I've posted about this before - my wife is a highly specialized surgeon. This article really only scratches the surface of the issues with surgery around the US, as a software developer working in a pretty transparent and open industry I'm always horrified at how surgeons practice in the US. In my opinion the core of the problem is the lack of transparency in the entire system. There are just very few pressures for surgeons to really improve like they should have to. If, as a surgeon at a academic center, you want to just cruise along, no problem, you can just publish a few papers each year, be nice to patients, and you will be considered a leader in your field - even if you have terrible outcomes. There is little to no data out there to help patients objectively evaluate a surgeon, and to force surgeons to become better.

Speaking of things that I found strange - my wife was blown away at her current practice because for every operation they 'pair-surgeon' full time. This seemed very normal to me, but outside of surgeon training this is considered bizarre - when she tells other surgeons they ask her if it is something to do with billing! (it is not, they can't bill for the second surgeon). She loves it of course, it forces her to up her game and gives her someone she can bounce her thoughts off of during the surgery. I've asked her if she could go visit another surgeon in another facility somewhere and work along side them for a few days to learn, but because of the red-tape and state licensing, this is extremely difficult. The cross seeding of surgical expertise becomes glacially slow after your initial training in residency, you pretty much hope you were trained well and stumble along with a bit of help here and there.