Most people have the belief that since you have an MD you are near god like. Few realize the large number of bad/average doctors & surgeons are out there. It would be great if there was published performance reviews for every time of doctor, including your primary care doc.

Practically everyone on HN programs, but few came from MIT, work at Google, or could write a paper that would make Carmack question his choices. Think of programmers you have met that aren't self motivated or continually improving their craft. It's exactly the same with doctors. Some just get their degree (which albeit is a lot of work and money) and never self improve. They can be swayed by drug companies who give them a nice dinner without really understanding what they are prescribing or why. They do the bare minimum to get their CME and select the easiest path to get there.

If you have something serious, that may or may not require surgery, it is in your best interest to seek out the absolute best you can afford. Look for institutions that get ranked high for those diseases/injuries which produce a lot of research on the subject.

You are a startup and looking to hire a programmer, which do you select:

* Guy who learned PHP 4 and has been writing everything in Dreamweaver since without changing

* Guy who learns Go/Scala etc and enjoys reading other's research,

* Guy who wrote Go/Scala etc

You are someone sick and need advice/treatment:

* MD who graduated from South Dakota State (no idea of they are bad/good, sorry SD) and practices in a town of 5,000 people

* MD who works at a ranked institution and is always looking for the best treatment after evaluating new research

* MD who invented the surgery

There are obviously many shades in between... but treat your MD like you would a programmer you want to hire. It's not easy to figure that stuff out of course, but do your best in researching them. If you can't find much stuff on the MD/hospital then be cautious/take another opinion.

The above is based on my wife's experience in 4 different ranked hospitals in major cities dealing with patients coming in from unranked hospitals who often was doing stuff out of date/not efficient or flat out got stuff wrong/harmed the patient.

PS: For your furry friends, this is much harder as vet clinics arent ranked and typically your only choice is a ranked teaching vet hospital. Quiz your vet on where they got their degree and what conferences they attended this past year (this won't mean much other than they are actively seeking out new methods/research) You increase your chances of getting a good vet vs old Dr Bob who still ties the horse to the fence post. Look for a Vet from UC Davis if your are in the bay area.

It doesn't work like that in the medical profession, MD's in general don't have the professional mobility of programmers, nowhere in the world, and surgeons have even less such mobility.

You can have very skilled guys at "provincial" hospitals, either because they are stuck there or because the small town hospital actually gives them special incentives to stay there. It's less likely, but the probabilities have a very odd distribution varying from country to country so it's nothing near as easy to reason about as programmers.

And at a university hospital, your life can end up in the hands of a very very smart surgeon-researcher with tens of published papers that may have revolutionized the entire field he works in and got him very highly ranked, but that super-surgeon-researcher might actually have quite poor surgical practical skills (think dexterity/speed) and although you may get a lower chance of complications in the end, you will mostly get it because of a better hospital with better post op care.

DON'T compare healthcare with programming, or even with other "normal" professions where you can easily rank professionals... everything is complicated and "opaque" and medical professionals make as much as possibles to prop each other and "leak" as little information as possible to the patients and general population.

Also, in surgery "a better surgeon" != "a smarter surgeon" != "a better educated surgeon". It's a complicated function of "natural talent", "capacity for performance under heavy workload", "motivation", experience, education and IQ (and unlike programming, here the last two factors tend to be least important imho, at least if they are above a certain threshold).

Probably from the same reason you cannot get statistics about your surgeon before surgery(only recently it's been possible in the u.k.[1]): doctors have huge political power , and they are using it to their advantage. Another reason , more legitimate is that surgery is a risky business by nature, and you have to give some protection to doctors who are taking the risks.

[1]http://www.telegraph.co.uk/health/healthnews/9935856/Heart-s...

Exactly (on both points).

I can't really cite anything for my remarks, as they are based on vaguely remembered news articles over many years, but my impression is that the medical profession - in the US at least - has resolutely opposed any reform that would give the public access to information on the performance of individual doctors, hospitals, clinics or other elements of the healthcare system. The most prominent examples have had to do with histories of complaints and lawsuits.

The argument for this anti-transparency stance - and for disallowing patients to have their choice of surgeons - has been that they all have to learn by practice, and if patients were allowed to choose they would largely reject the junior staff, and the latter would never get any practice.

There is also a culture of solidarity amongst doctors, where an incompetent may get reassigned eventually, but won't be "outed" to the public.

Plus, if everyone always wants only the best, then where do surgeons get practice to become the best?

In quite many cases I'd prefer a good doctor right now rather than trying to buy my way in some far away spot in best doctor's schedule.

And practice is supposed to be covered by med school and supervised residency, isn't it? The question mainly isn't about inexperienced surgeons, but about experienced surgeons who simply are poor at the actual surgical technique, and possibly won't ever get much better.

And choosing who gets which doctor based on, say, patient paying ability is actually better than the current semi-random choice - because it creates motivation for the worst surgeons to, well, try something else - if they're smart doctors, then they can be useful without cutting people up.

In America, from the people who cannot pay for the best.

Not sure if you meant that to be a criticism, but... exactly.

I look at it as a good thing since the alternative to letting quality seek compensation advantages is to accept a general malaise of mediocrity like we have in public education.

In America, people who cannot afford the latest $1.99 app created by some startup ending in -ly or .io are getting surgical care provided by some of the best surgeons in the nation. This is because the people who cannot pay end up at their local hospital, which for many people (in, e.g., Baltimore, Boston, New York, etc.) ends up being the nation's best hospitals, where they are treated by some of the nation's best surgeons supervising the best surgeons-in-training.

from article, paragraph 8:

"It has been clear for nearly 30 years that not all surgeons produce the same results. The reasons, however, have remained elusive."

Not being snarky, just seemed to be the subject of the article. I'd be interested to hear the answer to your other questions. I certainly hope surgeons could be judged on videos of previous performances.

Other than for research, surgeries are not routinely recorded.

All that matters is the success rate. Watching videos of individual surgeons is pointless to pretty much everyone except surgeons.

I'd love to have the stats on each doctor.

Stats are hard because of all the other factors involved. It would be quite likely for the very best surgeons to have lower survival rates than mediocre surgeons, simply because the mediocre surgeon would refer the objectively harder cases to the expert, which would give better chances for that particular patient while lowering his 'batting average'. And if you give direct financial motivation for doctors to avoid taking such patients, then it's a bad thing for the whole system.

Stats can help you weed out obvious outliers - i.e., the ones who should be kept away from patients; but it's not so simple to make them useful in actual prioritization.

Success rate alone may encourage doctors to form other kind of risk preference in general. The fundamental issue is huge information asymmetry with different conditions. I guess there is not a simple solution to this. However, different simple solutions from different levels may benefit both good doctors and patients. Doctors and their organizations has much bigger power than patients do. Information could be something powerful to make the situation better, but not even close to perfect.

It would be useful in part because another surgeon can assess how well he is doing before actually stacking up enough bad/good statistics to notice. It's also useful for training, just like watching yourself swing a golf club or a baseball bat or rereading your old code can help you, with the aid of others, see what you could improve on. Doing the wrong thing over and over in a vacuum doesn't make for much learning..