Medical centers in the United States

This article discusses the major medical centers in the U.S. For all hospitals, see List of hospitals in the United States. For a general discussion about U.S. health care see Health care in the United States.

Medical centers in the United States are conglomerations of health-care facilities including hospitals and research facilities that also either include or are closely affiliated with a medical school. Although the term medical center is sometimes used to refer to any concentration of health-care providers including local clinics and individual hospital buildings the term is more properly used to refer to larger facilities or groupings of facilities that include a full spectrum of health services, medical education and medical research.

The major medical centers represent the crown jewels of health care in the United States. They vary greatly in their organization, the services they provide, and their ownership and operation.

Overview

In the United States, ownership of the health care system is mainly in private hands, though federal, state, county, and city governments also own certain facilities. Many major hospitals, generally the backbone of any medical center, are non-profit and many of these have their origins in religious organizations. Despite their non-profit status, affiliation with private ventures and major medical schools often allows them to maintain state-of-the-art facilities and services. The non-profit hospital's share of total hospital capacity has remained relatively stable (about 70%) for decades.^[1] There are also privately owned for-profit hospitals as well as government hospitals in some locations, mainly owned by county and city governments.

Major medical centers provide many specialized services, some even containing multiple specialized hospitals and clinics each dedicated to specific types of patients and/or services. Additionally they are centers of medical education, centers of medical research, and incubators for medical innovation and technology. A given medical center may include a medical school in the same complex as the rest of the facilities or may be closely affiliated with a medical school on a nearby campus. Similarly a given medical school may be closely associated with multiple tightly linked hospital campuses which function to some degree as a unit though the group may not be referred to as a single medical center (e.g. the Harvard Medical School network of teaching hospitals).

There are about 1,100 teaching hospitals in the United States. Approximately 375 of the larger institutions belong to the Association of American Medical Colleges’ Council of Teaching Hospitals and Health Systems (COTH). COTH teaching hospitals train about 75 percent of residents yearly and provide more than 40 percent of all hospital charity care in the nation.

Major medical centers

Although any rankings of medical centers are highly subjective, this section describes some of the largest and most prominent centers in the nation. Note that the rankings and importance of individual hospital facilities may be different from the medical centers that they belong to.

National Institutes of Health

NIH Mark O. Hatfield Clinical Research Center, Bethesda, Maryland

The National Institutes of Health (NIH) are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research.

The NIH's research is divided into two parts: the Extramural Research Program is responsible for the funding of biomedical research outside the NIH, while the Intramural Research Program (IRP) is the internal research program of the NIH, known for its synergistic approach to biomedical science. Intramural research is primarily conducted at the main campus in Bethesda, Maryland, immediately adjacent to the Walter Reed National Military Medical Center and right outside Washington, D.C.. The NIH campus houses the divisions of intramural research for eighteen of the twenty national institutes, including the National Institute of Allergy and Infectious Diseases, the National Cancer Institute, and the National Institute of Mental Health, as well as the National Library of Medicine, while the adjoining Walter Reed campus houses the military medical center, the Uniformed Services University of the Health Sciences, the Armed Forces Radiobiology Research Institute, the National Intrepid Center of Excellence, and the Joint Pathology Center.

Johns Hopkins

Billings Building, The Johns Hopkins Hospital

The Johns Hopkins University School of Medicine, located in Baltimore, Maryland (USA), in addition to operating a major medical school, operates the Johns Hopkins Hospital, which consists of both a teaching hospital and biomedical research facility. It was founded using money from a bequest by philanthropist Johns Hopkins. The Johns Hopkins Hospital and the Johns Hopkins School of Medicine are the founding institutions of modern American medicine and are the birthplace of numerous traditions including “rounds,” “residents” and “housestaff”.^[2] The Johns Hopkins Hospital is the birthplace of many medical specialties including neurosurgery, urology, endocrinology, pediatrics, cardiac surgery^[3] and child psychiatry.^[4][5][6] It is widely regarded as one of the greatest hospitals in the United States and the world.^[7] It has been ranked by U.S. News and World Report as the best overall hospital in America for 20 consecutive years.^[8][9][10]

Mayo Clinic

The Gonda Building, one of the many Mayo Clinic buildings at the main campus in Rochester

Mayo Clinic is a non-profit organization and internationally renowned group medical practice headquartered in Rochester, Minnesota. Its headquarters consist of the Mayo Medical School, the Mayo Graduate School, the Mayo College of Graduate Medical Education, and several other health science schools. Its research facilities are in Rochester, Minnesota, in addition to hospitals and clinics in Jacksonville, Florida, Scottsdale, Arizona, and Phoenix, Arizona. Mayo Clinic partners with a number of smaller clinics and hospitals in Minnesota, Iowa, and Wisconsin, an organization known as the "Mayo Health System."

Mayo Clinic pays medical doctors a fixed salary that is unaffected by patient volume. This practice is thought to decrease the monetary motivation to see patients in large numbers and increase the incentive to spend more time with individuals. Salaries are determined instead by the marketplace salaries for physicians in comparable large group practices.

