An earlier article discusses research on the high skills of high-volume doctors, and how to find such doctors. However one would not want a high-volume doctor who does unnecessary work.
There are some high-volume doctors to avoid, such as anyone who advertises a lot. Billboard ads for weight loss surgery in southern California were accused of drawing in a high volume of patients to unsanitary and dangerous surgery centers. The ads ended when the FDA complained that warnings on them were too small to read. The New York Times reported on questionable heart operations at two major hospital chains in California and Florida. The Washington Post reported on questionable spinal fusions in Florida. USA Today had many examples of unnecessary work from 2001-6 in a 2013 article.
Several papers reported in early 2015 that the Justice Department joined 2 whistle-blower suits (one started in 2011) charging a Florida cardiologist with unnecessary work. The D25 file (see box) shows he was the highest-volume doctor for some procedures, and near the top for some others.
Medicare's fraud team has charged doctors with "schemes to submit claims to Medicare for treatments that were medically unnecessary and often never provided." From March 2007 to May 2014 the team "charged almost 1,900 defendants who collectively have falsely billed the Medicare program for almost $6 billion." About a fifth, or 400 of them, were doctors. You can check online for such federal cases and state penalties, and keep your wits about you, though you don't need to fear all high-volume doctors.
Consumer Reports lists 10 overused procedures and 12 overused surgeries. 63 medical societies have released their own lists, with an overall search window. Patients need to be careful before accepting one of these procedures.
Can patients protect themselves from unnecessary work before public charges are filed and proven? Often yes, whether a doctor has high or low volume.
The first protection is a 2nd opinion. Most charges in these articles concern procedures on Consumer Reports' or medical societies' lists of overused procedures, where 2nd opinions are crucial. Wise and confident doctors encourage 2nd opinions
Consumer reviews (especially Vitals) often critique doctors, years before any charges are filed. These criticisms give even more reason for second opinions. Of the 2 doctors named by the LA times in 2010-12, one had his license revoked, so is not listed on consumer sites. The other has had complaints about poor work, starting in 2009, though many patients are still happily seeing him in 2014. Two of the three doctors named publicly by the NY Times in August 2012 had complaints as far back as 2009 alleging poor or unnecessary work, along with other good reviews. However the 3rd doctor had 2 good reviews and no bad ones. The doctor named by the Washington Post in October 2013 had many good reviews, and 1 bad one in April 2010 about lack of care in a hospital.
Dr A was charged by Medicare in May 2014. He has many good reviews, but also a complaint from June 2012 about poor communication with the patient's primary care doctor and poor service when the patient did not change his insurance as requested by the specialist.
The high-volume cardiologist reported by several papers in 2015 had numerous complaints on consumer sites about unnecessary tests as far back as 2009. RateMDs rates him lowest among 26 cardiologists in Ocala. The whistle-blower (qui tam) suits which the Justice Department joined had been filed July 2011 and June 2014, but the public had no way to know these allegations were pending. This type of suit is "filed under seal, without notifying the defendant... to protect the confidentiality of the government’s investigation until the investigation is concluded" (p. 5). The judge kept the suits sealed for successive 2-month periods during the next 3½ years, while he treated hundreds more patients and Medicare paid his practice more than any other cardiologist's practice. The government was telling the judge it needed more time. The suits were finally unsealed and could be found on Pacer starting December 22, 2014. So the only notice to the public until then was from complaints about him on consumer sites.
Professional reviews do not list doctors to avoid, but at least they try not to recommend doctors with problems. None of the doctors named in the articles and complaints above was listed as a top doctor by Checkbook or SuperDoctors. In any case those publishers lack coverage in northern Florida where several of the doctors are. One of the doctors, Dr C from the NY Times article, is a Top Doctor at Castle Connolly.
All these examples show the need for careful checking, whether one uses a local or distant doctor. Primary care doctors rarely have the time for such checking, except in the specialties they refer to most. Patients will devote substantial time to treatment and recovery, so checking is worth their time.
RETURN TO ARTICLE ON FINDING HIGH-VOLUME SPECIALISTS