Choosing a Good Surgeon
Choosing a surgeon will be a choice you live with for years, if not your entire life.
How to choose a surgeon
The surgeon you choose can mean the difference between a successful outcome and one with serious consequences.
♦ Choosing the surgeon should never be taken lightly.
Surgery of any type is stressful and many times risky. But not all surgeries require specialized training.
A general surgeon will often be called upon to repair an inguinal hernia. But someone needing a knee replacement will need an orthopedic surgeon who specializes in knee replacement. Finding the best surgeon for your situation will take some work.
Most people learn from a specialist that they will need surgery to fix their problem. This can be a very surprising moment and one that can cause a lot of people to panic. You should step back and ask your doctor to explain clearly why the surgery is needed.
• Are there any alternatives to having the surgery?
• What kind of outcome can you expect?
• How could the surgery affect your quality of life?
These are just the start of many questions. If your doctor cannot give clear answers you need to seek out another doctor and get a second opinion.
• Who does your doctor recommend to perform the surgery?
• The doctor himself or are you being referred to someone else?
• If you are being referred to another doctor, you need to know why?
• Does that doctor have special skills that your specialist does not?
If your doctor refers you, you should ask him if he would be comfortable having that doctor perform the surgery on him or a member of his family. If there is any hesitation in your doctor’s reply, you should check that surgeon off your list.
Questions for your surgeon
• Is surgery really necessary?
You cannot not ask this question too many times.
• How often have you done this?
Surgeons that perform the same procedure regularly have the greatest success rate. Specializing in a particular procedure greatly cuts the risks of complications and mortality.
Avoid the doctor who has little experience doing your procedure.
Studies have shown that for people undergoing complicated procedures, death rates were nearly four times higher for those treated by surgeons who performed the fewest operations compared to those who performed the most.
• How successful have you been?
• Has this surgery failed or had complications?
A good surgeon will tell you clearly. A poor surgeon will be evasive and vague. Check the evasive one off your list and move on.
• What are the risks?
All surgeries have risks. Your surgeon needs to explain to you fully all the potential harm that might occur. If he or she does not explain this or simply downplays the risks then it is time to find another doctor.
A second opinion is good even if you are comfortable with the first surgeon. A second opinion should be from someone associated with a different group. A second opinion is especially important if you are having a complicated procedure or one that is new.
• Most insurance plans cover the cost of a second opinion.
♦ Don’t be surprised if the second opinion is different from the first. Roughly 1 in 5 second opinions do not agree with the initial treatment plan. Some surgeries more than others have conflicting second opinions. Back surgeries are one where some doctors are quick to send people under the knife while other doctors want to pursue physical therapy forever.
• If your surgeon does not have a clear plan or gives vague answers, you need a second opinion.
You will need to make an appointment and make it clear that you are seeking a second opinion. The doctor may request in advance your medical records. Otherwise, be prepared to bring them to the appointment.
Finding a surgeon
Talk with your primary care doctor. There is a good chance your primary care doctor knows the surgeon you are considering. No doctor will say outright that another doctor has a poor skill. Pay attention to how your primary care doctor talks about the surgeon.
♦ Ask your doctor, “would you be comfortable having this person operate on you?”
You may need to make an appointment to get time with your primary care doctor. Make the best of the time by preparing at least a couple names of possible surgeons and a few quick questions.
Talking to friends and colleagues can be very uncomfortable depending upon the surgery.
Most people don’t feel uncomfortable talking about something like cataract surgery. A friend who has had a successful cataract surgery is usually quite eager to provide plenty of details.
However, if your friend has not had the same surgery the discussion may not be very constructive.
Ask your insurance company
♦ A survey performed by the Stanford School of Medicine found that 50% of the respondents considered acceptance of their insurance the highest priority when choosing a surgeon.
These days almost all insurance companies have websites and a way to search for providers by specialty. Most will send you a hard copy of their provider list if you ask. You can also call your insurer’s customer service number located on the back of your insurance card. Calling can be easier but the amount of information you can gather will be less than a website search.
If you live in a larger metropolitan area you will have many more choices for surgeons than rural areas.
It is possible there might not be a qualified surgeon in your immediate area. In that case, you need to ask your insurance company for permission to use a surgeon outside of coverage area or your plan’s network. This is most critical if you have an HMO or EPO type health plan.
Check the surgeon’s qualifications
Licensed in Your State - The Federation of State Medical Boards (FSMB) can tell you if the surgeon is licensed in your state.
The Federation of State Medical Boards (FSMB) has a searchable online database. All disciplinary action is supposed to be reported by the states.
The site is called DocInfo. You can search by name and state.
The results are simple. They will show the doctor's education, active license and any actions.
For a $9.95 fee, the FSMB will provide the disciplinary history of specific doctors in every state.
If you see any references to “actions,” you probably want to scratch this doctor off your list. If you want to investigate more thoroughly any “actions,” you will need to contact your state medical board.
The nonprofit ProPublica has put together a nice list of states and who to contact.
Board Certification - Board certified means a physician has undergone lengthy training in a specialty and passed a stringent exam. Roughly 80% of all doctors are board certified. To find out whether the surgeon is board certified, check with the American Board of Medical Specialties (ABMS).
If you see the words, “board eligible” it means the doctor has finished the appropriate training and residency but has yet to pass the exam. The doctor may not have had time to take the test or may have tried and failed.
It is common for young doctors to be “board eligible.” They are allowed a several years to take and pass the exam. There are a few doctors that try to use the term “board eligible” for their entire career. The ABMS is now threatening those doctors with penalties.
Below is a screenshot of ABMS’s search results for a well-known doctor in the Atlanta area.
Surgeon’s Success Rate
It is difficult to assign a score to a surgeon’s skill level. The Centers for Medicare & Medicaid Services (CMS) collects tons of data on surgical procedures and their outcomes. The CMS has records on individual physicians but they are slow to share that specific data with the public. Pressure from doctors and hospitals appears to be the driving force.
♦ Some argue that the data is imperfect because it is collected on older people. Medicare patients tend to have more health problems and hence more surgeries. Older patients are also likely to have other health conditions which might affect their recovery.
• To try to alleviate concerns that the results may be unfair to some doctors or poorly reflect on hospitals the data is starting to be released with restrictions requiring considerable massaging.
The nonprofit group Consumers’ Checkbook has been able to receive some of this data and has compiled it into a searchable form. At this time, results for only 12 common types of surgery can be viewed for free.
If you pay them $28 per year you have access to their searchable databases for both doctors and hospitals.
• The free search is a kind of teaser. Still it does show quite a few doctors.
The site is well worth the time to check out. It is called Surgeon Ratings.
♦ Unfortunately, as of the end of August the site was down. "Coming Soon!"
It appears they intend to relaunch some time in the future.
If you click on a doctor’s profile you will see a rating for percent success, education and board certifications.
Below is a screenshot for hip and knee surgery.
You shouldn’t make a choice or move forward with surgery until you feel completely comfortable with the surgeon and his or her plan. Your health and quality of life depends on it. Take your time choosing your doctor.
Ask questions… Do your research...