Best hospitals for…
• Breast Cancer, Lung Cancer, Colon Cancer, Prostate Cancer, Giving Birth
• Fertility, Stroke, Alzheimer’s Disease, Parkinson’s Disease, Migraines
• HIV/AIDS, Heart Surgery, Knee Surgery, Back Surgery, Hip Replacement
• The Top Ten Hospitals by Field
• Why Large Teaching Hospitals Are the Best
• How We Chose the Hospitals
• Best Hospitals Directory
Memorial Sloan-Kettering Cancer Center
The facts are no less grim for being frequently repeated. One in nine women will be diagnosed with breast cancer in her lifetime, and nearly one in four of them will succumb to the disease. Because there are so many different forms and stages of breast cancer, knowing exactly what you’re dealing with, and how to treat it, can spell the difference between life and death. Doctors at MSK have seen just about every variation of the disease. The hospital’s 65 specialized medical oncologists, surgeons, and radiologists treat some 92,000 breast patients each year and oversee 2,800 breast-cancer surgeries annually, second only to Institut Gustave-Roussy in Paris. MSK is not only the country’s most highly regarded breast-cancer-surgery center but also a top research hub, with some 30 clinical trials going on at any time. “Clinical trial treatment is some of the best you can get,” says Dr. Marisa Weiss, founder and president of Breastcancer.org, an advocacy group. You’re getting access to the latest therapies, she says, and “you’re so closely watched.” MSK’s breast-cancer team is headed by Dr. Larry Norton, a onetime presidential appointee to the National Cancer Advisory Board of the National Cancer Institute, who has made a number of the field’s most important breakthroughs. Most recently, he created a chemotherapy regimen that gives the same doses of chemo but more often, providing breast-cancer patients better results with surprisingly fewer side effects. “He’s been an innovator for decades,” says Weiss, “in clinical and laboratory work, patient advocacy, and mentorship.” MSK is currently operating at full capacity, but in 2009, it’s scheduled to complete its sixteen-story Breast and Imaging Center, set to be the largest such facility of its kind.
RUNNER-UP: New York–Presbyterian, Beth Israel, and St. Vincent’s have highly regarded breast-cancer programs, but NYU Medical Center’s program is widely seen as second only to MSK’s.
Memorial Sloan-Kettering Cancer Center
Sadly, a lung-cancer diagnosis is usually a death sentence: In a recent study, the disease was found to be fatal for 90 percent of men and 84 percent of women diagnosed with it. That’s why a patient’s best hope lies with a team of doctors who can attack the condition with a 360-degree approach. MSK patients have access to the city’s highest concentration of medical oncologists, surgeons, pathologists, and radiation oncologists who specialize in lung cancer, and lung cancer only. Among them: Dr. Kenneth Rosenzweig, the city’s only radiation oncologist dedicated exclusively to the disease; Dr. Mark Kris, known for his role in establishing a new treatment for lung cancer by finding new chemotherapy agents to shrink tumors prior to surgery or radiation therapy; and thoracic-surgery chief Dr. Valerie Rusch, whose department performs the largest number of lung-cancer resections in the New York area, yet still ranks among the best for length of hospital stay and mortality. Recent advances coming out of MSK’s clinical trials include Avastin (a tumor-shrinking drug tried at MSK for seven and a half months and approved by the FDA several weeks ago) and Iressa (a cancer-cell growth suppressor).
RUNNER-UP: NYU Cancer Institute’s widely cited for its strong contingent of lung-cancer specialists and its research. NYU is also the only hospital in the city to participate in the creation of the first national registry of patients considered at high risk for the disease.
Memorial Sloan-Kettering Cancer Center
How’s this for a roster of talent? Dr. David Kelsen, MSK’s chief of gastrointestinal service, oversees a team of oncologists that includes Dr. Leonard Saltz, who was the principal investigator on two new chemotherapy agents that have received FDA approval in the past six years, including Camptosar, the first new drug for colon cancer in 40 years. Saltz’s colleague Dr. Nancy Kemeny developed a revolutionary technique for delivering chemo for metastasized cases through the liver (rather than through an arm) via an implantable pump—which, along with Saltz’s drugs, has contributed to the doubling of overall survival rates for colon cancer in the past ten years. Then there’s MSK’s colorectal surgical team, headed by Dr. W. Douglas Wong, often said to be the premier rectal surgeon in New York. A giant in the field and the president-elect of the American Society of Colon and Rectal Surgeons, Wong has been a leading developer of surgical techniques, as well as the pioneer of presurgery ultrasound analysis of rectal tumors. Currently, he’s the only doctor in Manhattan experimenting with an artificial bowel prosthesis that may eliminate the need for a colostomy bag. Wong’s team also includes laparoscopic surgeon Martin Weiser and Dr. José Guillem, who’s leading a national study on the genetic indicators of colon cancer. Together, the five doctors perform some 970 surgeries a year, among the highest number in the city. “Their surgeons are well trained, incredibly current, and adept at the complicated and not-so-complicated cases. And they have terrific oncologists,” says Dr. Ronald Bleday, a leading colorectal expert at Brigham & Women’s Hospital in Boston.
RUNNER-UP: New York–Presbyterian, Weill Cornell’s Jay Monahan Center for Gastrointestinal Health, named after Katie Couric’s late husband, has research and clinical excellence comparable to MSK’s. Dr. Jeffrey Milsom, the city’s most accomplished laparoscopic colorectal surgeon, and his colleague Mark Pochapin recently developed a procedure for patients with difficult-to-remove polyps that’s only offered at Weill Cornell.
