This week, I spent over 3 hours struggling with my chief resident in a clinic case doing a robotic hysterectomy and staging. Granted, the patient was an obese, hypertensive diabetic who benefited from avoiding a big midline incision, but it did make me think of one of my mentors from fellowship.
Dr. R, a busy gynecologic oncologist who performs 7-10 hysterectomies per week, once turned to me and said he would not be able to practice if he had to spend the time needed for laparoscopic hysterectomies. For him, the opportunity costs of switching to laparoscopic surgery was too high, and he would state boldly that he did not get paid more if a patient went home or returned to work sooner.
I do about 75% of my hysterectomies laparoscopically. The decreased work of early return to home and fewer office visits for wound separations outweighs the extra time in the OR.
How do you balance your costs? Do we have an obligation to consider costs like hospital stay and return to work?