in their 60s but they could see where that would be a problem as they aged, or if they needed care when there was bad weather which would make the driving even more difficult. This was one of the reasons that they moved to an area with better medical care.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by SoCalTXan » Sun May 31, 2015 7:42 pm

Interesting discussion. I work at a small 25 bed critical access hospital which is 180 miles from the nearest city of any size. One important consideration is the fact that we ship many patients out on an airplane for things that you would think could be treated at our hospital. I have seen people flown out for pulmonary emboli, some complex fractures, stroke/brain bleeds and others. Sometimes the orthopedic surgeon is backed up in surgery or the towns only neurologist is out of town on vacation. I have heard of some people receiving a $50,000-$100,000 bill from the company who flies them out. Honestly I don't know how comfortable I would feel being treated at my hospital in a major trauma/medical emergency.

The other day we had a person who rolled his car 8 times and suffered a nasty tibial plateau fracture. The surgeon couldn't fix the fracture for 5 days. As a result, the patient had to have someone pick them up and drive 300 miles back home to have surgery at their local hospital.

I'm not sure if this is factually correct, but I have heard that in teaching hospitals the physicians are not compensated by the number of patients that they treat; they are payed an annual salary instead. Anyone know if there is any merit to this?

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by mudphudstud » Sun May 31, 2015 10:21 pm

I'm not sure if this is factually correct, but I have heard that in teaching hospitals the physicians are not compensated by the number of patients that they treat; they are payed an annual salary instead. Anyone know if there is any merit to this?
Yes, this is often the case, although not always. I think many of these "salary" systems also include performance incentives, based mostly on billable volume. It's also important to note that this setup doesn't by any means indicate less intense demands on those physicians' time, but rather just that they are often feeling a great deal of pressure coming from institutional expectations, in addition to their own desire to be productive and efficient.
According to the parents (patient is a minor) they request that "no students are involved" in the actual medical procedure as it is performed and feel like that is enough to ensure no one "learns" on their child.
I have encountered this a few times so far, although thankfully not too often. It is an understandable sentiment for people dealing with very serious, challenging, and often unforeseen situations. We as the medical team respect these wishes when possible, albeit with significant regret for the fact that it deprives us (the future physicians who will be taking care of the patient in 5-10 years, or taking care of the patient's children) of some bit of the experience and education necessary to become the best possible practitioners of the profession. I will say that many senior physicians feel strongly that if a patient comes to an academic hospital, it is with the understanding that there will be trainees involved in the delivery of their care. It is universally the case that academic centers take very seriously the appropriate supervision of any and all trainees, which is constantly tailored to the individual student/resident/fellow's (current) level of experience and competence.

It's also important to note that in almost all cases, the business of providing healthcare in a teaching hospital would come to a screeching halt without the trainees carrying a huge portion of the workload. If you request to have no students, residents, or fellows, you may well find that many of the routine parts of your care are less expeditious and more disjointed than you expect, because many senior academic physicians are no longer used to doing them.

-Currently in training at a major academic medical center.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by robert88 » Sun May 31, 2015 11:23 pm

Here's probably a dumb question, but in major metropolitan areas, are there many hospitals which aren't teaching hospitals? Are non-teaching hospitals mostly hospitals which don't have a med school nearby?

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by reggiesimpson » Mon Jun 01, 2015 7:17 am

As an old guy I just had the experience of sampling both hospital types for the same condition. The Teaching Hospital won hands down. With that said you must always be your own best health advocate so continue to be wary.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by VictoriaF » Mon Jun 01, 2015 2:39 pm

mudphudstud wrote:
According to the parents (patient is a minor) they request that "no students are involved" in the actual medical procedure as it is performed and feel like that is enough to ensure no one "learns" on their child.
I have encountered this a few times so far, although thankfully not too often. It is an understandable sentiment for people dealing with very serious, challenging, and often unforeseen situations. We as the medical team respect these wishes when possible, albeit with significant regret for the fact that it deprives us (the future physicians who will be taking care of the patient in 5-10 years, or taking care of the patient's children) of some bit of the experience and education necessary to become the best possible practitioners of the profession. I will say that many senior physicians feel strongly that if a patient comes to an academic hospital, it is with the understanding that there will be trainees involved in the delivery of their care. It is universally the case that academic centers take very seriously the appropriate supervision of any and all trainees, which is constantly tailored to the individual student/resident/fellow's (current) level of experience and competence.

It's also important to note that in almost all cases, the business of providing healthcare in a teaching hospital would come to a screeching halt without the trainees carrying a huge portion of the workload. If you request to have no students, residents, or fellows, you may well find that many of the routine parts of your care are less expeditious and more disjointed than you expect, because many senior academic physicians are no longer used to doing them.

-Currently in training at a major academic medical center.
I don´t understand this issue. As I mentioned in an earlier message, when I come for checkups, my PCP sometimes brings students. But she is always there too.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by Artsdoctor » Mon Jun 01, 2015 6:53 pm

Great topic. As a doctor, I can't imagine living somewhere so removed that I'd have to be helicoptered out for medical care--although I have no problem personally taking vacations in remote regions of the globe. I think it's a matter of statistics. And I have evacuation insurance!

There are plenty of excellent medical facilities that are small to moderate in size--and non-teaching. There will be pros and cons of obtaining care at teaching facilities versus non-teaching facilities. To me, the point is being able to choose.

Over the past few years, we have seen several friends moving away from Los Angeles and into very small communities throughout the state, and not one of them gave any thought to choosing a community with superb medical care. This is most likely a function of being in the 55-60 age group, as well as having no medical problems.

So the short answer is: you don't necessarily need to live in an area with a teaching facility but I'd really recommend that you live somewhere with decent care.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by mlipps » Mon Jun 01, 2015 8:37 pm

robert88 wrote:Here's probably a dumb question, but in major metropolitan areas, are there many hospitals which aren't teaching hospitals? Are non-teaching hospitals mostly hospitals which don't have a med school nearby?
Yes, in most cities there are a small number of teaching hospitals, and then any number of hospitals which are not teaching hospitals.

A teaching hospital is one that is associated with a medical school. It's not so simple as nearby, the school and hospital are more or less one unit.

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by texasdiver » Mon Jun 01, 2015 8:44 pm

Artsdoctor wrote:Great topic. As a doctor, I can't imagine living somewhere so removed that I'd have to be helicoptered out for medical care--although I have no problem personally taking vacations in remote regions of the globe. I think it's a matter of statistics. And I have evacuation insurance!

There are plenty of excellent medical facilities that are small to moderate in size--and non-teaching. There will be pros and cons of obtaining care at teaching facilities versus non-teaching facilities. To me, the point is being able to choose.

Over the past few years, we have seen several friends moving away from Los Angeles and into very small communities throughout the state, and not one of them gave any thought to choosing a community with superb medical care. This is most likely a function of being in the 55-60 age group, as well as having no medical problems.

So the short answer is: you don't necessarily need to live in an area with a teaching facility but I'd really recommend that you live somewhere with decent care.
This recent article in the NYT is certainly apropos

http://www.nytimes.com/2015/05/06/busin ... -bill.html

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Re: Retirement and Proximity to "Teaching Hospitals"

Post by HIinvestor » Mon Jun 01, 2015 8:57 pm

I have no idea what happens to the helicopter, airplane and other transportation bilks for the many patients flown from neighbor islands to Oahu for care. Haven't seen or heard it in the news, so perhaps insurers, Medicare and Medicaid are covering? I would never want to LIVE where there was a strong likelihood if needing to be flown for medical treatment in an emergency.

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