Determinants of surgical decision making: a national survey
Niamey P Wilson1, Francis P Wilson, Mark Neuman
1Robert Wood Johnson Clinical Scholars Program, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, West Pavilion, 3rd Floor, Philadelphia, PA 19104, USA; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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.
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