Dr. John-Paul Byrne:

I think that there are more challenges in such hospitals. We studied eight level 3 hospitals and specialist hospitals, and seven level 4 hospitals. The interesting thing in comparing the hospitals - we do not look at hospital-level data; we focus on the individual doctor’s experience - is that the doctors in the smaller hospitals tend to have better interpersonal relationships with much of their team and closer relationships with HR and with administration, by comparison with the level 4 hospitals or the bigger hospitals. This is the case even though they face many resource gaps in terms of the care they want to provide. There is a mixed picture when hospitals are compared. It is not something we would do. However, based on the experience, we would say that there are pros and cons to working in smaller hospitals compared to the larger hospitals.