How much less safe?

Questions missing from the “already too-complicated health care debate”: “The Case of the Missing Assistant Surgeon.” 

We hardly know they’re there…but they’re about to disappear. Not knowing can be deadly.

You probably haven’t heard much about the assistant surgeon, but all the same, it might interest you to know that we’re running out of them…

The statistics are grim: a report in the journal Surgery places the nationwide general-surgeon shortage at 1,300 currently, and estimates that the country will be at least 6,000 surgeons short by…2050.

Never mind that that projection was made without calculating further attrition predicted to come with major health care regulation changes. 

Here’s the more immediate problem as it’s unfolding. It’s dollars and sense.

Most of the surgery in the country takes place in hospitals without residency programs. In these hospitals, the attending surgeon is paid by an insurance company to do the operation (in contrast, at most teaching hospitals, surgeons are either on a fixed salary or part of a group that pools and divides fees) — and he must arrange for another surgeon’s help. This used to be easy, in 1985, when the standard assistant surgeon’s payment of 20% of the primary surgeon’s fee was a great incentive. Since then, the surgeon’s expenses have more than doubled, while fees have shrunk to a quarter or less of what they were. The assistant’s share has dropped to 16%, and, more frustratingly, even after spending their time helping they often are not paid at all, with insurance companies saying the services of an assistant surgeon are “unnecessary.”

Most docs tend to think they should be the ones to decide what services are necessary or not, since they are personally responsible for the results of the surgery. Yet when insurance companies refuse to pay for an assistant, they cite “American Medical Association (AMA) guidelines,” which list procedures as “assistant required” or “not required” (often “not required”). Not surprisingly, 84% of practicing American doctors do not belong to the AMA, and many in my acquaintance have quite a negative view of this organization.

The AMA has not represented a majority of the nation’s doctors for years and years. They just give the perception they do. A media-fed perception. But look at what’s not getting attention: Doctors begging for “freebies” from colleagues, or appealing to their “goodwill” to assist in surgeries.

If all else fails, you just have to operate without another doctor. This is especially true for middle-of-the-night and weekend emergencies. Common sense and unfortunate anecdotes tell us it is unquestionably less safe for the person on the table to have only one doctor present. But, not surprisingly, no surgeon, hospital, insurance company or government agency has wanted to come up with a hard statistic on how much less safe it actually is. It is clearly against all of their interests to show that assistants are needed. And it’s not something I’ve seen brought up in the already too complicated health-care debate. Yet the issue of the missing second surgeon is hurting patients right now.

If they’re not even addressing it, they’re not working on a solution for it.

So articles like these don’t answer questions, they only raise more. From my friend Nancy Valko:

This article brings up a point about proposed health care reform that really concerns me as a 40 year veteran of nursing and one that I have not seen addressed so far: If we want to insure good routine health care for an estimated additional 40 million people, where are the plans to increase the numbers of doctors and nurses necessary to care for them?