Memorial Sloan-Kettering Cancer Center
Anyone unfortunate enough to be given a prostate-cancer diagnosis usually finds himself facing a choice: surgery or radiation. Which route to take depends on a number of factors, from how old you are and whether you’re healthy enough to handle an invasive procedure to how far the disease has advanced and how willing you are to risk loss of sexual function. While a number of programs feature a star surgeon or radiation team, MSK’s urology department is said to be the most well-rounded program overall. On the diagnostic front, there’s Joe Torre’s oncologist, Howard Scher, a self-proclaimed “tiebreaker” on radiation-versus-surgery who specializes in customizing treatment plans. The surgical team, led by Dr. Peter Scardino, performs a total of 750 radical prostatectomies per year, making it one of the busiest programs in the country. Scardino was among the earliest doctors to refine a technique invented by Johns Hopkins prostate legend Patrick Walsh, which helped raised the percentage of men able to maintain sexual function from near zero at one point to 50 to 70. And in 1997, Scardino performed the first nerve graft on a radical prostatectomy patient—now a regularly offered service at MSK—successfully replacing the erectile nerve with a nerve from another part of the body. MSK is also home to Dr. Michael Zelefsky, who just published the largest study to date of an external-beam radiation-therapy technique that many prostate doctors are hailing as the wave of the future. It uses something called intensity-modulated-radiation therapy (IMRT) to deliver concentrated pinpoint beams to the prostate. The idea is to treat the disease while minimizing sexual, urinary, and other side effects. Although the rate of erectile dysfunction in the men studied was still 49 percent, all patients retained urinary continence, and the technique proved effective in removing the cancer in 67 to 89 percent of the cases studied.
RUNNER-UP: New York–Presbyterian, Columbia University Medical Center also has a program for IMRT as well as a genitourinary oncology team headed by Dr. Daniel P. Petrylak, who recently discovered that chemotherapy may work on some severe prostate cancers. It also has a Center for Holistic Urology, which has had promising results with betulonic acid, a compound found in birch trees.
New York–Presbyterian Hospital, Weill Cornell
Bringing Junior into the world, happily, isn’t usually a life-and-death situation. But if things go wrong, the best place to be is New York–Presbyterian, Weill Cornell. Cornell is one of just eight institutions in New York City with a Level 4 (the highest rating) neonatal intensive-care unit (NICU) and one of just two hospitals in the city with an extracorporeal membrane oxygenator (ECMO), essentially an infant heart-lung machine, said to be the state-of-the-art technology in emergency neonatal care. Of the 50 OB/GYNs on staff at Cornell, ten are high-risk specialists, and they get a lot of practice, delivering more high-risk babies than any other hospital in New York. Last year, the team delivered approximately 4,800 children, 50 percent of whom fell into the high-risk category. Led by Dr. Frank Chervenak, Cornell doctors are also research forerunners. Dr. Robin Kalish, director of clinical maternal fetal medicine, has identified genetic markers that can help identify patients who may be at risk for preterm labor in multiple births. “Cornell has a very strong maternal-fetal medicine unit,” says Dr. Mehmet Genç, an internal-fetal-medicine specialist at Brigham and Women’s Hospital in Boston, one of the most highly thought-of OB/GYN hospitals in the country. “It’s one thing to have a single famous doctor, but you really have to have a group with expertise. That’s what makes the difference at Cornell.” Cornell’s eleven labor-and-delivery suites are spacious and attractive and outfitted with modern birthing beds. Recovery takes place in one of the 50 shared or 11 private rooms, including three suites. Cornell’s uptown sibling, Columbia, which also has a Level 4 NICU and ECMO device, also excels in the high-risk category—19 out of 31 OB/GYNs are high-risk experts (though they split their time between Columbia and New York–Presbyterian’s Allen Pavilion in Inwood). Located in the newly constructed Morgan Stanley Children’s Hospital, Columbia’s NICU is part of a unique, comprehensive high-risk-pregnancy program. Specially trained obstetricians and pediatric subspecialists (in neonatology, cardiology, cardiac surgery, genetics, orthopedics, urology, neurology, neurosurgery, pediatric surgery, and other disciplines) can manage the care of a high-risk pregnant woman, all under one roof, from the earliest stages of pregnancy through the birth of her child and beyond.
RUNNER-UP: Mount Sinai has a Level 4 NICU, and highly respected labor and delivery practices.
New York–Presbyterian Hospital, Weill Cornell
In a city known for its trailblazing fertility programs, New York–Presbyterian’s Weill Cornell Center for Reproductive Medicine and Infertility leads the way. Under Dr. Zev Rosenwaks, known to his peers as the guru of the science, the facility has pioneered many of the procedures—including egg donation, embryo freezing, and in-vitro fertilization—that are now standard practices in fertility centers nationwide. The busiest facility of its kind in the city, Weill Cornell administers some 2,200 IVF and related cycles a year and has achieved a 50 percent live-birth rate with non-frozen embryos, according to the latest Centers for Disease Control statistics (and the world’s highest success rate, 30 percent, of conception with frozen embryos, according to Rosenwaks). While its overall live-birth rate is not the highest in the city, experts say it’s arguably the most impressive because Weill Cornell treats a disproportionately high percentage of difficult cases; nearly every woman who conceives there has failed an IVF cycle somewhere else. The center’s Male Reproductive Medicine and Microsurgery division is also at the forefront of fertility treatments; doctors there were the first to report successful births fathered by men rendered sterile by chemotherapy or radiation. “People are treated very thoughtfully at Cornell, and they’re serious about the science of their work,” says Joe Isaacs, the president of the infertility-advocacy group Resolve: The National Infertility Association. “They’re one of the premier centers in the country.”
