Choosing your surgeon is a high-stakes, deeply personal decision and can have significant emotional, physical, and financial implications. To be clear, every surgeon can have complications or unexpected outcomes, but not all surgeons have consistent, good outcomes with low rates of complications and/or surgical failure. Knowing how to find the surgeon high performer can be challenging but is critical when pursuing esophageal surgery. Very few decisions in life are more important to get right than this one.
Some Data
Interestingly, only 31% of patients do any research on surgeon qualifications and outcomes and instead rely on a physician referral. In the book The Patient Will See You Now by Eric Topol, it is noted that 40% of patients prioritize convenience over exhaustive research for healthcare decisions. A study published in Health Affairs found that patients spend 2–6 weeks on average choosing a surgeon for elective procedures but far less in urgent scenarios. In contrast, the Journal of Consumer Research reports that high-cost purchases (homes, cars) involve an average of 50–70 hours of active research over a few months.
Think about that. For an operation that is intended to return someone to health or prevent disease, and if there is a complication or failure can result in life-long complications or side effects, and even death, individuals typically spend 1/2 as much time investigating their surgeon as they do researching about the house they might buy.
Why Not Just Get a Referral?
I get it, you trust your primary care physician or gastroenterologist to know who is good and make the right referral. At one time that might have been valid. Historically physicians succeeded or failed based on their reputation and the referrals that followed. If you weren’t good, you would not get referrals. That model or professional reputation to motivate and assure high performance and competency is long gone. Today, the majority of doctors are employed by a healthcare system, and referrals are typically made to surgeons within that healthcare system, not the best surgeon for your needs. In fact, doctors are instructed to use the surgeons in their system or hospital rather than going “outside” with a referral. In a recent survey of doctor referral patterns, 78% of primary care doctors within a healthcare system referred only to surgeons within their system, and knew very little about the training and experience of the surgeon to whom they referred a patient. Similar data exists for large, multi-specialty clinics. Insurance companies are also directing referrals by forcing patients to use only doctors in their panels or covered networks. Put simply, referral patterns no longer assure quality but, rather, tilt toward improving revenue and profit margin for interested parties.
Marketing & The Internet
Another significant change has been the internet and the ease and comfort with which doctors now advertise their services. Thirty years ago it was unheard of for a reputable doctor, especially a surgeon, to advertise their services directly to the public. Doctors who did this type of marketing were branded “quacks” whose only way to build a practice was to market their services directly to patients, bypassing the screening that a referring physician would undertake before making a referral. I remember early in my career being approached by colleagues expressing concern that a local surgeon had a billboard just outside of the Atlanta airport. At the time that surgeon had a poor reputation in the Atlanta area. Today, billboards for doctors and their practices line the freeways of every major city. The only billboards more prominent are those of personal injury attorneys, often chasing malpractice cases from poorly performing surgeons. And compounding this is the internet, a massive digital billboard where flashy and extremely credible looking websites – unregulated by the way – can present a surgeon and their practice in misleading or inaccurate ways leaving it almost impossible to know what to believe.
With all this information to process, when making a decision about your surgeon, what do you do? In the rest of this post, I will try to provide some insight and guidance to answer this extremely important question: How do I pick my surgeon, and how do I know if they are right for my problem?
I will outline a series of actions that you should “check-off” as you answer this question for your situation. Ideally you will check each box before locking in your decision. You will need to consider your specific situation, like your location, ability to travel for care, financial situation including insurance coverage and out-of-pocket expense, but touching on each issue outlined in this post will give you the best chance of making the best decision, even within those limitations.
NOTE: While beyond the scope of this post, it is worth mentioning that there are urgent or emergent situations where you don’t have much choice. In those cases, you are left with the on-call surgeon at the hospital where you are seeking urgent care. That said, for benign esophageal conditions, this should be a very rare situation, unless you have ignored an obvious problem or ignored the recommendation to pursue surgery, thereby allowing an elective procedure to become an emergent procedure. Herein, I will be outlining how to pick your surgeon for an elective esophageal operation.
The Process of Assessing A Surgeon
The process will involve creating a "short-list" of possible surgeons from which to chose and then assessing each surgeon in three key metrics:
Qualifications
Knowledge
Compatibility and fit for you
Before getting to the step-by-step process, a few comments about these three key metrics.
