Do you need to undergo surgery? Do you have a choice of hospitals or surgeons to take care of you? If so, you probably have many questions and concerns about what is your best course of action. Facing surgery of any type can be quite frightening and stressful for many people. Putting your health in someone else's hands can be quite a leap of faith.
One of the largest concerns many people have is whether to choose a private or academic hospital for their care. While both are potentially excellent there can be some differences. The following comparison is a generalization. Not all academic or private hospitals are the same so you should investigate your own options as well.
Academic Versus Private Hospitals: What is the difference?
Generally, academic hospitals are teaching institutions. They are often associated with some university or other school system, although there are exceptions. What defines them is that academic training and/or research are conducted at these centers. This means that medical students, interns, residents and/or fellows may be involved in the care of patients.
A private hospital is one which is privately owned and operated. While there can be academic private hospitals, a purely private hospital does not generally train students, residents or fellows. Therefore, all your care is provided by physicians who have completed their training, along with nurses and/or physician assistants.
What are the advantages of a private hospital?
Private hospitals are often run very efficiently. Therefore, operating room schedules, clinics and other care is generally more prompt and efficient. Additionally, your surgeon and/or other physicians are all finished with their training. No students or physician trainees are involved in your care. Many patients find this to be an important point, but it is not always necessarily better, as will be discussed shortly. Finally, most large private medical centers are very efficient and skilled at treating "bread and butter" cases which are performed frequently. For example, general surgical procedures like an appendectomy or laproscopic cholecystectomy are often performed hundreds or thousands of times a year and are therefore done very well with a low rate of complications.
What are the advantages of an academic hospital?
Academic hospitals are often large medical centers with a full range of sub-specialties covered. Because of the number of physicians who have specialized interests in various areas you can often find the leaders of each field in an academic setting. Because of this sub-specialization and the resources available to a large academic center, many rare and complex cases are referred to them. For this reason, academic centers often have a larger clinical volume and therefore more experience with treatment of these difficult cases. For example, whereas a neurosurgeon at a small private hospital may only perform a few of a given procedure a year, a specialized neurosurgeon at an academic institution may see dozens or hundreds of that type of case.
Studies have shown that the outcomes and rate of complications with a given surgical procedure is strongly related to the experience and volume of such cases treated at a given institution. Therefore, outcomes are more likely to be better with fewer complications when a procedure is performed by an experienced team which has performed many of those procedures. For complex surgical procedures, most academic hospitals have superior volumes of such cases. There are exceptions of course, with some private hospitals supporting a large volume of complex cases in a particular area of specialization.
Finally, while some people would consider medical trainees a disadvantage, there are some advantages to having medical students and residents involved in your care to consider. Academic hospitals often have one or more resident and/or medical student on call and in the hospital at all times. They are responsible for the minute to minute care of patients on their service. The advantage of this can be that you may have more regular attention from a physician. In some private hospitals, physicians may not be as available, particularly during off-hours. Therefore, some people feel the continuity of care and the availability of doctors is greater in some academic institutions.
You must remember that faculty surgeons are often very busy individuals, pulled frequently in multiple directions. In a private setting they may be spread thing, without residents to back them up. In an academic setting, the resident team manages the patients day in and day out and therefore are often much more in tune with the minute to minute and day to day issues that may arise in your care. Knowing that you have a strong team caring for you may be comforting to many patients.
In the end, if you have a choice, you must go with what feels best to you. If you do not have first hand experience with a particular hospital or physician, ask someone who does. Ask how their care was conducted. What was the availability of physicians? How much of their care was through nurses, physician assistants, medical students, residents or others and was the care thorough and attentive? Only you know what form of care you will feel most comfortable with so go with your gut instinct. After all, your comfort during your surgery and hospitalization are most important.
Josh Dusick is the editor of Nervous System Diseases, at http://www.nervous-system-diseases.com, your guide to diseases of the neurological system, providing an in depth introduction that is understandable even if you do not have a background in science or medicine.
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