20 Factors in Selecting a Surgeon

These twenty points are not in the order of importance.

1. Orthopedic or Neurosurgeon

It should be noted that many spine surgeons have taken to calling themselves neurosurgeons. Traditionally, neurosurgeons have focused on brain surgery. But very few cases of spine surgery involve surgery on nerves. In fact, the vast majority of spine surgeries never involve the surgeon touching the spinal cord or the radicular nerves or nerve roots. The vast majority of spine surgeries involves the restoration of the skeletal structure and functions of the spine and should be more accurately referred to as orthopedic surgery, not neurosurgery. Indeed it is skeletal pathology of the spine that leads to the vast majority of patients' pain. However, the name that a surgeon calls himself is not a concern when selecting surgeon.

2. Competition

It should be noted that Germany has twice as many MDs per person as the USA. This makes for a great deal of competition among doctors. This competition expectedly produces better doctors and surgeons. However, competition is a broad brush with which to select a surgeon, especially when we are selecting only one.

3. Education

It should also be noted how doctors are usually trained in Germany and Austria. Premed is usually the last two years of high school, which lasts to the age of 19. Then would-be doctors go straight to medical school. After four years of medical school an internship is usually undertaken. This internship can involve a PhD program, where the student must complete a dissertation. This makes for a better surgeon, because the doctor better understands outcomes and research, and does not just repeat a procedure he has learned. (One should be definitely savvy when reading research. There are many pitfalls.) Doctors who do not get a PhD generally become what is known as house doctors, working in the hospital. This more productive way of training doctors allows more years during their life-time to practice medicine and to do so at a younger age.

But in the patient’s quest for selecting the best orthopedic spine surgeons, the patient should go beyond just the traditional orthopedic PhD route. The patient should look for surgeons who have had a mechanical engineering background, who understand the extremely complex mechanical forces on the spine. If these biomechanically-trained surgeons have patents, all the better, because they completely understand the patent and FDA/CE process for approval.

4. Professorship

When a university confers a title of professorship, it is yet another endorsement and it means the doctor teaches at a university medical school. Again it shows they have a continuing interest in research, while practicing surgery..

5. Publications

Doctors, who publish in medical journals and at conferences/congresses are accepted by their peers as experts in their field.

6. Progression of career

Who has the most logical and continuous progression of a career? For a rather extreme example, we would look less favorably on a psychiatrist or an endocrinologist, who suddenly decided to become a spine surgeon, than an orthopedic surgeon, who decided to take on a subspecialty like spine surgery.

7. Country

It is important that the surgeons practice in a technologically advanced country. This means they are trained using the latest, safest surgical equipment. Doctors trained in poorer countries do not have these advantages. This is why we focus on Western Europe, particularly Germany.

8. Surgical facilities

Doctors who operate in Class 1 hospitals provide a safer environment should something go wrong, obviously an additional layer of safety. If something does happen then the patient has immediate emergency care at the facility. In lesser facilities the patient must be transported to an ER. The time required to do this can be critical.

9. Local Patients

There are many facilities dedicated only to foreign patients. We like surgeons, who treat local patients as well as foreign patients. Establishing a good reputation with local, long-time residents further assures patients that the surgeon is doing good work. It is often too convenient for such facilities to give a foreign patient a surgery, discharge them and never respond to them again.

10. Investigator for device manufacturers

Surgeons, who are hired by medical companies to do trials of their devices, is a strong vote of confidence. This means these companies have confidence in the surgeon, as they could well be staking the survival of their firm and the money of their investors on the outcomes. This is an important endorsement by knowledgeable people. Please note this is quite different from a surgeon just taking up the newest device and marketing it.

11. Third party verified outcomes

Too often statistics quoted to the public appear false or misleading. When you have a surgeon working as an investigator, third-parties must verify success rates. (And we should note here that success rates and patient satisfaction rates are two different things.) It is simply not up to the doctor to publish his "success rates". We should also note that success measured for ADR surgery is much more stringent and complicated than fusion surgery, which is only if the bones fuse.

12. Patient satisfaction rates

Although slowly changing, few surgeons do periodic patient satisfaction questionnaires along with imaging. Prof. Dr. Bertagnoli with his research staff does this. He is primarily interested in long-term outcomes.

13. Doctors as patients

Surgeons, who other doctors choose for medical treatment, is a strong endorsement.

14. Surgical Talent

There is no substitute for surgical talent. Here we are talking about the sheer mechanical and manual dexterity of the surgeon. This cannot be taught. Only trained people in the OR can see it and recognize it. This is inside knowledge

15. Extra safety and care

As with any complicated task there are many ways to do it. Prof. Dr. Bertagnoli goes the extra mile for safety. For example, in lumbar ADR surgery this includes a retroperitoneal approach to the spine and an adhesion barrier between the spine and vessels after implantation of the ADR. This is more time-consuming and costly, than if no adhesion barrier is used and a transperitoneal approach is used, but bodes well for the patient in the long run.

16. Personality of the surgeon

A caring personality by the doctor is therapeutic. You only need to view the videos and written testimonials to see how caring Prof. Dr. Bertagnoli is.

17. Hospital stay

Patients should remain in the hospital for at least five days after most surgeries. This is a safety concern. It is always possible that a thrombosis or hematoma could occur. Being out of the hospital the day after surgery is malpractice, by way of cost-cutting, which is done too often in the USA.

18. Low cost

While every place in the world has a lower cost than the USA, the lowest cost option should be avoided. Care is often compromised by the lowest cost providers. Costs are substantially lower in Germany for surgery than in the USA, yet they have vigorous regulatory and inspection programs. Multi-level lumbar ADR surgery is not approved in the USA and only one and two-level cervical surgeries with one specific model of ADR are approved.

19. High-cost marketing budgets

Patients should be suspicious of facilities, which engaged in high-cost marketing programs. Usually these are associated with gimmick medical procedures. These companies often fail, whether they are in the US or Europe.

20. Surgical Team

Obviously a surgeon does not work alone. Strongly vetted and long-term OR techs and hospital staff are an important part of any surgical intervention.