RUNNER-UP: The NYU Program for In Vitro Fertilization, Reproductive Surgery & Infertility performs fewer IVF cycles than Weill Cornell, but boasts a 52 percent success rate for live births using non-frozen embryos. The staff of 60 is overseen by Rosenwaks’s protégé James Grifo, a nationally recognized leader in egg freezing and preimplantation genetic diagnosis, which allows for screening of embryos for inherited genetic defects. NYU also has a reputation for being gay-and-lesbian-friendly.
New York–Presbyterian Hospital, Columbia
The stroke center at New York–Presbyterian’s Columbia facility was created more than two decades ago by Dr. J.P. Mohr, a founding father of research in the field whose 1986 textbook, Stroke: Pathophysiology, Diagnosis, and Management, remains one of the most influential volumes on the subject. Mohr was behind the groundbreaking study concluding that aspirin was as effective in staving off strokes as the commonly prescribed blood thinner Coumadin, a drug with risky side effects. Today, the facility is headed by Dr. Ralph Sacco, a renowned epidemiologist in his own right and head of the Northern Manhattan Stroke Study, a first-of-its-kind look at race and ethnicity that has established risk factors specific to Hispanics, who have the highest stroke incidence in the country. Columbia is also one of seven hospitals nationwide—and the only one in the city—to be awarded the $10 million Specialized Program of Translational Research in Acute Stroke, a National Institutes of Health–funded grant aimed at finding new treatments. Columbia is the place other top doctors come to polish their skills; the facility has trained the directors of several of the stroke centers in the tri-state area, including NYU Medical Center and Long Island Jewish Medical Center. And Columbia is known not only for its research: The facility saw 669 stroke patients last year, the most of all the city’s designated stroke centers, and still managed to come out with a low-risk-adjusted mortality rate of 9.3 percent, according to the Alliance for Quality Healthcare. “It’s not just the best in New York City,” says Dr. William Powers, a professor of neurology, neurological surgery, and radiology at Washington University. “It’s one of the best in the country.” Though it lags behind its sister hospital in research, New York–Presbyterian Hospital, Weill Cornell’s stroke center excels in patient care, with a risk-adjusted patient-mortality rate of 7.4 percent. As part of an effort to raise its profile, Weill Cornell recently lured the renowned Dr. Pierre Gobin, who invented the merci Retriever, a mechanical device that can remove clots in arteries up to eight hours after a stroke.
RUNNER-UP: Last year, NYU was named the first state-designated primary stroke center in Manhattan. And NYU’s Rusk Institute of Rehabilitation Medicine, with a section devoted to stroke, was rated the No. 1 facility of its kind in New York State and No. 8 in the nation by U.S. News & World Report.
New York–Presbyterian Hospital
There’s no cure for Alzheimer’s, so a patient’s best hope is to be seen at a hospital known for cutting-edge research and access to the latest clinical trials. An Alzheimer’s Disease Research Center and one of three Alzheimer’s Disease Centers in New York (the designations are federal and state marks of excellence), New York–Presbyterian’s Taub Center (at Columbia University Medical Center) has one of the largest DNA Alzheimer’s databases in the world. Containing the genetic fingerprints of 1,000 families affected by late-onset Alzheimer’s, the database is considered a uniquely promising tool for unlocking the secrets of the disease and perhaps finding a cure. Led by Dr. Richard Mayeux and Dr. Michel Shelanski, Taub Center doctors are involved in studies that promise immediate benefits as well. In one recent clinical trial, Mayeux demonstrated that maintaining a Mediterranean diet can slow the progression of Alzheimer’s and in some cases prevent it. “From a research point of view, Taub stands out,” says Dr. David Knopman, a professor of neurology at the Mayo Clinic and an investigator at the Mayo Alzheimer’s Disease Research Center. New York–Presbyterian’s Memory Disorders Program (at Weill Cornell) is another leading research facility. Program director Dr. Norman Relkin is currently heading a study involving human antibodies called intravenous immunoglobulin. The antibodies (FDA-approved, though not for Alzheimer’s) have been shown to latch onto and draw out certain proteins that cause the loss of memory and cognitive ability that characterize Alzheimer’s. The experimental therapy, which it’s hoped could someday lead to an Alzheimer’s vaccine, recently received significant National Institutes of Health funding. New York–Presbyterian has the latest diagnostic tools, including advanced brain imaging and molecular diagnostic testing, which are essential for detecting the disease early (early detection can slow Alzheimer’s progression and improve a patient’s quality of life). And the hospital’s world-class team of neurologists, neuropsychologists, and social workers has a reputation for providing thorough and sensitive care to help patients cope with Alzheimer’s debilitating effects.
RUNNER-UP: New York’s other Alzheimer’s Disease Centers are Mount Sinai Medical Center and NYU. Mount Sinai is also an Alzheimer’s Disease Research Center.
