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Low Blow Against High Volume?

Every time our Academy takes one step towards conciliating with anterior segment surgeons, it takes at least one backwards. It recently teamed with ISRS to bring us a first-class refractive surgery subspecialty day in Anaheim. Finally we saw teamwork and cooperation between the Academy and refractive surgeons, and even if was for only for a few days, it was very encouraging.

Unfortunately, the November issue of its most excellent scientific journal contains a disappointing article about risk factors for being sued after performing refractive surgery. Apparently it took a research team to determine that if one does more surgery, one gets sued more often. Not more often per case performed, just more often, period. The authors admit that intuitively more cases lead to more potential for complications, but dismiss this because there is no published data to support such a claim. Hmmm . . . if Doctor A does one case a year and Doctor B does 10,000 does Doctor B have more chance for complications? I don't need published data to guide me because I already know the answer: Yes, 10,000 times as many chances.

The authors quote a study that concludes that "low-volume, beginning surgeons" had comparable results to experienced surgeons. I wonder if they'll be willing to choose a low-volume, beginning surgeon when they have their coronary bypasses. I know I won't.

What Exactly is Going on Here?

The article also defines other risk factors for lawsuits in addition to doing a lot of cases. These include being a man, spending less time with a patient, advertising, and co-managing. Can it be that the surgeons doing a lot of laser cases tend to be men who have large staffs to help them in the office, advertise, and who work with other doctors in the community? Are these factors, perhaps, modestly synonymous with most high-volume refractive surgeons?

The authors would like to use their findings as data for underwriting criteria and risk management protocols. Could they (A) want to push refractive patients to low-volume, beginning women surgeons who do not advertise and who do all of the work in their offices themselves? Or are they (B) generating articles to justify urging OMIC to stop insuring those who co-manage, thereby using the eminent journal to push a political/economic agenda rather than a scientific one? I vote for B.