Determinants of surgical decision making: a national survey

BACKGROUND: We conducted a national survey of general surgeons to address the association between surgeon characteristics and the tendency to recommend surgery. METHODS: We used a web-based survey with 25 hypothetical clinical scenarios with clinical equipoise regarding the decision to operate. The respondent-level tendency to operate (TTO) score was calculated as the average score over the 25 scenarios. Surgical volume was based on self-report. Linear regression models were used to evaluate the associations between TTO, other covariates of interest, and surgical volume. RESULTS: There were 907 respondents. The mean surgical TTO was 3.05 +/- .43. Surgeons had significantly lower TTO scores when responding to questions within their area of practice (P < .0001). There was no association between TTO and malpractice concerns, financial incentives, or compensation structure. CONCLUSIONS: Surgeons recommend intervention far less frequently within their area of specialization. Malpractice concerns, volume, and financial compensation do not significantly affect surgical decision making. (C) 2013 Elsevier Inc. All rights reserved.