New York–Presbyterian Hospital
As Rush Limbaugh recently found out a few days too late, each case of Parkinson’s is highly idiosyncratic. There’s no cure, a still-limited body of knowledge about how the disease progresses, and an equally limited understanding of how to deal with the often-unpredictable effects—like the controversial movements in Michael J. Fox’s stem-cell ad—of the known therapies. The best approach, therefore, is to have access to the largest possible body of treatment options and, just as important, doctors familiar with the multitude of turns the disease can take. New York–Presbyterian’s Dr. Stanley Fahn, chairman of last year’s first-ever World Parkinson Congress oversees more Parkinson’s-specializing doctors (seven) and more patients (five to six new cases each day) than any other physician in the city. Robin Elliott, executive director of the Parkinson’s Disease Foundation, describes Dr. Fahn as “the leading Parkinson’s specialist in the country”; his program, based at New York–Presbyterian’s Columbia University Medical Center facility, also encompasses heavily funded research labs—among other projects, they link highly precise scanning equipment to motion-capturing devices to try and find patterns behind seemingly random tremors—and Fahn’s colleague, Dr. Blair Ford, is an authority on leading-edge non-pharmaceutical treatment, “deep brain stimulation.” The DBS surgeons at Columbia have performed hundreds of the procedures—a battery and two electrodes are implanted within the brain’s motor-control system—in the decade since the FDA approved its use. On average, patients see a 90 percent reduction in tremors, a 90 percent reduction in dyskinesias (the shaking movements triggered by Parkinson’s medication), and a 40 to 70 percent reduction in the time spent in motionless spells, “which means several more hours a day of functional mobility,” says Ford. New York–Presbyterian’s Weill Cornell facility conducts its own next-generation research. In one experimental trial program currently being coordinated by Dr. Michael Kaplitt, gene compounds are being injected into the same region as the DBS electrodes in the first-ever attempts to achieve brain-rejuvenating effects through genetic therapy.
RUNNER-UP: Beth Israel’s program, run by Dr. Susan Bressman (who was at Columbia for some twenty years), has been instrumental in researching family histories to establish the disease’s genetic origins.
Montefiore Medical Center
The 29 million Americans who suffer from migraines—the head-splitting pain, the debilitating nausea, the hypersensitivity to light and smells—want one thing, and fast: They want all of those things to stop. The doctors at Montefiore’s Headache Center, one of just two comprehensive headache facilities in the city, are among the world’s leading authorities on how to quiet the pounding. Montefiore’s program, which sees almost 4,300 patients per year, among the highest number in the city, is run by Dr. Richard Lipton, the president of the American Headache Society and professor of Neurology, Epidemiology and Population Health at Albert Einstein College of Medicine (the university with which Montefiore is associated) and an internationally recognized headache authority. Lipton and his team are currently conducting research on experimental pain-treatment devices like neurostimulators (which use electrodes to deliver stimulation to the spinal cord or nearby nerves), and PFO closure (the PFO is an abnormal opening between the heart’s upper chambers, and sealing it often reduces the incidence of headaches). “Lipton has the best worldwide reputation,” says Dr. Jerome Goldstein, director of the highly regarded San Francisco Headache Clinic. “He’s written a tremendous amount, he’s doing the most advanced research, and he’s a very good clinician.” Lipton and his team also have a well-deserved reputation as outstanding diagnosticians, which is critical, considering that migraines are notoriously difficult to diagnose (there are multiple types of headaches and the differences can be subtle, which may explain why more than half of headache sufferers are misdiagnosed), and each kind of headache can require different treatment. Migraine treatment is also about pain relief, of course, and Montefiore excels there too. The program’s staff psychologist has specialized training in pain-control techniques, and patients have access to nontraditional migraine therapies like vitamins, herbs, and Botox.
RUNNER-UP: St. Luke’s–Roosevelt Hospital’s Headache Institute is the city’s other comprehensive headache center, and its program director, Dr. Larry Newman, was trained by Lipton.
New York–Presbyterian Hospital, Weill Cornell
Even in the age of life-extending drug cocktails, the holy grail in HIV/AIDS remains a vaccine or cure. New York–Presbyterian’s Center for Special Studies (an affiliate of Weill Cornell) has the only NIH–funded HIV vaccine trial unit in New York City. The hospital is also leading the way in research into the metabolic complications of HIV, in areas such as specific bone loss and osteoporosis in postmenopausal Hispanic women. One of just a handful of New York State Designated AIDS Centers (defined by the state Health Department as “state-certified, hospital-based programs that serve as the hubs for a continuum of hospital and community-based care for persons with HIV infection and AIDS”), the Center for Special Studies employs eleven full-time doctors, five psychiatrists, and a team of nurses, nutritionists, and social workers who specialize in HIV/AIDS-related illnesses, including nationally recognized physicians like Dr. Jonathan Jacobs, the center’s director. “New York–Presbyterian has an absolutely outstanding program,” says Dr. Diane Havlir, chief of the internationally renowned HIV/AIDS program at the University of California, San Francisco School of Medicine. “It excels in leadership, research, patient care, and prevention.” New York–Presbyterian also has a “one-class care” policy, so patients with Medicaid/Medicare get the same treatments, doctors, and drug access as patients with private insurance. And the hospital also works closely with Gay Men’s Health Crisis, the premier community-based HIV-program in the country. GMHC provides legal services, insurance services, counseling, and free meals for patients who need them.
RUNNER-UP: Mount Sinai’s Jack Martin Fund Clinic is the other New York State Designated AIDS Center. Among its notable research programs is one for HIV-positive African-Americans suffering from HIV-related kidney problems.
