When to chose a surgeon?

[logan]

So I want to get jaw surgery and have chosen an orthodontist, but am torn between two surgeons. They both seem very competent, one does not accept insurance but is closer (Dr. Neugarten @nyc), the other DOES accept insurance & is in-network but is farther (Dr. Derek Steinbacher @Yale, the distance is not a big factor tho). I'm guessing a 50/50 chance that insurance will approve this. If it is not approved then the cost will be essentially the same for both.

I'll need about 6 months of ortho before surgery. My main question is, do I need to decide on a surgeon now? Or can I wait until a few weeks before surgery, try to get it approved by insurance, and if it is not approved, then maybe go with the private practice surgeon since it'll be the same cost anyway? Would that piss off the surgeons?

If I should really decide now... is there any reason I should be wary of getting surgery at a teaching hospital?  Or if I can afford it, should I just go with the private practice doc? For some reason I found the Yale doctor easier to communicate with (probably just a personality thing) but obviously I care more in the end about functional+aesthetic surgical outcomes than personality

Thank you thank you in advance

[kavan]

I don't know the ins and outs of booking and then cancelling. But I will say that a surgeon who takes insurance most likely would be one who takes on more trauma work (which helps refine one's skills) than one who does not. Also being on the Medical faculty at YALE is a better CV than then the doctor who isn't as is being Cheif of maxfax, dentistry and director craniofacial. Steinbacher has a better CV than the other one.

[InvisalignOnly]

I highly doubt that you can choose a jaw surgeon a few weeks before surgery. First of all, the ortho and the surgeon have to work together and communicate from the start of the orthodontic treatment as the latter will depend on the surgeon's plan. Different surgeons have different plans and the ortho will move your teeth to suit the plan.

Secondly, jaw surgery is a long and expensive procedure, you typically have to select and book a date months in advance and pay a deposit if you are getting it done privately - at least this is my experience, no idea if it's any different in the USA.

Regarding the teaching hospital aspect: my understanding is that people tend to be wary of it in case student doctors carry out some or most of the procedure. I have no idea if this would be the case at this particular hospital, you would have to ask the doctor if you have concerns.

[ArtVandelay]

Most surgeons are booked months in a advance; even ignoring all the other considerations, which are very valid, it's not possible to book weeks in advance with most surgeons.

Regarding teaching hospitals. I used Dr. D B from NYP, which is a teaching hospital. In my operative notes, which were over 100 pages long, they detailed all aspects of the surgery like who administered which shot at what time but did not detail who actually performed the bone cuts and down-fracture. The part that Dr. D B wrote himself sounds very cut and paste and there's little specific to my actual operation. Dr. D B told me that residents only perform the gum cuts and stitching and nothing in-between like the osteotomies. I still believe he didn't lie for a variety of reasons. My bad outcome was really due to a poor airway oblivious plan, even my operating room complications can be traced to poor planning.

Speaking from personal experience. Another thing at teaching hospitals to be wary of is that the head surgeons can ride the coattails of the hospitals reputation. The danger being the surgeon could be mediocre and out-dated and have no incentive to change since the big hospital name can along bring a full patient pipeline. Look at Dr. D B, he doesn't even have a proper website. This will also be reflected in how you're treated after surgery. While they could get away with this type of behavior decades ago, now with the internet it's a lot tougher since a single patient can amplify their voice.

In that context I like Dr. S a lot. He doesn't appear to have taken anything for granted and is a machine with how active in the medical community he is. He's already dwarfed Dr. B's sad publication count for example. I think I saw on Dr. Alfaro's instragram that Dr. S visited and observed his surgeries. I couldn't imagine Dr. D B ever doing that.

[GJ]

Definitely should pick a surgeon early on before even beginning braces. They're going to have a way they want you set up for their plan.

Regarding a teaching college, I'd avoid it. They let students operate on patients many times.

[jawzmcgee]

My surgeon gave me a list of Orthos he works with. So I would go to the surgeon you want FIRST, then ask which orthos he recommends.

I would use consultations with orthos as a second opinion -- the ortho I went to suggested surgically assisted MSE + face mask, which is distinctly different from the MMA surgery suggested by the MaxFac surgeon.

[logan]

Thank you everyone for the replies!

I still feel like I don't have enough information to make a confident decision -- Dr. S sent me a nice detailed preliminary surgical plan, but the movements are not quite what I was expecting based on my discussions here and aesthetic goals, and Dr. N basically declined to discuss a plan in any detail before seeing the results of orthodontics. They both described the goal for orthodontics similarly however: to decompensate from my prior invisalign and flatten the occlusal plane as much as possible. I have an appointment soon to start invisalign treatment with a orthodontist (highly recommended by Dr. N, and ok with Dr. S), maybe discussing it with her will help me decide!