Thursday, July 06, 2006

Grading Surgeons

The debate on grading surgeons publicly has a new twist this AM. Historically there are three camps: those that think such report cards boost quality of health care, those that feel they really have no effect because patients ignore them (they tend to go on their doctor's recommendation), or third, those that think they may have some beneficial effect, but those effects can be offset by hospitals and surgeons gaming the system by avoiding sicker patients. (Historically, demographics and location have left a bias to smaller hospitals in poorer neighborhoods seeing sicker patients in my view).

David Wessel in today's Wall Street Journal noted that researchers have discovered that when surgeons that are labeled publically with bad marks, they quit:
"These are cardiac surgeons, the best students in med school, residency, fellowships - they've always been the stars. It's psychologically difficult to have spent 15 or 20 years training and practicing and then to be identified publically as one of the worst in the state," speculates Ashish Jha, one of the Harvard researchers.
I can't say I blame them. What other profession is subject to such public scruitiny and ridicule? There is no other profession that has such an arduous and complicated vetting process. I certainly never see lawyers subject themselves to public "grades." Sadly, I suppose the closest thing to such "grading" is politics and the press - but the press's objectivity (like the "tests" that surgeons must subject themselves to in the name of "quality") can miss the mark badly and ruin careers. And how many politicians attend to their constituents after hours, get called at three AM for a prescription for Xanax, or leave their families in the middle of their son's graduation to repair the ruptured aneurism in a total stranger?

The Wall Street Journal article missed another important issue. Maybe some of these surgeons were quitting because there just isn't as much work for them any more due to the innovations of drug-eluting stents and cholesterol-lowering statin drugs or the fact that liability insurance costs forced them to "retire."


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