New York–Presbyterian Hospital
When Bill Clinton, after five decades of extreme living and who-knows-how-many Big Macs, needed emergency triple-bypass heart surgery, he went to Columbia-Presbyterian Medical Center. When Charlie Rose, David Letterman, Walter Cronkite, and Larry King all needed open-heart surgery, they went to Weill Cornell Medical Center. There’s a good reason the well connected find themselves there. Doctors at these once separate, competing institutions, now both part of New York–Presbyterian Hospital, have some of the lowest mortality rates anywhere for heart procedures, even though they take on some of the riskiest patients. The pioneering hospitals (the first successful pediatric heart transplant and the first robotically assisted open-heart procedure were performed here) are home to a dream team of internationally recognized cardiac superstars, including Cornell’s Wayne Isom and Karl Kreiger and Columbia’s Mehmet Oz, Craig Smith, Eric Rose and Jeffrey Moses. In 2004, New York–Presbyterian hired away almost the entire interventional-cardiology department from Lenox Hill Hospital. Led by Moses, the former Lenox Hill team had mastered the one thing that New York–Presbyterian’s doctors once lagged in: the less-invasive angioplasties and stent insertions that are rapidly becoming the state-of-the-art treatment for many heart patients (where the department Moses now heads once performed 700 procedures a year, it now does about 4,000). This year, New York–Presbyterian broke ground on the Milstein Family Heart Center, a $250 million, 142,000-square-foot freestanding building in Washington Heights that, when it opens in 2008, will be one of the most comprehensive heart facilities in the world. And if you ever need the big kahuna of heart surgeries, New York–Presbyterian is the place to do it. Says Jeffrey Gold, a heart surgeon who once topped New York’s low-mortality list and is currently dean of the Medical University of Ohio, “If I lived in New York and needed a heart transplant, I’d go to Columbia.”
RUNNER-UP: Mount Sinai Medical Center is headed by one of the grand old men in cardiology, Valentin Fuster, and New York newcomer David Adams, considered a major catch when he was lured from Harvard five years ago. New York University, St. Vincent’s, Lenox Hill, and Montefiore are often cited as top programs as well.
Hospital for Special Surgery
The Hospital for Special Surgery’s aptitude for treating the types of high-impact joint injuries sustained by Olympians took up nearly an entire page of the NYC 2012 bid team’s proposal for the International Olympic Committee. That’s the same amount of ink spilled touting Ray Kelly’s contributions to public safety, and it’s not just Doctoroff-ian hyperbole. HSS’s capabilities are held in higher esteem by the nation’s top doctors than any other orthopedic department in the country—which, in part, is because a good portion of the nation’s top knee specialists who don’t work at HSS trained there (9 out of the 22 past presidents of the American Knee Society, for example, have passed through at some point). Doctors like Brian Cole (a former HSS resident who’s now a Chicago White Sox team doctor) say the hospital’s most significant attribute is the experience and knowledge of Renaissance surgeons who specialize in both orthopedic research and the practical applications thereof. Says Cole: “It’s called translational research—the ability to investigate a problem in the lab, from test tube to animal models, and turn it into something that can be done clinically.” If you’re getting a knee replacement, for example, you’ll likely be receiving an artificial knee designed by HSS researchers (who patented the first such device in 1974) and getting it installed by doctors who pioneered the practice of using pre-op MRI scans to make operations as quick and uninvasive as possible. HSS’s surgeons and rehab therapists in “sports medicine”—the catchall term for ligament reconstruction and other non-replacement operations—are the team doctors for such healthy-knee-reliant organizations as the Knicks, Nets, Liberty, Giants, and Mets. And patients—at least Turkish basketball-team forward Ersan Ilyasova, a source located by the NYC 2012 committee—seem to think the staff is really, really nice. “It’s the best treatment,” Ilyasova said in the 2012 brochure. “Not just the medical part, but also people-wise.”
RUNNER-UP: Lenox Hill Hospital. Doctors like Chitranjan Ranawat, who helped pioneer the artificial knee at HSS, is among the surgeons here. Ranawat has been flown to Mumbai twice (once for each knee) to operate on Indian prime minister Atal Behari Vajpayee.
Hospital for Special Surgery
Having a surgeon take a scalpel to your spine is every bit as scary as it sounds. One slip of the knife and a patient can be paralyzed or die. Back surgery can also be extremely painful, and studies show it’s often ineffective. HSS is the city’s, and one of country’s, leading innovators in safe and effective new surgical techniques. The current trend in back surgery is the use of minimally invasive procedures, which can reduce pain and recovery times and improve outcomes, and HSS is at the forefront of those techniques. The recently FDA-approved ProDisc, developed at HSS, is the most thoroughly researched and best-received total-disk-replacement device to date, and the most likely to restore maximum mobility post-surgery. Other recent advances to come from HSS include Dr. Frank P. Cammisa’s pioneering use of artificial, bonelike plugs as scaffolding for new bone to grow on for vertebrae-fusion patients, and the groundbreaking Isola Spine Instrumentation system, developed by scoliosis chief Dr. Oheneba Boachie-Adjei and his team, which allows for correction of spine deformities from all angles and can result in more-precise fixes. HSS’s thirteen surgeons perform 6,700 spinal surgical procedures a year, and their mortality rates are among the lowest in the country. “In New York, Special Surgery is No. 1 without a doubt,” says Dr. John Olsewski, who sits on the board of councilors of the American Academy of Orthopaedic Surgeons. The facility is also well known for its expertise in pain management and physical therapy.
RUNNER-UP: The NYU Hospital for Joint Diseases Spine Center has twenty highly regarded spine surgeons on staff, treats 1,400 cases annually, and was among the first hospitals in the country to perform artificial-disk implantation.
Hospital for Special Surgery
Hip replacement is now the safest and one of the most common types of joint-replacement surgery—about 330,000 procedures are performed in the United States each year—thanks in good measure to advances in the procedure pioneered at the HSS. The 270 doctors at the hospital replaced 2,608 hips last year—more than any other facility in the country—while maintaining safety standards that have been singled out as industry-leading by everyone from the NIH to the Consumers’ Research Council of America to the AARP. The average length of stay for a single hip replacement at HSS is 4.48 days (that’s considered excellent), and its strict adherence to surgical-infection-prevention measures earned it the No. 1 ranking in the area from the New York State Department of Health. Dr. Thomas Sculco has pioneered a smaller-incision hip-surgery technique that can minimize pain, side effects, and recovery time, and Dr. Edwin Su is one of the first surgeons in the country to do hip resurfacing, a new procedure that preserves the joint by using an innovative metal implant.
