Choosing a surgeon shouldn’t be a leap of faith

By Dr. MATHIAS P. BOSTROM
Guest Columnist

Americans rarely make choices blindly. They compare prices, read reviews, and study ratings before buying products, choosing restaurants, or booking trips.

Yet many people don’t realize they can – and should – take a similarly deliberate approach when making important healthcare decisions, like where to have surgery and who should perform it.

For major procedures, most patients depend on a referral from a primary care doctor or on advice from a loved one. While well-meaning, these recommendations aren’t always based on measurable performance data – and that data can make all the difference.

Surgical outcomes often differ sharply across hospitals. Research demonstrates that institutions handling higher volumes of complex, high-risk procedures consistently achieve better recovery rates than their less-experienced counterparts. This same pattern holds true for joint replacements, where lower-volume hospitals have been linked to a greater risk of complications.

Variation exists at the individual surgeon level as well, where repetition and technical skill play a critical role.

Surgeons who perform a procedure more frequently tend to develop sharper judgment, more consistent technique, and a stronger ability to anticipate and avoid complications. In orthopedics, that experience often shows up after surgery – in lower infection rates, fewer follow-up procedures, reduced readmissions, and steadier recoveries. Studies of shoulder operations, for instance, find that surgeons who perform a higher volume of procedures have better outcomes.

Despite the stakes, most patients never ask about this data – many don’t even know it exists. That’s concerning to me. Speaking from experience as an orthopedic surgeon, I always encourage these conversations, and my colleagues do, too.

Anyone preparing for surgery ought to feel comfortable asking direct questions about a surgeon’s experience and results. How many times each year do you perform this procedure? How often do your patients experience complications? What are your infection rates? How often do patients need to come back to the hospital or undergo another operation?

Patients should also ask how a surgeon stays current. Medicine changes constantly. New methods, devices, safety practices, and recovery strategies continue to emerge. While all physicians complete ongoing education, some are far more engaged than others in research, teaching, and continuous review of outcomes. That level of involvement can meaningfully influence the quality of care patients receive.

Academic medical centers may offer an advantage here because they’re often more likely to track results closely, evaluate performance, and incorporate new findings systematically. Excellent care is certainly not limited to those institutions, but settings that rigorously measure outcomes are better positioned to improve them.

Still, patients shouldn’t have to piece this together on their own. Hospitals and health systems should make outcomes data readily available and easy to compare. Before making a life-changing medical choice, individuals should be able to compare complication levels, return visits, repeat procedures, and reported recovery experiences.

More openness would benefit not only individuals but the broader system. Visibility drives accountability, helping reduce complications while lowering costs for patients and payers alike.

Americans routinely compare ratings for everyday decisions. Choosing a surgeon or hospital should be no different – and the healthcare system should take the lead in providing clear, accessible evidence.

Mathias P. Bostrom, MD, is Associate Surgeon-in-Chief & Director, Quality & Safety at the Hospital for Special Surgery.