Qualifications
Qualifications are the factual data about a surgeon's training: licensure, certification, specialty or practice focus, outcomes and performance issues (e.g., malpractice, complaints to regulatory agencies, etc.). Also part of qualifications are similar data about the hospital or facility where a surgeon operates. Even a great surgeon will have trouble performing a safe and high-quality operation at a hospital with inadequate infrastructure to assure those outcomes. Remember, the surgeon typically does not control who is assisting in the operating room or hospital room, including the anesthesiologist, nurses, and technicians involved. Researching a hospital or surgery center for documented safety and quality, and any history of problems, should be done.
Knowledge
This aspect may seem redundant. If a surgeon is licensed, certified, and approved to operate at a hospital, doesn’t this establish that they have the knowledge to do the job? In a word, no, especially when assessing a surgeon for an esophageal operation. The credentials I outlined above establish that a surgeon has finished school and training in a broad and general field of study, like General Surgery or Thoracic surgery. These credentials do not establish that the surgeon has the needed knowledge, experience, and expertise with esophageal conditions. In fact, the esophagus is largely ignored as an organ about which surgeons are specifically trained (see post, Why Isn’t There a Specialty for Esophageal Diseases?)
You must assess whether your surgeon has specific knowledge about esophageal conditions and the surgery to manage those conditions. In the "How To-Do" section later in this post, I will outline some questions to ask your surgeon and a process to assess that knowledge.
Compatibility and Fit for You
This may seem a bit “touchy, feely” coming from a surgeon, but trust me, this is a critical aspect of selecting your surgeon and assuring a good outcome. A long-held concept about a surgeon has been, “I don’t care about their bedside manner as long as they are a good surgeon”. Patients often walk out of a surgeon's office after a visit feeling uneasy and even not liking the surgeon but focusing on their reputation as a “good surgeon”. I held that belief, although always felt that I wanted to also have a good bedside manner. I did, however, train with a number surgeons who fit this perfectly; skilled in the operating and a disaster when interacting with patients and their families. A brief anecdote to highlight this opinion (after writing this I see it’s not so brief, but I believe worthy):
One day while sitting in the board room waiting for everyone to arrive before starting a meeting of the Executive Operations Team of the Mayo Clinic in Florida, I was in a discussion with the CEO, a medical oncologist, about one of our surgeons who had a large file full of complaints from nurses and families about their behavior and bedside manner. As the Surgeon-In-Chief, these problems were my responsibility to address. This individual was a very good technical surgeon (executed very well in performing an operation) and with that was widely regarded as a "good surgeon". I began my response to the CEO raising this issue by saying, “You know, he is a very good surgeon…”, and before I could get the next word out he assertively said, “No, he is not! A good surgeon is not only good at performing an operation but also good at communicating with patients and their families, and treating people respectfully. Don’t confuse being good technically in an operating room with being a good surgeon. He clearly is not a good surgeon.” I didn’t know what to say. For the 15 years of my career in academic surgery, teaching medical students and training young surgeons, no one had ever challenged that construct. I expected that I would have a discussion with the surgeon, make him aware of the issues and complaints, ask him to try and do better but to not worry too much about these issues – after all, by my long-held belief, he was a good surgeon. After thinking about what the CEO said, I realized he was absolutely right! Caring for a patient and delivering a safe, successful operation with a good outcome is so much more than just technical execution in the operating operating room. Decision making before and after the operation, especially communicating with patients and their families, is essential to making the correct diagnosis and formulating a treatment plan. Explaining the goals of surgery and setting expectations, along with an ongoing dialogue throughout the recovery after surgery, is also critical to an optimal outcome. While the technical execution of the operation itself is important, it is but one of many components of success. In fact, I now regularly teach:
Wrong diagnosis, wrong operation, perfect execution in the operating room = POOR OUTCOME
Right diagnosis, correct operation, perfect execution in the operating room, patient and family not prepared = POTENTIAL POOR OUTCOME
Right diagnosis, correct operation, perfect execution in the operating room, patient and family fully informed and prepared = BEST POSSIBLE OUTCOME
Perfect execution in the operating room only provides the best possible outcome when the right diagnosis has been made and the patient and family are fully informed and prepared. This is why you should assess your surgeon as a person and whether they are a good fit for you and your situation.
So, let’s get started with how to do it. The rest of this post will organize the process with specific details including Internet search strategies, where to find details about credentials, and how to interview and assess your surgeon for knowledge and fit for you.
A How-To Guide To Picking Your Surgeon
Step One – Create a “short list” of prospects
First, do an internet search using search terms that correspond with what you need. Here are some ideas about how to conduct that search.