RUNNER-UP: New York–Presbyterian’s Center for Hip and Knee Replacement did 1,040 hips of its own last year, which would make it the most-trafficked hospital in just about any other city. The highly regarded Dr. William Macaulay is the program’s leader.
The Top Ten Hospitals By Field
Points 1 New York–Presbyterian Hospital 5,088 2 Mount Sinai Medical Center 3,298 3 NYU Medical Center 3,031 4 Memorial Sloan-Kettering Cancer Center 2,253 5 Yale–New Haven Hospital 1,447 Points 6 Montefiore Medical Center 1,375 7 Hospital for Special Surgery 1,114 8 Hackensack University Medical Center 1,077 9 North Shore University Hospital 896 10 Long Island Jewish Medical Center 783
Points 1. Bellevue Hospital Center 3,560 2. New York–Presbyterian Hospital 1,980 3. Mount Sinai Medical Center 1,205 4. NYU Medical Center 1,205 5. Jacobi Medical Center 960 6. Montefiore Medical Center 703 7. Hackensack University Medical Center 684 8. Kings County Hospital Center 663 9. Yale–New Haven Hospital 598 10. Saint Vincent Catholic Medical Centers– St Vincent’s Manhattan 567
Points 1. New York–Presbyterian Hospital 4,844 2. Schneider Children’s Hospital 2,558 3. Mount Sinai Medical Center 2,350 4. Montefiore Medical Center 1,882 5. NYU Medical Center 1,810 6. Yale - New Haven Hospital 1,422 7. Hackensack University Medical Center 986 8. Children’s Specialized Hospital Center 819 9. Children’s Hospital of New Jersey at Newark 703 10. Westchester Medical Center 677
Points 1. Manhattan Eye, Ear & Throat Hospital 2,885 2. New York Eye and Ear Infirmary 2,638 3. New York–Presbyterian Hospital 2,243 4. Mount Sinai Medical Center 2,090 5. NYU Medical Center 1,499 6. Yale–New Haven Hospital 859 7. Beth Israel Medical Center–Petrie Division 759 8. Montefiore Medical Center 589 9. Lenox Hill Hospital 471 10.Long Island Jewish Medical Center 449
Points 1. New York–Presbyterian Hospital 3,592 2. Bellevue Hospital Center 2,541 3. Mount Sinai Medical Center 1,715 4. New York State Psychiatric Institute 1,495 5. NYU Medical Center 1,453 6. Yale–New Haven Hospital 1,158 7. Long Island Jewish Medical Center 628 8. Montefiore Medical Center 617 9. Beth Israel Medical Center–Petrie Division 542 10. Bronx Psychiatric Center 521
Points 1. Memorial Sloan-Kettering Cancer Center 7,391 2. New York–Presbyterian Hospital 3,309 3. Mount Sinai Medical Center 2,436 4. NYU Medical Center 2,109 5. Yale–New Haven Hospital 1,278 6. Hackensack University Medical Center 1,093 7. The Cancer Institute of New Jersey 894 8. Montefiore Medical Center 879 9. North Shore University Hospital 706 10. Beth Israel Medical Center–Petrie Division 592
Points 1.New York–Presbyterian Hospital 5,483 2. NYU Medical Center 2,879 3. Mount Sinai Medical Center 2,845 4. St. Francis Hospital–The Heart Center 2,133 5. Montefiore Medical Center 1,232 6. Hackensack University Medical Center 1,167 7. Lenox Hill Hospital 1,153 8. Yale–New Haven Hospital 1,139 9. North Shore University Hospital 968 10.Westchester Medical Center 583
Points 1.Mount Sinai Medical Center 4,267 2. New York–Presbyterian Hospital 3,281 3. NYU Medical Center 1,797 4. Yale–New Haven Hospital . 1,098 5. Montefiore Medical Center 1,055 6. Beth Israel Medical Center–Petrie Division 753 7. North Shore University Hospital 632 8. Hackensack University Medical Center 600 9. Long Island Jewish Medical Center 523 10. Memorial Sloan-Kettering Cancer Center 507
Points 1. Hospital for Special Surgery 5,737 2. NYU Hospital for Joint Diseases 3,170 3. New York–Presbyterian Hospital 1,931 4. Lenox Hill Hospital . 1,490 5. Mount Sinai Medical Center 1,340 6. Yale–New Haven Hospital 751 7. NYU Medical Center 693 8. Montefiore Medical Center 573 9. Beth Israel Medical Center–Petrie Division 558 10. Hackensack University Medical Center 529
Points 1. New York–Presbyterian Hospital 3,271 2. Mount Sinai Medical Center 2,526 3. NYU Medical Center 2,057 4. Lenox Hill Hospital . 1,227 5. Yale–New Haven Hospital 1,127 6. North Shore University Hospital 797 7. Hackensack University Medical Center 633 8. Beth Israel Medical Center-Petrie Division 584 9. Long Island Jewish Medical Center 581 10. Montefiore Medical Center 577
Points 1. New York–Presbyterian Hospital 4,791 2. NYU Medical Center 2,985 3. Mount Sinai Medical Center 2,446 4. Yale–New Haven Hospital 1,118 5. Montefiore Medical Center 993 6. Beth Israel Medical Center–Petrie Division 636 7. Bellevue Hospital Center 500 8. North Shore University Hospital 482 9. Memorial Sloan-Kettering Cancer Center 472 10. St. Luke’s-Roosevelt Hospital Center–Roosevelt Division 402
Why Large Teaching Hospitals Really Are the Best One physician makes the case.
