Why Do So Few Surgeons Work in an Actual Hospital As Opposed to Their Private Surgery Centers?

Question

Am I wrong in wanting to be operated on in a hospital, even though these surgery centers are accredited? It just seems safter.

David L. Kaufman, MD FACS · Answer

We perform almost all of our surgeries in our AAAASF accredited outpatient surgery center.  Why I think this is the best option is because:

	
		I hire all the staff, so they are the best in the business
	
		We do the same thing every day, so each person really knows their responsibilities well
	
		There are no sick people in our facility... so you won't get MRSA
	
		Your privacy can be protected and respected
	
		We have all emergency equipment, should there be an emergency


	In hospitals, even in the best, there just isn't the same commitment to excellence the we can provide in outpatient centers - where quality of care is the most important concern.

John J. Corey, MD · Answer

I understand your nervousness but accredited facilities are really very good. For my part, I work out of two centers that are free-standing and then I have two that are associated with hospitals but are their outpatient surgery centers and not in the main hospital and I do that for patients just like you that may want to be closer to a hospital so check around and you may find surgeons that do as well...

Douglas L. Gervais, MD · Answer

There are many reasons for plastic surgeons to perform cosmetic surgery in a private outpatient surgery center. The facility should be accredited by AAASF or similar governing body. The surgeon should also have privileges in other facilities (hospitals/surgery centers) and chooses to operate in the their center because they can, not because they have to. Staff at private facilities are experienced and dedicated to cosmetic surgery which is usually not the case in a hospital. There is continuity of care benefits as well in our facility. The nurses, techs and other staff you meet during your consultation are the same caring people you will see before, during and after your surgery. Timing and scheduling of surgery is much more convenient in a private setting not to mention that it is quieter, less hectic and offers more privacy. Most of the time, private facilities are less expensive as well. Overall, a healthy patient in an accredited, properly staffed facility will receive care that is as safe as any hospital. Good luck.

J. Brian Boyd, MD · Answer

The main reasons for a surgeon operating in his office are cost, convenience and efficiency. The back-up services  (cardiologists, anesthesiologists, other specialists, ICUs, special equipment etc.) are far greater in a hospital; so most people would consider that the hospital is indeed'safer.' The risk of infection in a hospital is not greater when we consider day surgery. 

	Unfortunately, hospitals are not geared to quick turnovers and the nurses and technicians are not selected by the surgeon. Operating is not so slick and can be frustrating when the staff is inexperienced.

	Furthermore, hospitals are not particularly keen on doing cosmetic surgery, because they are paid much, much, more by insurance companies for reconstructive cases. They do cosmetic surgery as a favor to the Plastic Surgeons, who they hope will use them for insured services.

	Nevertheless, if a patient has any serious medical condition, then the operation should be done in a hospital.

Richard Baxter, MD · Answer

There are several advantages to having elective plastic surgery in a private facility vs a hospital, provided that the facility is accredited by an agency such as AAAASF. Hospitasl are for sick people so your experience there will be different. In a private facility, you will have more privacy. A hospital surgery facility has to cater to a wide variety of specialties, while a private facility is designed to do only a few things but do them very well. Hospital nursing staff may not be as familiar with the fine details of plastic surgery procedures. The basic idea is that the plastic surgeon has greater control over every aspect of your care in a facility that he or she owns, but with equal safety. One more thing to point out though is that the surgeon should have priviledges at the closest hospital for the procedures that are performed in the private facility, so that their qualifications have been independently evaluated.

Jourdan Gottlieb, MD · Answer

There are many reasons.

	
		In my community, the hospital will charge $12,000 for three hours of surgery. The surgicenter will charge $1800 (and make a profit at that). The hospital charges me over $7000 for saline breast implants, the surgicenter charges $700.
	
		The surgicenters have personnel experienced with cosmetic surgical  cases. The hospital OR usually do not. 
	
		At the surgicenter we control the personnel. I have had patients scolded at the hospital for using resources meant for sick people, or asked how they can risk their health for vanity. Our staff members are understanding of all our patients. 
	
		If we are uncomfortable with the medical skills of hospital personnel, there is nothing we can do. At our surgicenters, we do the hires. 


	The truth is we tolerated many of these problems until we were priced out of the market. The hospital price alone for some procedures can be more than double the price for the entire procedure, including surgeon and anesthesia fees.

	If you were to ask the hospital to document better safety, I doubt they could prove it.

	Thanks for your question, best wishes.

Remus Repta, MD · Answer

Hello,

	Thank you for the question.  Since most of the plastic surgery cases are done at accredited surgery centers the hospitals neither want nor have experience with a lot of cosmetic plastic surgery.  The surgical teams composed of anesthesia, surgical assistant, and nurse in a hospital will likely be less experienced with these type if cases.  

	All the best,

	Dr Remus Repta

E. Ronald Finger, MD · Answer

The short answer is cost to the patient. The expense of the operating room, supplies, and anesthesia would be prohibitive for most patients. I began my first outpatient surgery center in 1973 after I had to follow a hemorrhoidectomy with a breast augmentation. It has been very gratifying for both my patients adn myself. The paper-work is less, starting times are much more dependable, and it's easier to get in ande out of the surgery facility. Also, I don't have to follow contaminated cases in my OR. Last but not least, the infection rate in office OR's is extremely low.

Robert L. Kraft, MD, FACS · Answer

I perform cosmetic surgery in my own Joint Commission accredited OR and in surgicenters.  The hospitals perform very little cosmetic surgery in my area.  They are more expensive and not really set up to provide personalized service to cosmetic patients.  In the private setting, I have much more control over staffing and selection of the anesthesiologist and things run more smoothly. I also use only board certified anesthesiologists in my OR facility.  Joint Commission accreditation of an OR facility is a tremendous responsibility for a plastic surgeon; I can honestly say that my office is more compliant with Joint Commission standards than the hospitals because we take it so seriously.

Christa Clark, MD, FACS · Answer

Many board certified Plastic surgeons have an accredited surgical facility on premises for privacy and convenience. As long as a patient is carefully screened preoperatively and the outpatient facility is fully accredited, the safety factor is just as high as it would be in a hospital. In addition, our facility uses only board certified anesthesiologists to provide the anesthesia---an added measure of safety for our patients.

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