Medicine: Inept Surgery

The No. 1 guardian of the standards of U.S. surgery—and, incidentally, of the prerogatives of surgeons—made a shocking charge last week. Said Dr. Paul R. Hawley, director of the American College of Surgeons: “It is reliably estimated that today one-half of the surgical operations in the U.S. are performed by doctors who are untrained or inadequately trained to undertake surgery.” One of “the most distinguished surgeons in the world” (whom he would not identify) had told him, said Dr. Hawley, that at least half his current practice “consists of attempts to correct the bad results of surgery … by doctors inadequately trained in this field.”

Physician Hawley offered this explanation: nowadays, nearly everybody has insurance to cover the basic cost of surgery, and every insured patient is a paying patient. At the Manhattan dinner where Hawley spoke, Dr. David M. Heyman got in a plug for systems such as the Health Insurance Plan of Greater New York, of which he is honorary board chairman. Under its group practice, said Dr. Heyman, doctors receive no extra fees for operations—so “there’s no incentive for unnecessary surgery.”