By Sandeep Jauhar
Which are the best hospitals in New York? According to the 1,000-plus New York–area doctors in New York Magazine’s inaugural survey on the subject, they’re generally large teaching institutions—sprawling multi-campus behemoths like New York–Presbyterian Hospital (the No. 1 Overall Best Hospital), Mount Sinai Medical Center (No. 2), and NYU Medical Center (yes, No. 3) that treat hundreds of thousands of patients a year. While I didn’t participate in the survey, I suspect my vote would have gone the same way. After training at two of the largest academic institutions in Manhattan, I’ve come to believe that big teaching hospitals are the best places to go when you’re sick. Based on these survey results, I’m hardly the only doctor who has this bias. But are we right?
On the evidence, it looks like we are. Two recent studies showed that patients treated for several common medical disorders fared better at teaching hospitals. In a 2002 study in The American Journal of Medicine, researchers analyzed a database of almost 400,000 patients admitted with heart failure, heart attack, or stroke to 248 hospitals around New York State. In-hospital death rates for all three conditions were much lower at major teaching hospitals than nonteaching institutions. What’s more, a study of hip fractures, stroke, coronary heart disease, and congestive heart failure published in The New England Journal of Medicine found that the care at major teaching hospitals was costlier but led to better overall survival, especially for those with hip fractures.
Why do major teaching hospitals produce better outcomes? Aren’t they known for delivering hopelessly impersonal, data-driven care from a revolving door of Scrubs wannabes? Sure. But that might not be a bad thing. While throngs of interns and residents may be annoying when you’re reciting the details of your fainting episode for the third time in the middle of the night—“So, tell me what happened”—all those eyes on each patient means things don’t get overlooked. Up to 80 percent of medical diagnoses can probably be made on the basis of a patient’s history, and the more people interrogating you, the more likely we are to get it right.
Big teaching hospitals also conduct topflight research, basic and clinical. With certain diseases, especially cancer, your best hope may lie with an experimental drug protocol, and the pace of innovation is so fast today that hospitals involved in the latest trials might just stand a better chance of saving your life. At the survey’s top-ranked cancer hospital, Memorial Sloan-Kettering Cancer Center, virtually every patient just diagnosed with cancer is offered the chance to participate in a study.
Another Big Medicine advantage? Volume. It may sound obvious, but would you rather have your arteries Roto-rootered by a cardiologist who does 200 angioplasties a year—or 20? A busy surgeon, research suggests, may, in fact, be a better one: A paper published in April 2002 in The New England Journal of Medicine examined statistics on 2.5 million operations between 1994 and 1999 and found that mortality decreased as volume increased for fourteen surgical procedures. With coronary-artery bypass surgery, the authors concluded that 314 deaths per year could be avoided in the United States if very-low-volume hospitals had the same operative mortality as very-high-volume hospitals.
A surprising amount of the time, big hospitals’ better outcomes are about nothing more exciting than good old-fashioned blocking and tackling. You’d be amazed how well a hospital can do simply by paying scrupulous attention to basic patient care and doing things in ways that have been proved to work.
That’s certainly true in my hospital system, one of the largest in the country (and one that counts two facilities, Long Island Jewish Medical Center and North Shore University Hospital, I’m happy to say, in the survey’s overall top ten). We meet each month to critique our own performance on certain “core” quality indicators: hospital-acquired infections, delays in administering antibiotics for pneumonia, “door to balloon” time in the cardiac catheterization lab, and the like. We discuss troubling statistics, such as that only about two-thirds of patients nationwide receive beta-blocker therapy after a heart attack, and roughly the same percentage receive ACE-inhibitor therapy after a diagnosis of heart failure, even though both treatments have been shown to prolong life. My hospital has even hired nurses to independently review patients’ charts to ensure that they’re receiving established therapies.
In the best academic hospitals, schooling doesn’t stop with the residents. Last year, my hospital’s quality-management department actually gave report cards to physicians on the faculty, grading us on how well we were doing on core measures, like advising patients with heart disease to quit smoking. While that may sound like the most rudimentary possible yardstick, sometimes the simplest yet most effective protocols are the first to be forgotten in the middle of a busy day.
As anybody who’s ever had to wait six months to see a big-name specialist or gotten hopelessly lost in a basement on the way to get blood drawn can attest, big hospitals are by no means the only solution for your medical needs. For a relatively minor procedure, like gallbladder removal, it probably doesn’t matter which hospital you go to. A community hospital may provide care comparable to a large, urban facility, and you may even get more personal attention. It’s also true that some smaller hospitals have established niches of care—for orthopedic problems, say, or strokes—that compare favorably to big general-care hospitals.
Still, if I were in trouble, and I had a choice, I’d go to one of the big hospitals. I remember a patient I treated during my fellowship at NYU: a middle-aged man who had collapsed several days earlier on a subway platform with a heart attack. Paramedics arrived, and they did all the right things: They gave him an aspirin to chew, placed nitroglycerin under his tongue, and administered oxygen through a face mask. Then they took him to a nearby hospital that did not perform angioplasty. The procedure, in which tiny balloons and stents are used to open blocked coronary arteries, is the best treatment for a heart attack if done expeditiously by experienced doctors. Instead, the man received a clot-dissolving drug—a thrombolytic—which in his case, unfortunately, didn’t work.
By the time he was transferred to my hospital for angioplasty, it was too late. He was already exhibiting signs of heart failure. At this point, there was little reason for us to open his blocked coronary artery, because the part of his heart that is fed by the artery was permanently damaged. If he had been brought directly to NYU, which had a cardiac-catheterization lab open 24 hours a day, the damage to his heart could have been averted, adding years to his life. Do you need a better argument for big teaching hospitals?
