Here’s a peek into the surgeon mentality

By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Austin, TX

Who do we love? Our surgeons, of course! Who do we hate? Our surgeons, of course. What is it about this group of practitioners that can drive us all to extremes, often within one day?

At Earnhart & Associates, we have almost 4,500 one-on-one, hard-core, direct interviews with surgeons. I took that database and then asked a group of surgeons I know well and respect to give me some insight into areas related to the OR. I want to share with you how the surgeons view themselves:

• How do most surgeons perceive themselves? We have this "captain of the ship" mentality. We are trained from day one to be in charge of, responsible for, and liable for everything that happens to our patients. We have been selected and conditioned to be aggressive, ruggedly independent, always in control, and intolerant of anything contrary to our patients’ best interests.

• What are your negative biases? Silly, stupid rules designed to generally make people angry by people who do not know the operating room. HMOs in general. Hospitals as majority business partners. Autocratic, top-down management policies in the operating room.

• Be honest. What do you really want in the operating room? EVERYTHING! Total control, maximum efficiency, top quality, LOTS of extra income . . . but no investment, no risk, and no effort.

• You are doing your own surgery center with the hospital. What do you want that facility to give you?

— Control. A medical advisory board, controlled by surgeons, that determines clinical management of the program: policies and procedures, rules and regulations, credentialing, facility certification, personnel training, and performance evaluation.

— Accountability to fellow surgeons.

— Efficiency. Short turnover times: a 10-minute target vs. 45+ minutes in the hospital. That alone can save me up to a half-day per week.

— Efficient posting: Block scheduling. No bumping. Flexible hours.

• What about quality? You know surgeons are sometimes criticized on quality when they have control. What do you expect your staff to provide? Fair question but not true. We want higher patient satisfaction, superb nursing skills and training, best equipment and instruments, low complication rate, accreditation, and strict quality assurance and utilization review monitoring.

• What, above all else, do you hate the most in the surgical environment? Loss of control! HMOs, arbitrary hospital or surgery center operating room policies, and the sense that our control over the OR environment has been and continues to be slipping away. That is enough for this issue. Next month, I will answer these and other questions:

What do you love in the operating room?

Do you guys really want to be in control?

How hard do you think it is to run a surgery center or hospital operating room environment — honestly?

How can hospitals head off surgeon relation problems?

(Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Contact Earnhart at 8303 MoPac, Suite C-146. Austin, TX 78759. E-mail: Web: