Published on: September 26, 2025 at 4:48 am
By Nick Keppler
Every year, millions of Americans undergo surgery when they probably don’t need to.
In 2013, a USA Today investigation found that 10% to 20% of surgical procedures in the U.S. may be unnecessary. In one study, second opinions after spine surgeries labeled 17.2% of them as needless. Entire categories of surgeries, such as spinal fusions for back pain and arthroscopic partial meniscectomy for knee pain, continue although evidence is spotty that they are effective for the condition they aim to treat.
The problem is not new. In 1953, the director of the American College of Surgeons told the New York Times the public would be shocked at “the amount of unnecessary surgery” performed in the U.S., and the American Medical Association raised the alarm in the 1970s.
Why would surgeons suggest unneeded surgery and encourage patients to take the risks of complications for a procedure they do not need?
One reason is it provides more money for hospitals than do other interventions or treatment methods, said Academy of Management Scholar Christoper Myers of Johns Hopkins University, who studies organizational practices in hospitals.
“In most locations, hospitals are still on a fee-for-service model, so they get paid when a surgery happens,” Myers said. “Those are quite lucrative for hospitals.”
The surgical department often financially supports other key functions of the hospital, he added, such as the emergency department.
Another factor is that surgeons—once independent professionals who mainly saw the hospital as simply their workshop—are increasingly directly employed by a hospital system or have a contractor relationship that makes them think like an agent of the hospital.
“That can at times create a weird dynamic between the surgeon and the hospital,” Myers said.
These surgeons are not acting out of sheer greed or malevolence, he said, but are reacting to “the introduction of performance metrics and targets that are often based on volume rather than quality.”
“So if I’m incentivized by how many surgeries I do—best intentions notwithstanding—I might consciously or unconsciously lean a little bit more towards doing the surgery, which is not risk-free,” Myers said. “Any time you operate on somebody, there are risks; there are potential complications.”
Maryland’s all-payer model presents one possible solution. The state uniquely obligates hospitals to charge the same fee, regardless of insurance and payment type, and includes other controls, such as a flat fee for treating many conditions.
“That should mean what you want to do is the thing that gets the best outcomes for patients, not the thing that creates the most billable hours,” said Myers. “You’re not incentivized to then just crank out a bunch of surgical procedures, because you’re not going to get paid any extra for doing all those extra unnecessary things.”
