How to assess skill in orthopedic surgery

[tinyhandsbob]

I have a question for practicing orthopedic surgeons. Assume you were somewhere where you did not know any colleagues to recommend a surgeon to you and needed orthopedic surgery for something routine like a knee, shoulder or ankle injury. What characteristics would you look for when determining which surgeon to pick? Would you try to assess clinical skill , overall reputation or maybe research or some combination of all of these? Are you of the opinion that the best surgeon would be whoever does that type of surgery with the highest frequency, or maybe you would look at where their residency/fellowship was done or what hospital they are affiliated with? Let's assume you were not able to talk to anyone in your specialty in that setting to get insider information about who the most respected surgeons are.

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[DoctwoB]

Not an orthopod but it applies to surgeons in general. It’s a tough thing to do out in practice. Being a big name doesn’t mean you’re good in the OR. Being respected by peers is nice and usually means you’re not crazy in terms of decision making, but those peers usually aren’t in the OR with you. Having high volume doesn’t explicitly mean your good but it helps a lot. Also if you were a high volume butcher, at least in a competitive market, word would get out and work would dry up.

If they’re at an academic center IMO your best bet is to ask a senior resident. They operate with everyone and are qualified to compare relative skill sets. Otherwise go with the high volume guy.

 

[OrthoTraumaMD]

I have a question for practicing orthopedic surgeons. Assume you were somewhere where you did not know any colleagues to recommend a surgeon to you and needed orthopedic surgery for something routine like a knee, shoulder or ankle injury. What characteristics would you look for when determining which surgeon to pick? Would you try to assess clinical skill , overall reputation or maybe research or some combination of all of these? Are you of the opinion that the best surgeon would be whoever does that type of surgery with the highest frequency, or maybe you would look at where their residency/fellowship was done or what hospital they are affiliated with? Let's assume you were not able to talk to anyone in your specialty in that setting to get insider information about who the most respected surgeons are.

I would look at fellowship training, publications, are they a fellow of the academy, are they board-certified, etc. but honestly the scenario you are describing would never happen for me as a surgeon as i would always be able to talk to someone.

 

[ChiDO]

Higher volume, fewer publications.

 

[tinyhandsbob]

Higher volume, fewer publications.

To clarify, if the volume was equal, you d prefer the lower publication over the higher publications surgeon?

 

[ChiDO]

To clarify, if the volume was equal, you d prefer the lower publication over the higher publications surgeon?

Depends. There are a lot of surgeons who are high volume and high publications, but their high volume is fellows doing the work.

I'd take the 800 joints surgeon in private practice vs the 800 joints surgeon at "insert big name here"

 

[OrthoTraumaMD]

I'd take the 800 joints surgeon in private practice vs the 800 joints surgeon at "insert big name here"

To anyone reading, the caveat to that is that private practice surgeons are literally incentivized to operate because that is what makes money. I have seen quite a few people who did not need surgery operated on and then have bad complications because of unscrupulous, predatory private practice groups who butchered them. The best thing in my opinion is to have someone who is balanced and who not only does things for themselves/their practice but also gives back to the broader orthopedic community through either publishing, teaching (technically, taking a resident through a case is much slower and is worse for the surgeon because it decreases the number of cases/day, and increases their time at the hospital when they could be home with family), etc. This can be done in private practice OR academics, but I would look for a surgeon like that. As for fellows, as they are more likely to be left alone in the operating room by themselves, so I would look for a surgeon with residents, but not fellows.

 

[VincentAdultman]

Depends. There are a lot of surgeons who are high volume and high publications, but their high volume is fellows doing the work.

I'd take the 800 joints surgeon in private practice vs the 800 joints surgeon at "insert big name here"

meh