The Mayo Clinic campuses in Rochester form the largest integrated medical center in the world.^[11]

Massachusetts General

Main entrance of Massachusetts General Hospital

Massachusetts General Hospital (also known as Mass General or MGH) and Harvard Medical School in Boston, Massachusetts collectively represent one of the oldest medical education and research centers in the nation. Massachusetts General itself is owned and operated by Partners HealthCare (which also owns Brigham and Women's Hospital and North Shore Medical Center among others). MGH is part of the consortium of hospitals which operates Boston MedFlight and is a member of the Dana-Farber/Harvard Cancer Center. Mass General is also the primary teaching hospital for Harvard Medical School.

The hospital has 1,051 beds and admits over 45,000 patients each year. The surgical staff performs over 34,000 operations yearly and hospital handles over 1 million outpatients each year at its main campus, as well as its six satellite facilities in Boston at Back Bay, Charlestown, Chelsea, Everett, Revere, and Waltham. In 2003, MGH was named the state's first Magnet hospital by the American Nurses Credentialing Center, a subsidiary of the American Nurses Association. In 2012 MGH was ranked the #1 hospital in the United States by U.S. News and World Report, for the first time supplanting the Johns Hopkins Hospital, which held first place for 21 consecutive years.^[8]

Texas Medical Center

Aerial view of the Texas Medical Center in Houston.

The Texas Medical Center is the largest medical center in the world with one of the highest densities of clinical facilities for patient care, basic science, and translational research.^[12] Located in Houston, the center contains 50 medicine-related institutions, including 21 hospitals and two specialty institutions, two medical schools, six nursing schools, and schools of dentistry, public health, pharmacy, and other health-related practices. All 50 institutions are not-for-profit and constitute some of the most highly regarded institutions in the country, including: M.D. Anderson Cancer Center, Texas Children's Hospital, The Texas Heart Institute, The Methodist Hospital and Baylor College of Medicine. The center is where one of the first and largest air ambulance services was created and where a successful inter-institutional transplant program was developed. More heart surgeries are performed at the Texas Medical Center than anywhere else in the world.^[13]

Cleveland Clinic

A portion of the Cleveland Clinic's main campus

The Cleveland Clinic is a multispecialty academic medical center located in Cleveland, Ohio. Currently regarded as one of the top hospitals in the United States,^[8] the Cleveland Clinic was established in 1921 by four physicians for the purpose of providing patient care, research, and medical education in an ideal medical setting. One of the largest private medical centers in the world, the Cleveland Clinic saw more than 2,800,000 patient visits in 2005, with almost 70,000 hospital admissions.^[14] Patients arrive at the Cleveland Clinic from all 50 states and more than 100 nations. The Cleveland Clinic’s approximately 1,700 salaried staff physicians represent 120 medical specialties and subspecialties and is ranked among the top four hospitals in America.^[8] The Cleveland Clinic has ranked number one in America for cardiac care for 15 years in a row.^[15]

NewYork-Presbyterian Hospital

NewYork-Presbyterian Hospital / Weill Cornell campus.

NewYork-Presbyterian Hospital is a prominent university hospital system in New York City, composed of two medical centers, Columbia University Medical Center and the Cornell University Weill Medical Center.

New York-Presbyterian Hospital, chartered as "The New York and Presbyterian Hospital" by New York State in 1996, was formed in 1998 with the merger of two large, previously independent hospitals, the New York Hospital and Presbyterian Hospital. The NYPH system includes a variety of outlying hospitals that had previously been acquired by NYH or Presbyterian; these hospitals stretch throughout the five boroughs, Westchester County, Long Island and New Jersey. NYPH is now the largest private employer in New York City.

The two medical schools remain essentially autonomous, though there is increasing cooperation and coordination of clinical, research, and residency training programs. NewYork-Presbyterian Hospital is one of the most comprehensive university hospitals in the world, with leading specialists in every field of medicine.

University of Pennsylvania Health System

The original building of Pennsylvania Hospital, as seen from Pine Street in Philadelphia.

University of Pennsylvania Health System includes the nation's first teaching hospital, Hospital of the University of Pennsylvania (HUP), and the nation's first hospital, Pennsylvania Hospital. It operates under the direction and auspices of Penn Medicine in Philadelphia, PA. HUP alone is ranked as the 9th-best overall hospital in the United States by U.S.News & World Report in 2010.^[16] Although it is not a part of Penn Health System, the Children's Hospital of Philadelphia(CHOP) is also on the same campus and it engages in many collaborative efforts. CHOP's physicians serve as the pediatrics department of Penn's School of Medicine.

