Peer Review of Surgeons' Skills Carries 'Threatening Undertones'
A study in which experienced surgeons submitted samples of their work for evaluation by an anonymous panel finds a large variation in technical skill. Now come questions about what is to be done with the information.
When experienced bariatric surgeons in Michigan were asked to select videos of their best gastric bypass operations and submit them for anonymous review so that their technical skills could be evaluated, judges found huge variations.
But most important, when their scores were linked with the state's risk-adjusted bariatric outcomes registry, patients of the most poorly rated surgeons' were twice as likely to die and have post-operative complications, than patients of surgeons with the best scores. And surgeons with the worst scores took 40% longer to complete their procedures than the best surgeons.
The study, published in the Oct. 10 New England Journal of Medicine, is loaded with implications. It suggests that hospitals, accreditation organizations and physicians have some deep soul searching ahead. Though it should be replicated by others, there is now a proven peer-review process to objectively critique the skill of surgeons who completed their training long ago.
Most important, and perhaps scary, is what doctors and hospitals do with the information they gain—however career limiting and economically devastating it may be—and whether patients have the right to know.
I asked the study's author, by John Birkmeyer, MD, director of the Michigan Surgical Collaborative for Outcomes Research and Evaluation, (M-SCORE) to discuss this fascinating and apparently first-of-its-kind study.