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Editor's Page
C'mon, Surgeons Can't Be This Bad
Dan O'Connor
Publish Date: August 7, 2008

If we are to believe everything that we read, then surgeons must be a bunch of dirty, rotten scoundrels: greedy, hot-tempered malcontents you wouldn't spit on if they were on fire. We know this not from what many of you have shared with us about the docs you love to loathe, but from three reports released last month that paint surgeons as:

Malcontents. Of all physicians in hospitals, surgeons are the least satisfied with how administration treats them, according to Press Ganey Associates' 2008 Hospital Check-Up Report: Physician Perspectives on American Hospitals.

What draws their ire? Disorganized and inefficient ORs and complications in scheduling surgery for times conducive to their schedules. The report finds all this "troubling because [surgeons] are the highest revenue producers," adding that the most satisfied physicians refer the greatest number of patients. Curiously, the report suggests hospitals work with these physicians not to create harmony and efficiency, but "to decrease the likelihood that they will establish their own ... surgical centers."

Greedy. We've all heard this one before: Physician-owners of specialty hospitals are more likely to self-refer their patients for a wide array of procedures ranging from surgery to imaging, according to a study in Medical Care.

The study's researcher found that physicians who owned shares in two Oklahoma specialty hospitals were far more likely to refer their patients for certain procedures than physicians with no ownership, and were more likely to refer patients for ancillary services such as physical therapy and MRI scans at the specialty hospitals. The study's author told us she considered the other benefits physicians often cite as reasons for performing procedures in a specialty hospital to explain the overutilization effect, such as having a set OR schedule, but ruled these out in favor of the financial incentive.

Cavemen. Finally, the Joint Commission released a Sentinel Event Alert to warn healthcare professionals that rude language and hostile behavior (on the part of physicians and nurses) threaten patient safety and quality of care. Such behavior can lead to medication errors or preventable adverse events. Many organizations are reluctant to address disruptive behavior issues with physicians as they are a major revenue source, says the alert. Beginning Jan. 1, 2009, hospitals will have to follow a new standard that defines acceptable and inappropriate behavior as well as identifies a process for dealing with disruptive behavior.

Despite what you'll read on page 10 ("What Were These Surgeons Thinking?") and 96 ("Outrageous OR Behavior"), we think it's wrong to paint all surgeons with the same broad strokes. They're not all Bad Boys of the OR. Cut surgeons some slack.