Internet Search Terms
GERD surgeon | Achalasia surgeon |
Linx surgeon | TIF surgeon |
Esophageal surgeon | Foregut surgeon |
Reflux surgeon | Nissen surgeon |
Fundoplication surgeon | Redo esophageal surgery |
Layer these terms into searches with search words like expert, experienced, best, near me, in my area, in the US, etc.
Examples:
Best Linx surgeon near me
Expert esophageal surgeon in my area
Best esophageal surgeon in US
NOTE: This post applies to benign esophageal conditions, not esophageal cancer. If you are looking for a surgeon for esophageal cancer I’d suggest looking at sites form the Mayo Clinic, MD Anderson, Cleveland Clinic, and other institutions who specialize in cancer.
Specializing in Esophageal Surgery
For benign esophageal conditions detailed here and on this website, in my opinion, you should be looking for someone who specializes in surgery on the esophagus, not someone who is more broadly focused or specializes in something other than esophageal surgery. For example, a general surgeon will have many different areas of focus and interest including esophageal surgery. This does not equal expertise with esophageal surgery. In fact, unless a surgeon is routinely performing esophageal surgery (25+ cases each year), they do not gain and maintain the skill needed for consistently good outcomes with esophageal surgery. A general surgeon who is doing a large variety of different operations does not manage enough esophageal cases to achieve this level of expertise. Similarly, a thoracic surgeon is a surgeon who is trained to operate through the chest on everything in the chest, including the esophagus. Like the general surgeon, thoracic surgeons are addressing all of the organs in the chest and may only occasionally perform operations on the esophagus. Finally, the bariatric surgeon is a general surgeon who has done additional training and focuses on caring for obese patients and performing weight loss operations. Regrettably, many bariatric surgeons also claim to have expertise in esophageal surgery. You want a surgeon whose main interest and focus is the esophagus, not someone who dabbles in esophageal surgery as a supplement to their other areas of interest. This is critical for more complicated problems and revision operations (REDOs).
Finally, as you are narrowing down your list of potential surgeons, do not be fooled by the institution, hospital, or healthcare system where the surgeon works. Even the Mayo Clinic has surgeons who are not at the top of their field. You must primarily assess the individual surgeon.
Now that you have a list of prospects, it’s time to roll up your sleeves and do the more detailed research on each of your prospects.
Step Two - Research Qualifications
This will be the easiest part of this process since most of this information is factual and can be found on the internet.
Board Certification: Ensure the surgeon is board-certified in their specialty (e.g., the American Board of Surgery).
American Board of Surgery - https://www.absurgery.org/check-a-certification/
Licensure: Verify they are licensed to practice in the state where you will receive care.
Note: some states consider complaints or disciplinary action against a physician confidential and, therefore, do not make that information publicly available. For example, Georgia considers that information confidential, Florida does not. Here is the URL for Georgia medical board. This is easy to find for each state.
Georgia Composite Medical Board - https://gcmb.mylicense.com/verification/
History of complaints or disciplinary action by state medical boards: This can sometimes be found through each state's Board of Medicine site. The site below aggregates information from all states.
Federation of State Medical Boards (FSMB) - https://www.docinfo.org/
Patient Review Sites. There are many. Below is a common one. All of this are less credible since they are comprised primarily of patient reviews rather than factual data.
Healthgrades - https://www.healthgrades.com/
Social Media: Another potential source might be social media sites where patients share their experience with different surgeons. These can be very informative. A few words of caution:
Remember that these reviews are sometimes one person’s opinion and experience. Look beyond the star rating and highlighted first comments to understand why the individual either really liked a surgeon or really disliked them.
Also be aware of sites that are managed by a surgeon. At first this may be hard to determine. Sites managed by a surgeon allow the surgeon to remove unfavorable posts and highlight favorable ones. Also, surgeons will solicit social media posts. In my opinion, solicited feedback from a patient should only be posted to the surgeon website as a testimonial. That allows you to know that this is select feedback, and while valid, may be incomplete.
Malpractice History: This is a bit trickier to find. Malpractice cases are publicly available, but there is no publicly available free way to search court records for filed cases. There are paid services that lawyers use, and their use is open to anyone who signs-up. A word of caution:
Even with access, these databases are not very user-friendly for the general public. Put simply, you almost need to be a lawyer to know how to use the search engine to find anything. I would recommend a simple Google or AI search for something like surgeon name malpractice.
Hospital Affiliation: Find out where the surgeon operates. This should be found on the website for a surgeon or their practice. Research that hospital for any history of problems, sanctions and/or whether they have any specific certification for safety and/or outcomes.
