When is Medical Tourism Itinerant Surgery?

Itinerant surgery is defined as any surgery performed by a surgeon outside his/her community where the postoperative care is left to another physician. In this age of medical tourism, policies concerning itinerant surgery will need to be reassessed since, instead of the surgeon coming to the patient (although this is sometimes done in a third country where the patient and the surgeon meet), the patient comes to the surgeon, possibly without arrangements for postoperative care at all or arrangements are made for postoperative care with another physician in the patient’s home country. The practice of itinerant surgery is strictly proscribed by the American College of Surgeons and other specialty societies.

The primary concern with itinerant surgery is the potential compromise of quality of care. Addtional questions surround fraud and abuse when surgeons charge for postoperative care that not delivered by the operating surgeon. Given these concerns, specialty and medical societies should be asking themselves some questions concerning their present policies on itinerant surgery:

1. Under what circustances is medical tourism itinerant surgery?
2. What evidence is there that quality is compromised when patients elect to have surgery performed by one doctor and follow up care delivered by another doctor?
3. How long is “follow up care”?
4. Should there be sanctions in place for surgeons who perform surgery without making arrangements for follow up care by a doctor in the patients home area?

Medical tourism is forcing a reappraisal of several professional dogmas. The definition of continuity of care and itinerant surgery is just one of them.

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