Are the best coronary artery bypass surgeons identified by physician surveys?

Objectives. This study assessed the validity of surveys for identifying the best coronary artery bypass surgeons. Methods. Data on physicians who performed coronary artery bypass surgery were available from New York, Pennsylvania, and Wisconsin. Data on physicians' reputation were obtained from one national and five city surveys. The measure of surgical performance was the mortality ratio (MR), that is, the ratio of the observed to the predicted patient mortality rate. Results. Mortality ratios were very similar for the 10722 patients treated by the 31 surgeons defined as 'best' doctors in the surveys (MR = .98) and for the 74 854 patients treated by 243 other surgeons who had more than a minimal number of cases (MR = .96). The mortality ratio was 1.34 for the patients treated by surgeons with the lowest volumes and .87 for the surgeons who performed more than 400 coronary artery bypass surgeries in 3 years. Conclusions. These results suggest that the quality of a coronary artery bypass surgeon may be more closely associated with patient volume than with the surgeon's reputation among peers.