Medline + - https://medlineplus.gov/ency/article/007497.htm
Specialization: Look for a surgeon who specializes in the procedure you need (see earlier comments).
Insurance: While not exactly a qualifications issue, determining if the surgeon you are considering accepts your insurance may be an important variable, especially if you do not have the financial resources to go outside of your insurance coverage. That said, YOU DO NOT WANT YOUR INSURANCE COMPANY TO MAKE THIS DECISION FOR YOU. More times than not, you can find the right surgeon who takes your insurance. If your situation is very complicated and specialized, you may find a limited number of surgeons who can address your particular situation and may not find anyone who takes your insurance. Explore your insurance options before taking those surgeons off your list. Sometimes an insurance company will allow a patient to use an expert surgeon who is out-of-network, or not covered, based on the uniqueness and complexity of the needed surgery. Put differently, if insurance does not provide you coverage for the surgeon you need, you should pursue forcing them to allow you to use that surgeon. Often this can be achieved.
Step Three - Assess Knowledge
Now that you have at least one, or a few surgeons who remain possibilities to help you with your situation, it's time to met the surgeon(s). It is through an interview process and a series of questions for the surgeon that you will assess their knowledge and experience with esophageal surgery.
NOTE: It is perfectly OK to see more than one surgeon. Explain to each surgeon that you are getting second and even third opinions. A surgeon who is upset by the prospect that you are “shopping” for a surgeon is revealing that they are not comfortable with being compared to other surgeons and probably for good reason. Never worry about upsetting a surgeon with your process or any questions. Again, if they are upset by being interviewed about their experience or being asked to offer a second opinion, then you should take them off your list. Great surgeons are not upset by being vetted.
The following questions should be a part of your surgeon interview:
Is my operation something you specialize in?
How often do you do this operation – total in your career, how many each year?
How long have you been doing this kind of surgery?
Is there anyone else that you would recommend for this operation (this can be a credibility question – unless you are in a very small and remote area, or the operation you need is very specialized (like a revision of previous surgery) the answer should always be yes. If the answer is no, trust may be called in to question.
Do you have any trainees who will be working with you? If yes, what is their role in my care?
Will they be doing any of the operation?
Will they be seeing me after surgery?
Will you be seeing me after surgery?
Will you see me for my follow-up visit?
How will I communicate with you through the process - will you be available or will I be dealing primarily with your staff?
Step Four - Fit For You
This is can be the most challenging step, but do not skip it because it is hard. The fundamental thing you are assessing here is how do you feel about the surgeon. Ideally, this will be a short-term relationship. If you have done Steps 1-3 well, the majority of the time (>90%) things will go smoothly, and after a few months, you will be fully recovered with a great outcome and saying goodbye to your surgeon. During that time, you may only see your surgeon once or twice. On the other hand, if there are any complications along the way, or your recovery is more turbulent with slow healing and resumption of normal activity, and even compromised success of the operation, your surgeon relationship will be very important to getting you through that period as comfortably as possible.
I frequently see patients who after a few weeks or months are not happy with their progress and outcome, and they no longer trust their surgeon, or find it difficult to communicate with them about their concerns. You do not want to be in that situation if you can avoid.
So how do you tackle this difficult step? Below is a list of questions you should ask yourself after you have finished Steps 1-3.
Did you like the surgeon?
How much time did the surgeon spend with you - was most of the time with a nurse or PA?
Did they take time to listen to your problem and concerns?
Were they prepared for your visit - reviewed you records ahead of time?
Did you feel like they cared and wanted to help you?
Were they professional - well dressed, on time, respectful?
Was their office staff professional and helpful?
Did the office staff seem to be familiar with the kind of care you need?
Did they appear comfortable talking about your condition and its treatment?
Did they take time to explain the problem and its solutions and answer your questions?
Did you feel rushed during the visit?
Did you trust the surgeon?
NOTE: This can all be very hard to process during the visit, especially if you are anxious and/or scared. If possible, bring someone with you to the appointment and be sure that they can sit in on your discussion(s) with the surgeon. If they are not allowed to be a part of the visit with the surgeon then take this surgeon off your list. This person can then be a second set of eyes and ears to experience the interaction and help you later reflect and answer these questions.
Of course, you may have more questions that are specific to your situation or personality, but the bottom line here is do you trust your surgeon. Once you have selected your surgeon and committed to an operation, that trust will be very important for you to go through the very scary and unique experience of having an operation, and if there are any issues through your recovery, that trust will be essential to effectively navigating that recovery to the best outcome possible.
C. Daniel Smith, MD