What Asking a Surgeon "How Many of These Do You Do?" Can and Cannot Tell You

Does it matter how many of these operations your surgeon has done?

It is a fair question and worth asking. A team that performs an operation most weeks has a routine, an anesthetist who knows the steps, and a familiarity that an occasional operator does not. But it is the second question, and asked first it is how people end up with an immaculately performed operation they did not need.

The first question is whether the operation beats not having it. For several common orthopedic procedures the honest answer is no. Subacromial decompression for rotator cuff disease has high-certainty evidence behind it, and what that evidence shows is no clinically important benefit over placebo surgery or over non-surgical care 1Ref 1Karjalainen TV, Jain NB, Page CM, et al. (2019).Subacromial decompression surgery for rotator cuff disease.Supports that high-certainty evidence shows subacromial decompression surgery provides no clinically important benefit over placebo surgery or non-surgical care for rotator cuff disease — the article's central example that indication outranks technique..

A flawlessly executed version of an operation that does not beat placebo is still an operation that does not beat placebo. Repetition cannot rescue the wrong indication.

This is the uncomfortable shape of the volume question. Technical skill is real and it matters. It is simply not where most of the variation in orthopedic results is decided. What decides it is the judgment made before the incision: whether to make one at all, and for whom.

The question that outranks volume

Before asking who should operate, it is worth establishing that anyone should. The subacromial decompression evidence is the cleanest illustration available, because it is not a close call or a thin dataset. Reviewers graded it high-certainty: the surgery delivered no clinically important benefit against placebo surgery — an operation where patients were anesthetized and the skin opened but the procedure itself not performed — or against non-surgical care 1Ref 1Karjalainen TV, Jain NB, Page CM, et al. (2019).Subacromial decompression surgery for rotator cuff disease.Supports that high-certainty evidence shows subacromial decompression surgery provides no clinically important benefit over placebo surgery or non-surgical care for rotator cuff disease — the article's central example that indication outranks technique..

That comparison is worth sitting with. It means the improvement people genuinely felt after the real operation was not coming from the part of the operation the surgeon performed. Shoulder outcome measures recorded real gains in both groups. The gains simply did not depend on the surgery.

The scale involved is not small. Rotator cuff problems account for nearly two million visits a year in the United States, and many are managed without an operation at all, using anti-inflammatories, injections, and physical therapy 2Ref 2American Academy of Orthopaedic Surgeons (OrthoInfo) (2024).Rotator Cuff Tears.Supports that rotator cuff tears account for nearly two million US visits per year, that many are managed nonsurgically with anti-inflammatories, injections, and physical therapy, and that most tears do not heal on their own..

None of which makes shoulder surgery useless. Most rotator cuff tears do not heal on their own 2Ref 2American Academy of Orthopaedic Surgeons (OrthoInfo) (2024).Rotator Cuff Tears.Supports that rotator cuff tears account for nearly two million US visits per year, that many are managed nonsurgically with anti-inflammatories, injections, and physical therapy, and that most tears do not heal on their own., and there are tears and shoulders where repair is the right call. The point is narrower and sharper: for the specific diagnosis of rotator cuff disease treated by decompression, volume is beside the point, because the operation itself is not doing the work.

What actually varies most between surgeons is who they operate on

The largest observable difference between two orthopedic surgeons is usually not their hands. It is their threshold — the point at which they conclude an operation is warranted. That threshold is a genuine clinical variable, it differs considerably from one practice to another, and unlike technical skill it is something a patient can actually probe in a consultation.

Guidelines make the threshold legible. For knee osteoarthritis, the orthopedic guideline grades the evidence supporting exercise and physical therapy, anti-inflammatories, and weight loss as strong 3Ref 3American Academy of Orthopaedic Surgeons (AAOS) (2021).Management of Osteoarthritis of the Knee (Non-Arthroplasty), Third Edition — Clinical Practice Guideline.Supports that the orthopedic guideline grades the evidence for exercise and physical therapy, NSAIDs, and weight loss in knee osteoarthritis as strong — used to show that a surgeon's operating threshold is legible against published recommendations.. A surgeon whose practice reflects that grading is making a visibly different decision from one who reaches for arthroscopy early — and the difference between them will show up in patients' results far more than a difference in operative volume would.

This is what the sequence-of-care idea means in practice, and it cuts both ways. The same guidelines that put exercise first also describe when operations belong in the plan; hip replacement indications, for instance, exist precisely because there is a point where the reversible options are spent and an operation is the reasonable next step. A good threshold is not a low one or a high one. It is a defensible one — and a surgeon who can explain theirs is telling you something a case count never could.

Why surgical outcomes are so hard to pin on the surgeon

Attributing a result to a surgeon is much harder than it feels, and the difficulty is structural rather than a failure of record-keeping. Most people with most orthopedic conditions get better over time, which means a good outcome after an operation is genuinely ambiguous: some of it is the surgery, and some of it is what would have happened regardless.