Dr. Sandeep Jauhar is director of the Heart Failure Program at Long Island Jewish Medical Center and the author of the forthcoming memoir Interred, to be published by Farrar, Straus & Giroux.
Who Chose the Hospitals?
The winning hospitals noted in the Overall Best Hospitals chart and the charts for the best hospitals in the ten broad care areas covered in these pages (cancer; ear, nose, and throat; emergency care; gastrointestinal disorders; heart disease/heart surgery; neurology/neurosurgery; OB/-GYN; orthopedics; pediatrics; and psychiatry) were selected through a survey conducted exclusively for New York Magazine by Castle Connolly Medical Ltd. For the “Best Hospitals” survey, Castle Connolly polled a randomly selected database of more than 30,000 physicians from the city and a number of surrounding suburbs and asked them to choose the top-ten hospitals (from a list of 199) in each of the areas noted above.
More than 1,000 physicians responded (a 3 percent response rate is typical for this type of survey). Each time a hospital received a No. 1 vote, it was awarded ten points; a No. 2 vote earned a hospital nine points, and so on down to a No. 10 vote, which was worth one point. The total points received by a hospital are noted in the chart next to the hospital’s name and ranking. (A note on the Overall Best Hospitals rankings: Voters were instructed by Castle Connolly, publishers of the annual guidebook Top Doctors: New York Metro Area and the group that helps New York compile its annual “Best Doctors” listings, to vote for the hospital that best fulfilled its mission. Hospitals that offer care in a broad number of areas, like New York–Presbyterian and Mount Sinai, therefore appear among the top ten along with more-specialized hospitals like Memorial Sloan-Kettering Cancer Center.)
It bears noting that all surveys of this kind have limitations. Some doctors who declined to participate said they didn’t know enough about hospitals outside their specialty to make an informed judgment. And because large hospitals employ the most doctors, the survey is likely weighted in favor of those institutions.
To select the hospitals rated the best in the fifteen subspecialties listed in these pages (Alzheimer’s disease, back surgery, birthing centers, breast cancer, colon cancer, fertility treatment, heart surgery, hip replacement, HIV/AIDS, knee surgery, lung cancer, prostate cancer, migraines, Parkinson’s disease, and stroke), a team of New York reporters canvassed leading doctors in each field and asked them, “If you or a loved one were in need of this kind of care, what hospital would you choose and why?” The winning hospitals (and the runners-up) reflect the physicians’ consensus choices.
Surveys and lists of this sort, it’s worth pointing out, should be used as one tool in evaluating hospitals, and not as a substitute for conducting thorough research on any given case for any given condition.
• Bellevue Hospital Center
462 First Ave.; 212-562-4141
• Beth Israel Medical Center–Milton and Carroll Petrie Division
281 First Ave.; 212-420-2000
• Bronx Psychiatric Center
1500 Waters Pl., the Bronx 718-862-3301
• The Cancer Institute of New Jersey
195 Little Albany St., New Brunswick, N.J.; 732-235-2465
• Children’s Hospital of New Jersey at Newark Beth Israel Medical Center
201 Lyons Ave., Newark, N.J. 973-926-7000
• Children’s Specialized Hospital
150 New Providence Rd., Mountainside, N.J.; 908-233-3720
• Hackensack University Medical Center
30 Prospect Ave., Hackensack, N.J. 201-996-2000
• Hospital for Special Surgery
535 E. 70th St.; 212-606-1000
• Lenox Hill Hospital
100 E. 77th St.; 212-434-2000
• Long Island Jewish Medical Center
270-05 76th Ave., New Hyde Park 516-470-7000
• Manhattan Eye, Ear & Throat Hospital
210 E. 64th St.; 212-838-9200
• Memorial Sloan-Kettering Cancer Center
1275 York Ave.; 212-639-2000
• Montefiore Medical Center
111 E. 210th St., the Bronx; 718-920-4321
• Mount Sinai Medical Center
1 Gustave L. Levy Pl.; 212-241-6500
• New York Eye and Ear Infirmary
310 E. 14th St.; 212-979-4000
• New York–Presbyterian Hospital, Columbia University Medical Center
622 W. 168th St.; 212-305-2500
• New York–Presbyterian Hospital, Weill Cornell Medical Center
525 E. 68th St.; 212-746-5454
• New York State Psychiatric Institute at Columbia Presbyterian Medical Center
1051 Riverside Dr.; 212-543-5000
• North Shore University Hospital at Manhasset
300 Community Dr., Manhasset, N.Y. 516-562-0100
• NYU Medical Center
550 First Ave.; 212-263-7300
• Schneider Children’s Hospital
262–01 76th Ave., New Hyde Park 718-470-3000
• St. Francis Hospital, the Heart Center
100 Port Washington Blvd., Roslyn, N.Y.; 516-562-6000
• St. Luke’s–Roosevelt Hospital Center, Roosevelt Division
1000 Tenth Ave.; 212-523-4000
• Saint Vincent Catholic Medical Centers, St. Vincent’s Manhattan
170 W. 12th St.; 212-604-7000
• Westchester Medical Center
95 Grasslands Rd., Valhalla, N.Y.; 914-493-7000
• Yale–New Haven Hospital
20 York St., New Haven, Conn.; 203-688-4242
Contributors: Katie Charles, Yael Kohen, Robert Kolker, Ben Mathis-Lilley, Rebecca Milzoff, Janelle Nanos, Emma Pearse, Emma Rosenblum, Stacia Thiel, and Jada Yuan.