ARE THE BEST CORONARY-ARTERY BYPASS SURGEONS IDENTIFIED BY PHYSICIAN SURVEYS

Objectives. This study assessed the validity of surveys for identifyin g the best coronary artery bypass surgeons. Methods. Data on physician s who performed coronary artery bypass surgery were available from New York, Pennsylvania, and Wisconsin. Data on physicians' reputation wer e obtained from one national and five city surveys. The measure of sur gical performance was the mortality ratio (MR), that is, the ratio of the observed to the predicted patient mortality rate. Results. Mortali ty ratios were very similar for the 10 722 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 t he surgeons who performed-more than 400 coronary artery bypass surgeri es in 3 years. Conclusions. These results suggest that the quality of a coronary artery bypass surgeon may be more closely associated with p atient volume than with the surgeon's reputation among peers.