@tdrell Thank you, yes, my spine health is great since my Mayo surgery 4 years ago. My insurance was "in network" at all the places I consulted for my spine. I prefer not to name names or locations because I want to be able to be brutally honest in these discussions. I didn't make any public comments or review the prior surgeon, but I did send him a kind letter along with the medical literature I found in the spirit of sharing information. As you might expect, there was no response. His staff could have discarded it and not shared it and I'll never know. That doesn't matter because my Mayo neurosurgeon told me he will always be my doctor and that he will stay at Mayo until he retires, so there are perks to having a surgeon younger than yourself. If I need spine surgery again, I would only want to see my surgeon at Mayo because I respect his knowledge, expertise and talent. He was also very helpful to me in recommending an orthopedic trauma surgeon at Mayo after I broke my ankle 4 months ago and sent me to a surgeon he trusts for his own family. I had been asking around locally and had called a few surgeons, but some couldn't see me or would only see me in a downtown location with all the crazy traffic, covid risk, and I couldn't drive, and my husband wasn't good with aggressive traffic. I had to get an appointment so they could decide if they wanted to help and that makes no sense that I would need to supply imaging before they would agree to see me. I already had an emergency surgery while on a trip that cleaned the wound from the compound fracture and placed a fixator cage to stabilize my ankle that was screwed into my shin and heel. This provides a couple weeks to allow for swelling to decrease before bones are set with plates and screws, so this was perfectly obvious that I needed further surgical help. I did have the 2nd ankle surgery at Mayo and am currently rehabbing my leg. All I had to do was contact my spine surgeon, and he responded that he was sending my request to another surgeon who would reach out to me for an appointment, and they did within an hour. I had appointments right away for the surgery itself and to come 2 days earlier to be tested for Covid and get further imaging and have the surgical consult. That was so easy, no jumping through hoops (as if I could!) and I had another great surgeon. I think that the first doctor you see at Mayo is your contact for future visits and that they arrange other specialists for you. I also saw a pulmonologist on one of my visits, again recommended by my spine surgeon. It is wonderful to have that kind of relationship where all I have to do is ask, and I can get medical help.

One other consideration is that at many facilities, surgeons practice there, but they own their practices, so they own the risk of malpractice or negative reviews that could affect if their business is profitable. They want to cherry pick cases they know will have a good outcome because the success rate for specific surgeries is recorded for each surgeon and hospital. Insurance companies track this too. If you are the patient who comes in with a confusing case, or with other health problems that can affect recovery, it's easier to refuse an offer for surgery, or to treat symptoms to postpone surgery such as spinal injections in the case of spine surgery. At Mayo, everyone is an employee and not in private practice, so there is no incentive to do surgeries for extra profits, so the opinion there isn't colored by financial motives. Mayo is known for taking complex cases that others refuse. I am sure this was part of my problem with the surgeons who turned me down because they were afraid to ruin their reputation if my surgery wasn't successful, and because they didn't understand the complete problem, they backed out. They should have looked farther, but they didn't. There are lots of other patient dollars walking through the door and they didn't want to invest any more time. Some were doing 30 minute spine procedures in comparison to the 2 hour spine procedure at Mayo which for the surgeon was an hour and a half of his time for the same procedure. I would rather be the patient of a surgeon who isn't rushing through the job because he has ten patients on his assembly line.

As for your question about admitting patients so other specialties can also consult, I think insurance companies would frown on this. They are in the game for profit and can refuse claims that don't follow correct protocol. If there is a valid reason why a patient should be admitted to the hospital, that is different. I was in the hospital 2 days after my ankle fracture because I couldn't manage to navigate well enough with a walker or be able to go up and down stairs. I had to figure this out with the therapists while I was in extreme pain and so nauseous and dizzy from the pain medications. I did better on lower doses that were more frequent. The doctors need to know a patient can navigate safely at home after release. If I had been more functional, they would have released me after one night. The problem of being an outpatient and seeing multiple specialists is the waiting time in weeks and months to see those doctors. That is not an issue at Mayo because they have figured out how to do it efficiently and usually complete it within a week.