how should i choose a surgeon

March 19, 2007 10:16 AM

looking for advice on choosing a surgeon.

I live in nyc and it looks like i need shoulder surgery.
Now the guy i was referred to does not take insurance, so the surgery would cost me around $4k. He's supposed to be the top shoulder guy though. On the other hand that doctor (at my request) listed a number of other docs in the hospital that do accept my insurance, and I found another doctor who also seems pretty good that accepts my insurance. I have a second opinion appt set up with this guy.
Now I can definitely afford the $4k. but that said, obviously i would prefer not to spend that if its not for any reason. On the other hand, if $4k makes my shoulder better, then i am happy to pay it.
Any advice on this decision? I'm seeing another doctor and if I "like" him, should i just go with that since he accepts my insurance? I really don't know what to do or how to decide.
Is a "top" shoulder surgeon better than another (still very good) shoulder surgeon?

posted by alkupe to health & fitness (17 comments total)

If it's a standard sort of procedure I think you'd be fine with a competent surgeon. I'd only seek out a "top" guy or gal if the procedure I was undergoing was new/risky/controversial.

YMMV. Best of luck, hope you feel better soon after.
posted by FlamingBore at 10:27 AM on March 19, 2007

yeah i guess its about as standard as it gets-a torn labrum repair.
posted by alkupe at 10:37 AM on March 19, 2007

According to this doctor in Slate, your normal doctor should be someone that you "like", but for your surgeon you want someone who does a lot of surgery.
posted by jefftang at 11:31 AM on March 19, 2007

Correct me if I'm wrong, but if you've got insurance, is it possible for you to file later for at least a portion of the surgery? Perhaps a discussion with your insurance company might clear this up.
posted by Geckwoistmeinauto at 11:40 AM on March 19, 2007

Don't just rely on gut feeling, ask detailed questions about how often he does the surgery, typical recovery times, complications and his expected results. Another good tack is to talk to the physical therapists he sends people to after surgery since they deal with a lot of cases from different doctors and may be able to tell you how well the patients from each doctor fared. This can give you a good sense of just how big the difference is between a top surgeon and a good surgeon.
posted by hindmost at 11:53 AM on March 19, 2007

yeah the insurance covers 50% , which leaves me with a bill of $4k. the insurance is covering most stuff--the hospital fees, the anesthesiologist, the MRI, etc--just not the surgeon.
Good tip on the PT, you think i should just call and ask to speak to a physical therapist about their thoughts on surgeons?
posted by alkupe at 12:01 PM on March 19, 2007

i think all these guys perform this surgery pretty often. i guess i could get some numbers on that. would the adminstrators have such numbers?
posted by alkupe at 12:03 PM on March 19, 2007

When choosing a surgeon I reckon the best thing is to do what hindmost said, but concentrate not only on what they answer but how they answer.

We have two neurosurgeons where I work and while one is a lot more by the book than the other the other seems to be far less concerned about potential lawsuits so is far more likely to give proper answers rather than dithering because he's scared of being sued. Consequently when my mum had to have brain surgery she went with the latter guy and felt like she was treated very well since not only did he do the surgery well but he was very honest as to her chances and treated her like someone who was smart enough to understand being told exactly what he was going to do and why.

A lot of doctors and surgeons will treat you like an imbecile; if you get any sense of that when you're talking to them don't use them!

(Plus, I don't know about the States but here in Australia most of your money goes to the anesthetist anyway.)
posted by Silentgoldfish at 12:42 PM on March 19, 2007

You might check out this book: YOU: The Smart Patient: An Insider's Handbook for Getting the Best Treatment. It has a full chapter on how to select the best surgeon, and questions to ask as you "interview" potential care providers. The authors are two doctors and the book was written at request of the Joint Commission.

There are also bits on choosing a hospital and tips on managing your health insurance for maximum effect.

(My favorite takeaway is that you don't want to schedule even a routine procedure in July, if you can avoid it: that's when the medical school year starts, so hospitals are full of eager newbies with very little clinical experience champing at the bit to cut on you.)
posted by pineapple at 12:48 PM on March 19, 2007

Watch out that insurance often pays 50% of their negotiated rate for out-of-network care, and that rate may easily be 50% or less of the billed amount. Meaning they only pay 25% of the bill.
posted by smackfu at 1:40 PM on March 19, 2007

smackfu
thanks for the advice. basically the doc agreed to take my $4k plus whatever the insurance kicks in.
posted by alkupe at 1:52 PM on March 19, 2007

I'm not really answering the question here - but jefftang's comment about getting someone who does a lot of surgery struck a nerve with me - I also suffered a torn labrum (and a separated shoulder) a little over a year ago. However, my insurance only would pay for a few doctors, so none of the guys I was referred to was available to me - I was basically reduced to checking if any of them had ever been disciplined, and which hospital they had admitting priveleges to. I picked a guy who was right near my office. Well it turns out his clinic has a bit of an assembly-line feel to it - there's a whole bunch of people handling the paperwork, and a bunch of surgeons in the practice, and it just seems very busy. The surgeon examines me, does a bunch of range of motion tests, asks me about how I got injured (I fell snowboarding), and looks at my Xray - nothing broken, range of motion isn't severely impaired - but he wants an MRI done to be sure. The surgeon seems OK enough, he hasn't set off any alarms in my head - but the assembly line feel of the place really bugged me - so for another opinion, I made it a point to find a sports medicine doctor who was more inclined to do PT first - I figured the contrasting approaches would help me make a decision. Before I get my MRI, I meet a guy who owns an MRI facility, who tells me that he gets referrals from the first surgeon - and he makes an offhand remark like "they're all crooks - he'll probably tell you to get surgery no matter what". To make a long story short - after my MRI, the surgeon tells me he doesn't think surgery is called for - his recommendation is physical therapy for a month, a change in exercise habits (basically I need to keep the shoulder strong for the rest of my life), and just watching it for the next year or so to see if any pain develops. The sports medicine doc told me he didn't think it was a situation calling for surgery, but I should get an evaluation and MRI from an orthopedist just to be sure. So it's a clear cut case that two docs didn't think I needed to be cut. But going in blind, I guess I it's a good thing that the first doc had such a busy practice -he's probably seen stuff like this all the time. I guess what I'm really trying to say is unless you've got someone on the inside guiding you through, all you can really do is whatever diligence you're capable of, and just take a leap of faith - if $4K is something affordable to you, I'd just pay it and go with the great surgeon if the alternate guy doesn't blow you away with his demeanor. Sorry for rambling on.
posted by Calloused_Foot at 2:42 PM on March 19, 2007

Considering you're in NYC, perhaps someone at the Hospital of Special Surgery at New York Hospital. It's on, I think, 70th and York.
posted by crayolarabbit at 4:15 PM on March 19, 2007

yeah that's what i was looking at. The guy that doesn't accept insurance is there. His administrator referred me to 5 other surgeons, also at hss, that do take insurance. so i could use one of those.
posted by alkupe at 5:00 PM on March 19, 2007

Situations like this one are the entire point of being in a position where you can afford to blow $4000. Spend the money.
posted by escabeche at 5:27 PM on March 19, 2007

Is this also a choice between doing it arthroscopically or with open surgery?
posted by Caviar at 7:37 PM on March 19, 2007

i think it will be arthroscopic either way, but that is a question i will be answering. If the $4k will be the difference, I will definitely do it.
posted by alkupe at 9:03 PM on March 19, 2007