The randomized trial of surgery versus non-operative care for lumbar disc herniation shows how stubborn this is even under trial conditions. Both groups improved substantially, and the comparison between the assigned strategies was inconclusive, because so many patients crossed from the arm they were assigned to into the other one 4Ref 4Weinstein JN, Tosteson TD, Lurie JD, et al. (SPORT) (2006).Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial.Supports that in the SPORT randomized trial of lumbar disc herniation both surgical and nonoperative groups improved substantially and the intent-to-treat comparison was inconclusive because of high crossover — illustrating how hard outcomes are to attribute to the operation..

If a large randomized trial with a protocol, a budget, and years of follow-up cannot cleanly attribute improvement to the operation, an individual story cannot either. "I had it done, my surgeon does hundreds a year, and I got better" is a true account of one person's experience and a very weak piece of evidence about the operation — because the person who would have improved anyway has no way of knowing that they would have.

Improvement after an operation is common. That is partly good surgery, and partly the ordinary tendency of these conditions to settle — which is a reason for hope rather than suspicion.

Doing the wrong thing more often does not make it right

The volume instinct — more repetitions means better results — assumes the repeated thing is worth repeating. When it is not, repetition can compound the harm rather than the skill, and there is a well-documented example outside the operating room that makes the logic plain.

Repeated corticosteroid injections into an arthritic knee are a common, technically straightforward procedure that many clinicians perform frequently. When they were tested against saline over two years, given every twelve weeks, they produced no improvement in knee pain — and the injected group lost significantly more cartilage than the group receiving saline 5Ref 5McAlindon TE, LaValley MP, Harvey WF, et al. (2017).Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.Supports that repeated intra-articular triamcinolone every 12 weeks over two years produced no knee pain benefit versus saline and was associated with greater cartilage volume loss — the article's example that skilled repetition cannot make an ineffective procedure effective..

That is a procedure performed skillfully, repeatedly, by experienced hands, that did not help and may have caused harm. The experience was real. The benefit was not. No plausible increase in the operator's case count would have changed either fact.

The lesson carries directly to surgery. Practice makes a procedure smoother, faster, and safer to undergo. It cannot make an ineffective procedure effective, and it cannot make an unnecessary one necessary. Which is why "how many do you do?" is a question about execution asked in a field where the errors are mostly about selection.

What you can actually look up before an operation

Some of what you might want to know is genuinely published, and learning to read the public sources yourself is more durable than any single number a clinic offers. Medicare's Procedure Price Lookup, run by the Centers for Medicare & Medicaid Services, shows national-average Medicare payment and beneficiary copayment amounts for outpatient procedures, and it breaks them out by setting: the same procedure in a hospital outpatient department versus an ambulatory surgical center 6Ref 6Centers for Medicare & Medicaid Services (2024).Procedure Price Lookup for Outpatient Services.Supports that CMS publishes a Procedure Price Lookup tool showing national-average Medicare payment and beneficiary copayment for outpatient procedures in hospital outpatient departments versus ambulatory surgical centers, and that displayed prices are national averages excluding physician fees..

Two things about that tool are worth understanding before it is trusted. The figures are national averages rather than a quote for your case, and they exclude the physician's fee entirely 6Ref 6Centers for Medicare & Medicaid Services (2024).Procedure Price Lookup for Outpatient Services.Supports that CMS publishes a Procedure Price Lookup tool showing national-average Medicare payment and beneficiary copayment for outpatient procedures in hospital outpatient departments versus ambulatory surgical centers, and that displayed prices are national averages excluding physician fees.. So the number on the screen is a floor and a comparison, not a bill — and the surgeon's own charge is a separate conversation that has to be had separately.

What the setting breakdown teaches is that where an operation happens is a real variable with real consequences for what you pay, and it is one you can look into rather than take on trust. That habit — find the public data, learn what it does and does not include, then ask the questions it leaves open — generalizes well beyond price. It is the same posture that turns a surgical consultation from an announcement into a conversation.

Where the indication is solid, the question becomes fair again

None of this argues against surgery, and it would be a poor reading of the evidence to leave thinking so. Plenty of orthopedic operations are clearly right: a fracture that will not hold, a joint destroyed by arthritis after the reversible options are genuinely spent, a shoulder that dislocates repeatedly, a nerve compressed with progressive weakness, an infection or tumor in bone. In those situations the operation restores something that has measurably failed, and the argument moves on to who should do it — where experience is a perfectly sensible thing to ask about.

So the questions before surgery worth spending your consultation on are the ones that establish which situation you are in. What happens if I do nothing for three months? What does the evidence say this specific operation beats — placebo, physical therapy, waiting? Out of 100 people with my exact findings who have this, how many are better, unchanged, or worse? What is the plan if it does not work?

That is shared decision making rather than interrogation, and good surgeons welcome it, because those questions are how they establish that you understand what you are agreeing to. A case count answers none of them. It tells you how often a surgeon does the operation, which only matters once you both know the operation is the right one.