Finding a good orthopedic surgeon, or any good physician for that matter, is significantly more challenging than looking for a good mechanic or finding the best restaurant. While many new physician review sites have emerged in the last 5 years, from a physician’s perspective, these websites leave a lot to be desired.
Online review sites like healthgrades.com can highlight great physicians, but this is certainly not the only source I would use to vet a good orthopedic surgeon or physician. Many physicians that I trust and refer family to have terrible online reputations. Most physicians do not dedicate any time to monitor their online reputation. Consequently, a few sour apples (which is inevitable in any service oriented field) often tend to dominate the available reviews and skew the perception of the physician. For most good physicians, majority of patient referrals come through word of mouth. Consequently, not all physicians are interested in spending time to cultivate their online reputation.
Where does that leave the consumer? This makes it very challenging to vet a good orthopedic surgeon outside of using review sites. I have found using the following tactics in conjunction with information gleaned on review sites can help identify good orthopedic surgeons in your community.
Verify the provider’s credentials.
First and foremost you want to make sure your orthopedic surgeon has the appropriate credentials to treat you. Not all orthopedic surgeons are created equal. Some will have additional specialized training in a particular discipline such as hand surgery, sports medicine injuries, spine surgery, etc. Be aware there are some sub specializations have similar names but reflect a different type of training. One confusing example is primary care sports medicine training versus orthopedic sports medicine training. Depending on the skill set you are seeking, certain training may be more relevant than others. If you are comparing doctors, you can also compare the quality of the institutions where the doctor received their training. Any training program that involves a high volume hospital likely gave the physician an opportunity to learn their craft effectively. Professional associations like the American Academy of Orthopedic Surgeons also maintain a searchable database of their members.
Vet their technical skill.
Don’t be afraid to check how much experience your orthopedic surgeon has with a given procedure. Call and ask their office how many of the specific surgery of interest the doctor has done. You may not necessarily get a straight answer on the phone, but asking how many of a particular case a surgeon does a month may give you an objective way of comparing one surgeon’s body of experience with anothers. If you are investigating a problem relevant to a Medicare population, a round about way of checking how many Medicare patients a physician is seeing is by utilizing the public medicare claims database (visit it here: Medicare Unmasked: Behind the Numbers). Use it with a grain of salt. A lot of physicians limit their Medicare insurance exposure so it may not tell the full story; but if your target doctor sees >50th percentile of volume of medicare patients for their region, you can bet they are getting lots of word of mouth referrals amongst the Medicare peer group.
Determine their years of experience.
The prime for an orthopedic surgeon is generally ages 40-50. By age 40 the surgeon has had enough repetitions to hone their skills. At this age they are still eager to embrace new technologies and introduce it to their practice. After age 50, not all surgeons, but for some, human nature takes hold, and the tendency is to fall into a routine and become more complacent as new things emerge. Obviously this does not describe everyone and is a gross generalization, but avoiding the most senile of surgeons is probably a wise idea.
Beware of snake oil salesmen.
In training I was taught it is good practice to never be the first, but also never be the last to adopt new technologies. If the physician you are considering is more eager to sell the all new cure-all treatment that hasn’t yet been vetted by the professional colleagues and organizations, in lieu of more established successful therapies, I would be very weary. For new technologies we often don’t necessarily completely understand their positive AND negative effects. Studies and comparisons help us establish what truly is the standard of care. I personally prefer to let the early adopters work out the problems in the technology. Once the technology has passed first muster of the orthopedic community, then only do I integrate it. The one exception to this is when dealing with salvage situations or when one has exhausted all therapeutic means. In these circumstances, with the lack of any better alternative, it may make sense to try a more experimental or novel technique. But if your condition does not fit that criteria, I would be averse to any physician eager to peddle an expensive, out of pocket, non-insurance approved treatment. Typically these snake oil physicians can be identified on the basis of their web site alone. If you find a dazzling website entirely focused on some new esoteric therapy, I would not see them no matter how great their reviews are. A great example of hype in orthopedic surgery is the hyperbole surrounding stem cell injections. While research is promising, no one has demonstrated that stem cells can be directed to grow new cartilage where needed, undo arthritis, restore ligaments, elongate tendons, tone muscles, strengthen bones, reverse aging, insert other preposterous claim here, etc. At this point we understand that stem cells can produce living tissues, but we don’t know how to necessarily coax them into the appropriate and desired pathways for producing tissues. It’s a bit akin to trying to build a house (desired living tissue) with a pile of wood chips (the stem cells) as opposed to tried and true logs.
Use the most under utilized resource, occupational and physical therapists in your community.
When I was looking for jobs, a strategy I would use to identify reliable physicians in the community was calling up the local therapists and asking “Who does the best ACL reconstruction in the area?” or “Who would you trust with your knee surgery?” to try and find out who were the reputable docs in the area that I might want to work with. Often after only 3 or 4 phone calls I could get a pretty good idea of who the trusted docs were whose names would keep on popping up. Physical therapists are great judges of orthopedic surgeon outcomes since they see patients often before and after their surgery.
Reach out to local athletic trainers.
This strategy piggy backs off the one above. Athletic trainers at your club sport or at school see a high frequency of sports injuries. All experienced trainers deal with orthopedic surgeons while managing their athletes. They will know first hand which doctors are getting their athletes back on the field.
Nurses, like other medical providers described above, are interacting with physicians all the time. Nurses also often witness patient and physician interactions. Operating room nurses in particular have likely seen a doctor’s reaction to adverse situations when things don’t necessarily go as planned. This inside information is valuable. Solicit a friendly nurses opinion and they will readily share who they think the better physicians are. Although they may not necessarily work with an orthopedic surgeon, there is a good chance they do know an orthopedic nurse, or someone who does know an orthopedic surgeon well.
Check with your friends.
Orthopedic injuries are pretty common. Check with your friends network. Many can likely offer good recommendations.
Search the doctor online.
Just googling the doctors name can reveal a wealth of information. It will pull up the reviews available online for them. Like I mentioned earlier, I use review sites as one element in my physician screening process. Obviously someone who has 10+ negative reviews raises red flags. I don’t put too much stock in reviews when there are less than 5. That is just not a fair sampling. Someone with several great reviews is definitely hard to ignore.
I hope you find some of these tips helpful. Feel free to drop a comment below if there is something you think I missed that should have been included.