Are More Doctors Cherry-Picking and Lemon-Dropping Patients?

Leigh Page

Disclosures

February 15, 2017

In This Article

Culling Out Patients With Complex Conditions

As the internist in the previous scenario alluded to, many physicians are worried about having a lot of patients with complex conditions, and go back and forth about what to do about it.

"Some of my clients think that limiting patients by complexity is ethically abhorrent," Borglum says. "But those same doctors are enormously concerned about drawing in too many complex patients. It remains a dilemma for them."

As a group, surgeons are already used to rejecting patients with more complex conditions. They've always selected patients on the basis of their ability to recover from the operation, and higher payment for better outcomes may simply prompt them to tighten their selection criteria.

"As a surgeon, outcomes are always important," a cardiac surgeon commented in the Medscape poll. "Therefore, it's very advantageous to have the option to 'cherry-pick' patients when possible."

An orthopedic surgeon said that if he were rewarded for better outcomes, "I would be more strict about whom I performed elective total joint replacements on. Morbid obesity carries a higher rate of complications."

A pulmonologist who responded to the Medscape survey was blunter: "Smokers can find a salaried physician somewhere who doesn't get dinged by a bad outcome."

In the Medscape survey, surgeons were more likely to endorse cherry-picking than doctors in most other specialties. Whereas 17% of all physicians said they would cherry-pick, fully 38% of orthopedic surgeons and plastic surgeons felt that way, and so did 31% of urologists, 27% of ophthalmologists, and 24% of gastroenterologists.

On the other hand, only 7% of critical care doctors, 9% of pediatricians, 11% of oncologists, and 14% of neurologists endorsed cherry-picking. Meanwhile, 18% of both family physicians and internists would cherry-pick.

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