Anesthesia Management: Elective surgeries surge during holidays

This is copied from today’s USA Today newspaper

Orthopedic surgeon Jeffrey Stimac worked part of Thanksgiving and Christmas and expects to work part of New Year’s Day checking on patients in the hospital after their operations.

‘Tis the season for elective surgeries.

“November and December are definitely my busiest months,” says Stimac, who works for KentuckyOne Health in Louisville and does a lot of joint- and knee-replacement surgeries. He says most patients are “trying to get elective procedures done before the new year because they are getting new insurance plans or they have met their deductibles” on current plans.

Stimac says his surgeries are up about 20% this time of year. It’s a trend long experienced by surgeons across the nation, and some say it has become more pronounced now that eight in 10 Americans have insurance plans with deductibles — what patients must pay before insurance kicks in. Even though many deductibles exceed $1,000 or $2,000 a year, patients often have spent that much on health care by November or December.

Frederick Greene, a fellow with the American College of Surgeons, says there are many reasons for the national phenomenon. In addition to having met their insurance deductibles, patients may have more time off from work and family members at home to handle responsibilities. And hospitals are generally less busy with inpatients during the holidays.

Although there are no concrete statistics documenting the rise of elective surgeries in December, doctors have noticed it for years. Some even promote it. A national coalition of ophthalmologists and optometrists, for instance, urges patients on its website, YourSightMatters.com: “End of Year Deductible: Get Your Cataract Surgery in.”

For doctors in private practice, competition can be an incentive to work during this time. “You want to accommodate your patients. If I can’t accommodate my patients, maybe someone else will,” says Greene, past chairman of surgery at Carolinas Medical Center in Charlotte. “There’s a competitive mode there.”
Paul Ruggieri, a surgeon in Fall River, Mass., agrees.

“It is a busy time. I am able to take time off but it is a two-edged sword. If I take time off, I might lose business by not being available to operate on those who want their surgery. Since I am technically in the service business, I need to be available,” says Ruggieri, author of The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry. “Most surgeons in private practice do not want to lose the income.”

Greene says patients should talk to their doctors before scheduling holiday surgeries. Ask if your surgeon will be around or, if not, who will handle the operation? Ask about anesthesia staffing. Greene says it’s likely that more junior employees will work the most unpleasant holiday shifts.

Meanwhile, doctors expect the phenomenon to continue. Stimac says his schedule is so crowded that he couldn’t fit all of the patients who wanted surgeries in December, so “my January is already booked.”