Determinants of surgical decision making: a national survey

Am J Surg. 2013 Dec;206(6):970-7; discussion 977-8. doi: 10.1016/j.amjsurg.2013.08.018.

Abstract

Background: We conducted a national survey of general surgeons to address the association between surgeon characteristics and the tendency to recommend surgery.

Methods: We used a web-based survey with 25 hypothetical clinical scenarios with clinical equipoise regarding the decision to operate. The respondent-level tendency to operate (TTO) score was calculated as the average score over the 25 scenarios. Surgical volume was based on self-report. Linear regression models were used to evaluate the associations between TTO, other covariates of interest, and surgical volume.

Results: There were 907 respondents. The mean surgical TTO was 3.05 ± .43. Surgeons had significantly lower TTO scores when responding to questions within their area of practice (P < .0001). There was no association between TTO and malpractice concerns, financial incentives, or compensation structure.

Conclusions: Surgeons recommend intervention far less frequently within their area of specialization. Malpractice concerns, volume, and financial compensation do not significantly affect surgical decision making.

Keywords: Malpractice; Surgical decision making; Surgical specialization; Surgical volume; Survey.

Publication types

  • Comparative Study

MeSH terms

  • Decision Making*
  • Female
  • General Surgery*
  • Humans
  • Male
  • Middle Aged
  • Philadelphia
  • Physicians / psychology*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Surveys and Questionnaires*