New, in Portland, OR, and researching surgeons

[patricia]

Hello! My husband, who needs a THR, and I recently moved to Portland, OR from CA. He was scheduled to have his THR in CA in May, but his surgeon felt there would not be enough recovery time prior to our move in mid July. So my husband postponed the surgery, but then had a heart attack the first weekend in June. So . . . his recovery from his heart attack has progressed well, but he is in near constant pain from his hip. We know that he will not be able to have the THR until six months post heart attack because of the stents that he has and the medication that he's on.

In the meantime, I have made it my mission to find a truly outstanding surgeon for his hip surgery, as I know that the quality of the rest of his life may well depend on the surgeon's skills. There are five relatively local hospitals which have earned the Joint Commission Excellence Award for Joint Replacement; I don't know if this is important, but I had to start somewhere, so I've been looking for ortho surgeons, covered by our PPO insurance (First Health by Healthnet) that work out of one or more of these hospitals. I have read through previous forum posts and it seems a major criterion should be the number of hip replacements done annually by a specific doctor is a reliable indicator of his/her skill. Having said that, I have found a doctor at Salem Hospital (about an hour away from Portland) who does more than 800 hip replacements per year (per his office staff when I called to inquire). I was astounded by that number; my husband worries that it is too many surgeries. Jo's rule of thumb seems to be at least 250-300 per year. But 800? Is that too many?
So far, I have been unable to find any Portland surgeons who are covered by our insurance and also complete at least 250 THRs per year. We, of course, may need to consider going out of network, and are willing to consider all options at this point. I appreciate any advice, recommendations, or suggestions that you are willing to offer. Thanks in advance!

 

[bottomshollow]

patricia, so pleased you have joined us here on the forum. You might use our "Find a Clinic" feature to help in your research. And yes, it is possible to do 800 hip replacements a year; however, I can't say if that's too many. I will tag Josephine, our forum mother hen and resident medical expert, and let her address that with you. It may be tomorrow before you hear from her, but she will post you.

In preparation for your husband's THR, I'd like to give you links to articles in our Library that are essential reading for anyone having this surgery:
Pain management and the pain chart
How Long Does Healing Take ......
Chart representation of THR recovery
Energy Drain for THRs
Elevating your leg to control swelling and pain
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Some suggestions for home physio (PT) and activity progress

Please take time to read these and have your husband read them, too. Then if you have additional questions or concerns, please post them for us. We're here to try to answer your questions and concerns, to give you a place to vent if you need to, and to support and encourage from pre op to post op through recovery. Take care. We care.

 

[Jamie]

Here is another article from our BoneSmart Library that may be of help to you:

Locating a Surgeon

The surgeon that does the 800 surgeries per year sounds promising. It's not too many. After all, the surgeon can set up several operating rooms to work from and he moves from one to the other to do the actual operation. Other members of his medical team will do the prep work and closing after the hip implant is properly placed and tested.

Say the surgeon did 3 surgeries in the morning and 3 in the afternoon for a total of 6 in a day, 800 surgeries in a year would mean he was in the operating room about 134 days out of the year. That is not out of line at all and it is quite possible that he would do more than 6 surgeries in a day, making it even easier to fit in his clinic time, vacations, weekends, etc.

 

[patricia]

thanks, Bottomshollow. I shall definitely read the articles to which you have linked. Hopefully, my husband will cooperate and read them, too

 

[patricia]

Thank you so much, Jamie, for your response. When we heard 800 per year, my husband likened it to a "Hip farm"! Good to know it's not out of line. I have not yet run across anyone in Portland, covered by our insurance, that does anywhere near that number. Thank you, again.

 

[bottomshollow]

patricia, FYI, it is not necessary to click on "Reply" to post--that allows you to quote the post you're responding to and is really only necessary if there are a lot of posts between it and your post. You can just drop down to the message box and start your post.

 

[rider1960]

I would definitely ask a lot of questions when you interview the 800 guy. That's a lot. And, it probably means that he has his staff do most or all of the hospital visits after surgery and a lot of the office visits.

My surgeon does about 500 per year--which is a lot compared to most US hip surgeons. He is pretty busy with that. When I had my first one done, he had the ORs (he works with at least 2 rooms going) and did 9 that day. Second surgery, he only had the ORs for half the day and he did 6. He's also in the office often enough that it's pretty easy to see him if I'm having a problem or to contact him with questions, and not just his colleagues or staff. I would ask about this kind of thing--you need to have "service before and after the sale" in addition to the actual surgery.

Dorothy

 

[Josephine]

800? Jeepers, that's some turnover! I would almost say physically impossible. How does he ever get time to see new patients, follow-ups or check on the post-op ones? :rolleyes: 500 is a goodly amount, 300 is a sane amount! Are you sure they said replacements and not just 'hip surgeries'? As for questions, did you read this article? Choosing a surgeon and a prosthesis

 

[rider1960]

Even if it's a variety of hip surgeries and not just hip replacements, 800 is still a massive amount, and I personally would be concerned. My hip replacements took about an hour from the first cut to the final stitch. My surgeon's time was less than that because his PA closed the incision while he went to the next patient in another room. I bet other types of hip surgeries take at least that long ... so your guy is still extremely busy with surgeries if 800 is the correct number. I'd still be concerned with whether your surgeon will be available for dealing with issues after surgery or general follow up. Just my 2 cents

Dorothy

 

[Poppet]

Hi Patricia, welcome to BoneSmart.

