Young child with cancer? Nope, not worth the risk.
Patient with mental health problems? Takes too long, outcome not easily measurable.
Obese patient with back pain? Let's do surgery instead of investigating and treating the root causes.
Just like schools, you can tell which teachers are good, even in districts with bad kids.
Have a torn meniscus and given age is dumped into "excise meniscus tear" bucket. While Dr knows that shortens the path to knee replacement (which he no less pointed out on several occasions).
Going to Dr. Now seems like you are a walking revenue center vs. patient in need.
(ps. Many current accredited studies suggest repair attempt vs. removal)
Young child - I have trained in mostly adults with some pediatric experience. Can I do a simple procedure on a teen? Probably. If something goes wrong I’m afraid I’ll be punished for not referring them to a pediatric center that specializes in these things. Of course if I’m at my main hospital where they do these often, I feel more comfortable doing pediatric procedures to an extent.
Mental health not really in scope of radiology
Obese back pain - I do a lot of procedures for these and certainly there are some surgeons that will operate on anything but I’d say 80-90% of spine surgeons will refer out to rule out every last cause before operating.
We are kind of incentivized to do procedures right now in American healthcare but I will say all my partners are cautious about just doing stuff.
I agree that incentives are frequently and perhaps typically exploited, especially when crafted carelessly or not iterated upon, as most incentives seem to be.
I would be eager to contemplate a clinical outcome based incentive scheme.