Checking Your Surgeon's Safety Record
There are plenty of doctor rating systems out there, but the problem is that the ratings are usually based on patient opinions. Sites like ZocDoc.com and www.Vitals.com overflow with patient comments such as, "The doctor was professional;" "he answered all my questions;" and "she listened to my concerns." While bedside manner certainly counts for something, when you're sedated and under the knife, skill matters a whole lot more. A physician who listens to your concerns but is lousy with a scalpel isn't your best bet in the operating room.
One of the better rating systems, Castle Connolly, which publishes The Best Doctors in America, depends on peer reviews. In other words, doctors rate each other, and those who receive the highest accolades get named to the elite volume.1 This may represent an improvement over patient reviews, in that Castle Connolly contacts more than 50,000 physicians each year to identify the top performers. They also contact heads of clinical departments and hospital administrators, who should know which physicians on their staff are the most competent.
The Castle Connolly website says, "Physicians can nominate those other doctors whom they feel are the most outstanding in their medical specialties, in any area of medicine and in any part of the country, indicating also whether they believe that the physician is among the best in their region or among the very best in the nation."
While doctors and hospital administrators certainly are in a better position than patients to know how other physicians actually perform over time, again, the Castle Connolly system also depends on opinion, and the same provisos apply. Hospital administrators will likely want to promote their physicians to enhance their facilities reputations. Doctors will probably be swayed by factors such as a peer's reputation, his research record, and how hard she seems to work. Again, these attributes do not necessarily add up to top-notch performance in the operating room or to competent follow-up after surgery. And so while certainly useful and likely an improvement over patient reviews, the Best Doctors guides also have severe limitations.
Now, though, there's a much more reliable rating system available, a kind of Consumer Reports for choosing surgeons based solely on hard data. SurgeonRating.org is a website launched by the Consumers Checkbook advocacy organization.2 The organization's website allows users to type in their zip code and pull up surgeon ratings that are based solely on data extracted from the records of 50,000 physicians who collectively performed more than four million surgeries. The chief parameters looked at are how many patients survived surgery with this doctor and how many patients had no serious complications such as infection or readmission to the hospital for up to 90 days following surgery.
SurgeonRatings.org includes 14 categories of major surgeries in its database-everything from hip replacements and spinal fusions to heart valve replacements and prostrate removal.3 Only a fraction of the 50,000 surgeons initially reviewed appear in the database because, to get listed at all, a surgeon has to have a better-than-average performance record. In other words, any surgeon included in the database is already ahead of the game.
The rating system in SurgeonRatings.org is a simple one. A chart shows whether the doctor has "Fewer Deaths or Other Bad Outcomes" on a scale of three stars to five stars. A five-star physician is what you want. But remember, even a three star surgeon is likely to be better than one who is not even included in the ratings. The chart also shows whether the doctor received a high number of recommendations from other physicians. Apparently, all surveyed physicians were asked to name one or two doctors in each of 35 specialties that they would trust to care for a loved one. Those physicians who got an outstanding number of mentions get a "YES" in the "recommended by other physicians" category. Finally, the chart shows the doctor's board certifications and the hospitals they work out of. If the surgeon had a better-than-average success rate at a particular hospital, the hospital gets a red check mark.
According to the Consumer's Checkbook.org data, your risk of dying or suffering serious complications in or after surgery skyrockets with a low-rated surgeon when compared to a top-rated one.4 On average, the poor-performing surgeons had death and complication rates three times greater than top-rated surgeons. For some specialties, the discrepancy was even greater.
"For major small and large bowel surgery, death rates ranged from less than 6 percent for the best-performing one-tenth of surgeons to more than 20 percent for the worst-performing one-tenth," the website reports.
The numbers are even more startling for heart surgeries, where risk nearly quadruples depending on surgeon competence. "For heart valve and bypass surgery, the patients of the best-performing one-tenth of surgeons had death rates of less than 3 percent in-hospital or within 90 days of discharge, compared to death rates of more than 11 percent for patients of the worst-performing one-tenth of surgeons."
There were objections to the website from physicians across the nation who said that you can't rely on such information because who knows where the data comes from or who is paying to get a positive listing, but the simple fact is that the data comes from physician records that the government released to Consumer's Checkbook after a 10-year battle. Previously, the government refused to reveal names of individual physicians. As for funding, the organization accepts no advertising and is supported solely through public donations. The website does include a ‘limitations to the data' section, and, while there certainly are some things to consider (for instance, a doctor working in a low-income area might have worse overall ratings because patients have poor support systems), overall, the website is a boon.5
If you or a loved one faces upcoming surgery, it certainly makes sense to pay attention to the data in this great new resource. And, then, as a final check, you might also want to consult the physician reviews on more of the subjective websites so you can find your way to someone both competent and caring.
- 1. "Nomination Process." Castle Connolly Top Doctors. https://www.castleconnolly.com/about/nomprocess.cfm
- 2. "Need a new knee? Heart valve? Back surgery? This Web site could help you find the top surgeons near you." 14 July 2015. Washington Post. 16 July 2015. http://www.washingtonpost.com/news/to-your-health/wp/2015/07/14/need-a-new-knee-heart-valve-back-surgery-this-website-could-help-you-find-the-top-surgeons-near-you/
- 3. http://www.checkbook.org/surgeonratings/
- 4. "Website makes data on surgeon performance public." 15 July 2015. CBS News. 17 July 2015. http://www.cbsnews.com/news/website-makes-government-data-on-surgeon-performance-public/
- 5. http://www.checkbook.org/surgeonratings/?action=article&articleID=more-about-our-measures-of-outcomes