Posted by Bill Sandweg on 08 August 2016.
As I have observed on many occasions, medicine is a business and we patients are its customers. It is as true in Phoenix, Arizona as it is in New York or California. Under the fee for service model of payment, doctors don’t get paid unless they do something to you or for you. This is particularly true for surgeons. They don’t get paid unless they perform operations. It apparently doesn’t really matter if the operation may not be the best form of treatment for you. It apparently doesn’t really matter if scientific evidence shows that the operation is not all that helpful. These are the conclusions of a number of studies. Even though scientific evidence strongly shows that certain operations are not effective or are no more effective than non-surgical alternatives, surgeons just keep on performing the operations. Why? Because that is the way they get paid.
Over and over again, studies have found that money drives the decisions of many doctors, either consciously or unconsciously. If surgeons own a company which sells surgical implants to a hospital, the patients of those surgeons are much more likely to end up with those implants inside them than patients of surgeons who do not sell implants to the hospital. If urologists own a special radiation machine for treating prostate cancer, their patients are much more likely to receive the super expensive radiation treatment than patients of urologists who do not own such a machine. Of course, the doctors will always tell you that you are imagining things and that their financial interest never influences their decisions or the decisions of their patients. It is all a giant coincidence.
So, if scientific proof won’t stop surgeons from performing unnecessary or ineffective operations, what will? The simple answer is money. Since the early 2000’s, the scientific proof has been strong that spinal fusion surgery is no better at relieving back pain than non-surgical treatments that both cost less and expose the patient to less risk of a bad outcome. Notwithstanding that scientific proof, the rate of spinal fusion surgery in the United States went up and up until 2012. In 2012, some insurance companies said enough was enough and that they would not pay for spinal fusion surgery any longer. Without money as a lure, the rates of spinal fusion surgery took a nosedive. It is a sad commentary on the practice of medicine in this country when we have to depend on health insurers to improve quality and to save us from unnecessary operations.