Sorry to hear about your husband's heart attack and subsequent surgery.

Aren't you a wonderful wife to go into research mode.. So important.. I note that you have moved to Portland.. I believe one of our members who has had a very successful bilateral THR comes from that area, so I will tag Deb, she may be able to offer some suggestions.. djklaugh;

Hi Deb xoxoxox

 

[djklaugh]

Hi Patricia welcome to BoneSmart and welcome to Portland Both really terrific communities. I had bilateral hip replacements about 8 months ago - but I had mine done through my HMO insurance (Kaiser) - while I would highly recommend my surgeon he only sees Kaiser members. I'd suggest recontacting the surgeon you found in the Salem area and asking not his office staff but his nurse about the number of surgeries he does in a year - also is there only one surgeon in the practice or are there several? The office staff may have meant that 800 hip replacements are done by their practice - or may have only been guessing at a number. While 800 for one surgeon seems high to me too (but I'm not a medical person) it would mean he is an expert on hip replacements which is definitely a good thing. I'd also encourage you to check with your insurance carrier to make sure you know exactly what is required to have this surgery covered - some plans require a referral from a primary care provider before they will authorize specialty services. Oh yeah I also worked for Kaiser for 24 years so I know a bit about the health insurance business ;) Also try a google search for "hip replacement surgeons + Portland, Or" - a very quick perusal of the resultant list came up with several possibilities that would be closer to you than Salem.

 

[patricia]

Hello, again, and thank you to each of you for your thoughtful replies. In doing more digging, I have located a couple of other surgeons closer to Portland who appear to meet the 250-300 threshold of THR/year. One is Dr. James Ballard in Oregon City, who is highly rated by his patients and seems to have a good volume. My husband is likely to be unwilling to check out more than one doctor if he is confident with the first (I know that makes no sense, but that's how he is), so I will probably urge him to make an appointment either with the Salem doctor (and I'm beginning to doubt if that 800 number is accurate, too, after all of your replies) or with Dr. Ballard. There are other options a bit closer to home in Portland, but based on what our insurance will cover and the surgeons' reputations a bit further away, I am leaning toward the little more distant options for now.

On another note, it has been interesting calling doctor's offices to ask about volume of surgeries. Some are very upfront and open about it; others say "several per week" or "gee, I don't know, I would have to count but I think it's a lot". At one office, I was told 20-30 THR per year! Not going there! I'm also a bit taken aback by how many offices think it's an unusual question. Given that my husband's quality of life is dependent on finding a great surgeon, it seems like a reasonable query.

And thanks, djklaugh, for your advice about contacting insurance now regarding coverage. That is my next assignment! Also, do you mind telling me the name of your Kaiser doctor? We supposedly are allowed to choose any doctor, but if he's out of network , it's more expensive with our PPO. Thanks again.

 

[Poppet]

So pleased Patricia, you have connected with Deb.

Yes, when dealing with the reception staff at some of these OS practices, they often don't seem to be very educated in what their surgeon does.. I certainly encountered this myself with a rather traumatic experience..

I did lots of preparatory research and it is a real and worthwile mission.. Good luck, I will pop by now and then to see how it is going

 

[djklaugh]

Patricia - my surgeon's name is Thomas Toal - his office is at the Kaiser Sunnybrook Medical office building and he does his surgeries at Kaiser Sunnyside Medical Center in Clackamus, Or. LOL he calls himself the Hip King - and given my success with bilateral hip replacements I'd agree with that ;) He is the Portland area Kaiser hip expert and mostly does hip replacements though he does do some other procedures as well. He told me he does about 400-500 hip replacements a year. But like I said he only sees patients who have Kaiser insurance. The way the Kaiser HMO works is they employ the doctors, provide the clinics and staff, and also provide the hospital for patients who enroll in Kaiser insurance. And they won't even schedule an appointment if you don't have this insurance - if you and/or your husband now have Medicare you can opt to sign up for Kaiser as your health care provider - or call the business office about changing over your insurance if you want to consider that. It's a huge bureaucracy - but they do provide excellent medical care. If you have other questions about Kaiser specifically I'd be happy to answer any that I can - either here on your thread or you can send me a private message. And as I recall, part of the employment contract for doctors is that they can not practice anywhere else outside of the Kaiser network.

 

[bottomshollow]

Patricia, we have a member who is familiar with the Salem area and with the clinic who reported the following to us: It prides itself on its "team approach" to joint replacement. There are several surgeons and there is not a clear delineation of what patient belongs to which surgeon. You end up interacting with all of them. I have a hunch that 800 applies to the entire clinic and not to one particular surgeon.

Hope this info is helpful.