The term “ghost surgeries” refers to a practice in which the designated surgeon attends a small portion of a surgery but the cost of the procedure is billed as if he was the primary surgeon. The practice is also called “double booking,” in which a prominent surgeon may schedule two overlapping procedures, but only attends part of each, with residents or fellows doing most of the surgical work.

It became an issue recently when a prominent neurosurgeon was hired by Rutgers University Medical School, but then terminated when he was charged with doing “ghost surgeries” at his prior employment.  Rutgers investigated the charges and then reinstated the doctor as a professor.

The investigators found that there was insufficient evidence that the doctor didn’t attend the most important part of concurrent surgeries. However, those critical parts are defined by the surgeon himself, the person being investigated.

Two surgeries were studied by the Rutgers investigators, scheduled at separate times. One was a craniotomy to access a brain tumor for biopsy. The other was a laminectomy, in which spinal bone is removed to relieve pressure on spinal nerves. 

During the craniotomy, the doctor was present in the OR before the surgery started, but then left the hospital to attend a virtual symposium. He returned when the biopsy was being done, did not “scrub in,” but watched from a distance for three minutes. Although this was a crucial part of the procedure where things can go wrong, the doctor could not have assisted without first leaving the OR to scrub in so he is sterile.

Medicare regulations require that teaching physicians must be available to supervise the doctors doing the procedure; but the federal standards do not specify that the teaching physician actually scrubs in or even uses instruments during the procedure. And the specific question of what parts of the surgery are critical, requiring the presence of the attending surgeon, is left to the surgeon himself. The major issue in this controversy is money.  When a teaching physician is “performing” the critical parts of a surgery or is monitoring the procedure, the amounts billed to Medicare or insurance companies can be much higher.  Hospitals defend the practice of “ghost surgeries” because, they argue, more patients get the benefit of the higher level skills than if the surgeon had to be present during the entire procedure.