University of Pittsburgh Medical Center

UPMC's flagship facility, Presbyterian University Hospital, located in the Oakland neighborhood of Pittsburgh adjacent to University of Pittsburgh's main campus

The University of Pittsburgh Medical Center (UPMC) is headquartered in Pittsburgh, Pennsylvania and is closely affiliated with its academic partner, the University of Pittsburgh and its six schools of the health sciences. UPMC is one of the largest medical centers in the world with 20 hospitals, 4,200 licensed beds, and 400 outpatient sites in Western Pennsylvania, as well as locations overseas. Appearing on US News & World Report's honor roll of the top hospitals for over a decade,^[17] it was the site of the creation of the first polio vaccine by Jonas Salk, helped to develop emergency medicine under Peter Safar, and pioneered organ transplantation under the direction of Thomas Starzl, at one time boasting the largest and busiest organ transplantation program in the world.^[18] A fully integrated health care system that includes its own health insurance and commercial services divisions, UPMC has exported its clinical and administrative expertise and technologies around the world, including the ISMETT organ transplantation center in Sicily, a hospital and cancer centers in Ireland, and partnerships in the United Kingdom, Qatar, Cyprus, Japan, and China.

UCSF Medical Center

UCSF Parnassus campus at the base of Mount Sutro, San Francisco

The UCSF Medical Center is a world-renowned teaching hospital and center of biomedical research located in San Francisco, California, with campuses in Parnassus Heights, Lower Pacific Heights and Mission Bay. It is one of the leading hospitals in the United States and with the UCSF School of Medicine has been the site of various breakthroughs in all specialties of medicine, including the discovery of oncogenes, prions as the etiologic agents of transmissible spongiform encephalopathies, first in-utero fetal surgery, development of catheter ablation therapy for tachyarrhythmias, and the discovery and treatment of surfactant deficiency in neonatal respiratory distress syndrome (RDS). UCSF's faculty has included five Nobel laureates, 31 members of the National Academy of Sciences and 69 members of the Institute of Medicine. The Mission Bay campus currently under construction contains the largest biotechnology construction in the United States as well as the future 183-bed UCSF Benioff Children's Hospital and new cancer and women's specialty hospitals.

UCSF Medical Center is affiliated with the University of California, San Francisco, which in 2012 was ranked second among world universities in clinical medicine and pharmacy by the Academic Ranking of World Universities.^[19] The medical center has ranked among the top 10 hospitals in the United States for 11 of the last 12 years by U.S.News & World Report.^[20]

Ronald Reagan UCLA Medical Center

UCLA Ronald Reagan Medical Center, from the south-west looking across Westwood Bl.

The Ronald Reagan UCLA Medical Center is a hospital located on the campus of the University of California, Los Angeles in Los Angeles, California.

UCLA Medical Center has research centers covering nearly all major specialties of medicine as well as dentistry and ophthalmology, and is the primary teaching hospital for the David Geffen School of Medicine at UCLA. The hospital's emergency department is certified as a level I trauma center for adults and pediatrics.

It is rated as one of the top three hospitals in the United States and is the top hospital on the West Coast according to US News & World Report.^[8] The hospital has been ranked in the top twenty in 15 of the 16 medical specialties ranked by the US News ranking. Ten of those specialties were ranked in the top ten.

Duke University Health System

The Duke University Health System, located in Durham, North Carolina, combines the Duke University School of Medicine, the Duke University School of Nursing, the Duke Clinic, and the member hospitals into a system of research, clinical care, and education.

For its part the Duke University Hospital is a 924 bed academic tertiary care facility located in Durham, North Carolina. Since its establishment in 1930, the hospital has grown from a small regional hospital to a world-class academic medical center. Duke University Hospital is the flagship teaching hospital for the Duke University Health System, a network of physicians and hospitals serving Durham and Wake County, North Carolina and surrounding areas as well as one of three Level I referral centers for the Research Triangle of North Carolina (the other two are UNC Hospitals in nearby Chapel Hill and WakeMed Raleigh in Raleigh).

Marshfield Clinic

The Laird Center for Medical Research on the Marshfield Clinic campus

Marshfield Clinic is a non-profit group practice health care system serving northern, central and western Wisconsin with over 50 community care centers and hospitals, covering more than 80 specialties, and employing more than 700 physicians as of 2013.^[21] It was founded in 1916 by six local physicians: K.W. Doege, William Hipke, Victor Mason, Walter G. Sexton, H.H. Milbee, and Roy P. Potter, in the community of Marshfield, Wisconsin.

Marshfield Clinic supports a number of centers and foundations including:

• Marshfield Clinic Research Foundation, a non-profit research organization composed of five research centers: the National Farm Medicine Center, the Marshfield Epidemiologic Research Center, the Center for Human Genetics, the Biomedical Informatics Research Center and the Clinical Research Center.
• Marshfield Clinic Education Foundation, Marshfield Clinic's education division, provides residency programs for medical school graduates in the disciplines of internal medicine, pediatrics, medicine and pediatrics, dermatology, surgery and transitional year. All programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME) of the American Medical Association. About 125 members of the Marshfield Clinic staff hold clinical teaching appointments from the University of Wisconsin School of Medicine and Public Health.

See also

• Health care in the United States
• Academic health science centre

References

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