title: Determinants of surgical decision making: a national survey.
abstract: BACKGROUND
  We conducted a national survey of general surgeons to address the association between surgeon characteristics and the tendency to recommend surgery.
  
  
  METHODS
  We used a web-based survey with 25 hypothetical clinical scenarios with clinical equipoise regarding the decision to operate. The respondent-level tendency to operate (TTO) score was calculated as the average score over the 25 scenarios. Surgical volume was based on self-report. Linear regression models were used to evaluate the associations between TTO, other covariates of interest, and surgical volume.
  
  
  RESULTS
  There were 907 respondents. The mean surgical TTO was 3.05 ± .43. Surgeons had significantly lower TTO scores when responding to questions within their area of practice (P < .0001). There was no association between TTO and malpractice concerns, financial incentives, or compensation structure.
  
  
  CONCLUSIONS
  Surgeons recommend intervention far less frequently within their area of specialization. Malpractice concerns, volume, and financial compensation do not significantly affect surgical decision making.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, West Pavilion, 3rd Floor, Philadelphia, PA 19104, USA; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: niamey@mail.med.upenn.edu.
authors.forename: Niamey P
authors.initials: NP
authors.lastname: Wilson
authors.forename: Francis P
authors.initials: FP
authors.lastname: Wilson
authors.forename: Mark
authors.initials: M
authors.lastname: Neuman
authors.forename: Andrew
authors.initials: A
authors.lastname: Epstein
authors.forename: Richard
authors.initials: R
authors.lastname: Bell
authors.forename: Katrina
authors.initials: K
authors.lastname: Armstrong
authors.forename: Kenric
authors.initials: K
authors.lastname: Murayama
mesh_terms: D003657:Decision Making; D005260:Female; D013502:General Surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Malpractice; Surgical decision making; Surgical specialization; Surgical volume; Survey