Emergency physicians from top organizations representing emergency medicine traveled to Washington, D.C., on Sept. 22, 2014, to meet with Ben Harder, managing editor and director of health care analysis at U.S. News & World Report, and Nate Gross, MD, cofounder of Doximity, an online social-networking service for U.S. physicians that conducts surveys for U.S. News.

The purpose of these meetings was to convey the concerns of nine emergency medicine organizations (see sidebar) about the results of a Doximity survey, which was promoted by U.S. News & World Report, identifying the nation’s top emergency medicine residency programs. Emergency physicians are concerned that the sampling method fails to achieve the survey’s objective: to identify top emergency medicine training programs. ACEP and its members also believe the survey conveys a message that some programs are better than others when, given the survey’s limitations, this would not be accurate.

Doximity surveyed its members in July 2014, asking them to nominate the five “best” residency programs in the country. From these nominations, which were heavily weighted toward older, larger programs with more alumni, Doximity assembled its list of top residency programs. No outcomes or public data were used in creating the rankings.

Prior to the meeting, emergency physicians from the nine organizations held a conference call and developed a joint letter to U.S. News and Doximity challenging the sampling method and the implications of providing misleading information to medical students and the public.

Four physicians represented the groups at these meetings:

• Hans R. House, MD, FACEP, ACEP Board member
• Jeffrey N. Love, MD, MSC, President, Council of Emergency Medicine Residency Directors
• Jordan Celeste, MD, President, Emergency Medicine Residents’ Association
• Mark Mitchell, DO, FACOEP, President, American College of Osteopathic Emergency Physicians

During the meetings, the physicians conveyed to U.S. News and Doximity that the results they published:

• Are misleading to medical students because they are not based on objective criteria.
• Are not useful to medical students because residency choices are made for many reasons, including geography, which are not factors in the Doximity survey.
• Are not accurate portrayals of residency programs because they are based solely upon opinions expressed by physicians who have no firsthand knowledge of any residency training programs other than the ones they attended.
• Do not reflect the unique nature of emergency medicine.
• Send a dangerous public health message to patients having medical emergencies.

The physicians expressed that there is potential value in a secure data service for communicating HIPAA-compliant messages between emergency physicians. Also, a resource that provides detailed information on residency programs and their alumni could help medical students in making decisions about their applications to specialty training. However, the collective organizations that represent all of emergency medicine could not support the data as long as the rankings were included. Both U.S. News and Doximity agreed there were significant limitations to the data and discussed the challenges of developing objective measures for emergency medicine because it is a unique medical specialty. Both also agreed that these data would not be promoted to the general public. Of note, emergency medicine was the only specialty that raised objections to this survey and ranking system despite the universally poor methodology.

U.S. News describes its publications that rank hospitals and medical specialties as “consumer decision support,” which is intended to help members of the general public make decisions about where to seek care for complex medical problems. Emergency medicine has never been included in these rankings in the past, and there are no plans to begin doing so. U.S. News recognizes that, in a medical emergency, the best place to get care is the nearest emergency department.

Dr. House is professor of emergency medicine at the University of Iowa and vice chair for education in the department of emergency medicine. Laura Gore is director of public relations at ACEP.