As early as 1979*, we’ve observed a correlation between a surgeon’s annual procedure volume and adverse event rate. This has been corroborated by multiple studies, most recently the Annals of Surgery’s report on 16,954 thyroidectomies. The New York Times reported this week the drastic range in complication risk – from 87% among low volume surgeons (1/year), to 3% for high volume surgeons (21-25/year). Clinical experience matters - this should surprise no one.
However, when it comes to selecting a provider in a physician network, volume alone doesn’t cut it. As ProPublica’s “Making the Cut” report demonstrated, relying on physician volume in isolation could be a dangerous way to choose a provider – for example, high volume surgeons have also been associated with high complication rates.
The additional factors that drive such nuance are not easily understood or explored; factors such as where the physician trained, with whom he/she trained, the hospital, and alignment across the care team all impact the patient outcome. While volume may be our most readily available, data-based proxy for experience, it by no means draws a complete picture of a provider’s abilities.
Identifying the “right” doctor is a dynamic question that requires integrating multiple data elements. For a flu shot, the “right” provider (who may not need to be a doctor) is down the street, available today, and charges a $10 co-pay. For a coronary bypass operation (CABG), the “right” provider is a highly trained cardiac surgeon who performs many CABGs each year. Tolerance for a 10-day wait time and a 90-minute drive increases with the complexity of the procedure and the specialization of the provider.
Health systems must understand their clinical assets in order to meet the unique demands of not only populations of patients, but also individual consumers to provide a truly meaningful patient experience. Volume matters, availability matters, and so do dozens of other factors such as insurance acceptance, gender, language, and location. Finding the right health care provider is not one-size-fits-all – it’s too important for that.
* Luft, H. S., Bunker, J.P, Enthoven, A.C. “Should Operations Be Regionalized? The Empirical Relation between Surgical Volume and Mortality.” NEJM. 301. 24 (1979): 1364-1369.