I think the smart thing to do is get a thoracic surgeon involved, .
The smart thing to do is to avoid these cases.
2011 Medicare reimbursement in Kansas for an Ivor-Lewis esophagectomy: $2417.06.
Think about it:
-4 to 6 hours of OR time.
-post-op ICU for a few days
-all the attendant intra-op and post-op risks not limited to leak/sepsis/death
-90 day global period during which you can add a few gray hairs' worth of stress.
Thankfully as a plastic surgeon I have nothing to do with esophagectomies of any kind. Fortunately I have the opportunity to do a fair amount of hand surgery. For example the Medicare reimbursement in Kansas for a zone II flexor tendon repair without graft is $1014.36. This case takes about 45 minutes to an hour to complete, is done as an outpatient, and has none of the morbidity of an esophagectomy. There is no ICU rounding, no takeback stress, and I can do many more cases and still be home by 4 or 5 pm if I choose.
I guess when I see pissing matches brewing between general surgery and (fill in the blank) specialty about who is doing this case or that, I realize how great my life is. Then again, it is a pick-your-poison world in surgery. Some guys just love to be stressed out in the hospital all day, and some guys like to be home by 5 in time to watch some college hoops. Enjoy those esophagectomies guys and gals.
(Edit: Not trying to be inflammatory by this post, but reimbursement/stress/morbidity are factors that should be considered, although as trainees no one tells you about this stuff. In fact, most academic physicians take whatever deal they get and don't ever look underneath the hood and understand the true economics of what they are involved in. General surgery is typically the most poorly reimbursed field for the amount of work and stress involved. God forbid I ever need an esophagectomy, but if I do I pray that there will be a passionate and skilled surgeon to do it. However, it is worth asking yourself as a trainee if you are up for a lifetime of hospital dwelling, and stress, in order to become great at doing the big operations.)
One more thing: Neither of the reimbursement scenarios above is very good. In either case it will be very difficult, nigh impossible, to cover overhead if all one does is Medicare cases.