Dr. Paul Ruggieri is a practicing surgeon from Providence specializing in general, advanced minimally invasive and thyroid surgery. During his 20-year career in medicine, Ruggieri has held department of surgery chairman positions at several community hospitals, and has been a clinical instructor at Harvard Medical School. He is also author of the new book “The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry,” which is due for release Sept. 2.
PBN: What percent of surgeons’ decisions about whether to operate involve money and how many of those decisions should involve money?
RUGGIERI: I have no way of answering this question. There are no studies that broach this sensitive topic. Every surgeon has taken a professional, ethical oath to do what is in the best interest of the patient and not what is in the best interest of the surgeon. In an ideal world, money should not be part of the equation.
PBN: You mentioned in a recent op-ed that surgeons’ residencies are less intensive than formerly. Should residencies be lengthened by a few months, say, to make up for the fewer number of hours per week to bring up the experience level to where it previously was?
RUGGIERI: Yes, increasing the length of surgical training (and even decreasing the time in medical school) is one idea leaders of the national surgical organizations in this country are discussing. Due to the work-restriction rules placed on surgical residents today, they are spending less time in direct patient care and less time inside the operating room. Many surveys have indicated that the majority of surgical residents are not happy with the duty hours-per-week restrictions placed on them. Several studies have indicated surgical residents in training today may also not be getting enough clinical experience upon completion of their training.
PBN: You’ve also written about a lack of transparency in the surgical profession. How much should a patient be able to know about a potential surgeon, and what would be the best way for that information to be provided to the patient?
RUGGIERI: Patients should be aware of their surgeon’s clinical experience, in regards to their particular operation. Even in my world, practice does make perfect. “High volume” surgeons have better patient outcomes then “low volume” surgeons. A patient needs to be aware the monthly, yearly frequency at which their surgeon is performing their needed operation. In addition, a patient should be aware of his or her surgeon’s complication rates and surgical site infection rates. The problem here is there is no way for patients to know realistic numbers. The only thing they could do is directly ask their surgeon and trust in his or her answer. Their is no proven public data base where patients can go to find this information out before entering the operating room.
Hospitals and insurance companies have this data and have yet to share it with the public.
PBN: How are the restrictions on the number of covered doctors and hospitals, part of the response by insurers to the ACA, playing out? Does a patch need to be placed on the law to address this?
RUGGIERI: The physician (and hospital) network restrictions inherent in the Affordable Care Act’s health insurance exchange system, to me, limit a patient’s choice when it comes to their health care. This is an unfortunate byproduct of the current system. Many patients who sign up for health care on state exchanges are limited to the physicians and hospitals they can use in the case of illness. Yes, these patients can now afford health care. However, the trade-off is a limited choice. If they want to go out of their “network” it will cost more money out of pocket. In addition, physicians are now declining to electively take their exchange-based health insurance because of the low reimbursements that come along with it. This phenomenon will further limit a patient’s choice. It may even lead to health exchange patients not having access to the most experienced physicians in their community. I believe this discrepancy will worsen and have to be addressed on a federal level.
PBN: What country’s health system creates the most favorable environment for surgeons to practice their profession, and how does that country support its surgeons?
RUGGIERI: I still believe this country continues to offer the most favorable environment for surgeons to practice on a clinical, as well as business level. The best surgical care offered in the world is right here in the United States. It may not be the cheapest, but it is still the best. Surgeons today have access to the best operating-room technology and are not hostages to the inflexible financial budgets of national health care systems abroad. In addition, surgeons in this country continue to get paid better for their expertise then any other country in the world. As long as the fee for service model stays in existence, this will continue. However, in the future when the reimbursement model changes, surgeons may be negatively impacted.