FWIW, in this respect, I'm just relaying from my parents: dad's an ortho trauma surgeon who now runs a trauma department, and mum's an ophthal surgeon. As much as I'd like to claim I'm casually reading the NEJM every day, I've only ever read papers they share with me, which they do at an annoying frequency considering I'm in trading.

I assume the general silent belief would be that your guy with the spectacular failure is some kind of "take the tough cases" dude?

By the way, when I was much younger (maybe 10-15 years ago), I recall my dad coming back from an AO Foundation conference where there was a talk about some particular procedure in some Scandinavian country where the range of outcome quality was so high for a particular non-emergency THR/TKR or something like that and so they shut down the procedure in the remote hospitals and centralized it in a few (3?) tertiary healthcare centres. Do you recall something like that? I have this memory in my head but I can't find the original material. The story is so good: EBM driving patient outcomes; but I can't find it so I don't share it and I would like very much to, if it is true.