Large percentages of high-risk surgeries and procedures in New York are performed by physicians who do just one or two, too few of them to become expert, according to a study of state health department statistics released today.
In many cases, one-third to one-half of all physicians performing a procedure did just one of them in the whole year, according to a study of 2001 state data on 44 different procedures by the Center for Medical Consumers in New York City.
For example, New York physicians performing just one procedure made up 31.8% of all those performing carotid endartorectomies, 27.6% for mastectomies, 48.5% for coronary artery bypass surgeries, 48% for colonoscopies and 45% for angioplasties, the center reports.
Arthur Levin, director of the center, points to a growing number of studies showing that doctors are more proficient in a certain procedure when they perform a high volume of them.
Levin says the data do not explain why so many physicians perform only one procedure. In some cases, he says, a hospital may have reported the wrong physician ID number; in others, one of the thousands of medical residents in New York state may be doing one procedure under supervision. And in procedures like colonoscopies, many physicians tend to do most of them in outpatient facilities that are not required to report to the state, Levin says.
But Levin says many of the physicians doing one or two cases a year appear to be general surgeons, and he thinks hospitals should restrict their privileges so they cannot do them. He stays the state could push hospitals to do this by requiring volume thresholds for each hospital, as it already does for heart surgery.
"I'm not a great believer in pushing medicine into more and more specialization, but in these cases maybe it needs to happen," he says.
On its Web site, Levin says the center lists volume for each New York physician and hospital in each of 44 procedures, so that consumers can pick a physician. Though the health department collects the data, he says the department has chosen not to publish it.
Only a few other states collect such data, he adds.