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Our "I need a" series is a helpful guide to finding the care you need when you don't know where to start. Today, we're learning how to find a colorectal surgeon.
If you're considering having colorectal surgery to address a health concern like inflammatory bowel disease or colorectal cancer, choosing your surgeon is a big decision. So, before you start your search, let's answer some helpful questions.
What Does a Colorectal Surgeon Do?
Most surgeons focus on certain areas of the body or treating specific diseases. The term "colorectal" is a combination of the words colon and rectum, but colorectal surgeons focus on the entire lower digestive tract, including the colon, rectum, anus, pelvic floor, and, in some instances, the small intestine.
What Type of Surgeon Performs Colorectal Surgery?
Knowing what types of surgeons may offer the services you need can help you refine your search and make it easier to focus on what you need. Surgeons that operate on the lower digestive tract may include:
- Colorectal surgeons have completed general surgery training and then undergo additional training through fellowship programs focusing on conditions affecting the lower digestive tract.
- Surgical oncologists treat cancers of the colon or rectum, as well as cancers related to other organs. The amount of colorectal-specific experience a given surgical oncologist has can vary widely.
- General surgeons often perform colorectal surgeries but lack the additional specialized training of colorectal surgeons. Part of this stems from a relative shortage of colorectal surgeons in the US.
What Credentials Should I Look For?
It can be hard to find a surgeon by looking at credentials alone, but it's a helpful place to start. Knowing that a surgeon has completed additional training or has been certified by a professional board is a good sign that they have the expertise you are looking for.
- Residency – All colorectal surgeons will have completed a surgical residency, meaning that after medical school, they trained for years under the supervision of seasoned physicians.
- Fellowship – Fellowship is additional, focused training after residency. A fellowship-trained colorectal surgeon has completed a specialized training program under the supervision of an experienced surgeon.
- Board Certification – This process demonstrates that a surgeon has met rigorous standards set by their peers through a governing organization, or board. These boards are recognized by the American Board of Medical Specialties and the American Medical Association.
- Colorectal surgeons become board-certified through the American Board of Colon and Rectal Surgery (ABCRS) and the American Board of Surgery.
- Professional Societies and Organizations – Membership groups like the American Society of Colon and Rectal Surgeons (ASCRS) indicate that a colorectal surgeon is active in their specialty's clinical and research communities.
The American College of Surgeons (ACS) offers a helpful Find a Surgeon tool that lets you search by the colorectal surgery subspecialty. The ACS is the world's largest organization of surgeons, and its comprehensive member database of board-certified surgeons is a great place to start looking.
The ABCRS and ASCRS offer online resources to help patients search for surgeons with specific expertise.
🚩 Fellowships are a great way to know that a surgeon has taken the time to learn to perform a specific type of surgery by experienced experts.
A Word About Top Doctor Awards
When searching for a doctor of any kind, you'll probably come across advertisements for sites boasting Top Doctor lists, or you may find these awards mentioned in a surgeon's profile. While many of these awards are legitimate and are based on peer-nominated candidates and vetted feedback, not all lists are created equal. Some are essentially lists intended to promote only the doctors who have paid for the privilege. If you use a Top Doctor list in your search, make sure that's only part of your criteria.
What Else is Important to Look For?
If you're looking for colorectal cancer treatment, you might want to focus on designated cancer centers and academic medical centers. Research has shown that working with a surgeon at a cancer center that can offer comprehensive and coordinated care yields the best results. Colorectal cancer can spread aggressively, so you may need to coordinate other treatments like chemotherapy and radiation therapy as part of your care to ensure that all of the cancer is destroyed or removed.
Clinical Trials
Treating colorectal cancer is challenging, but new approaches are being explored to improve outcomes and quality of life. Clinical trials offer the latest experimental treatments driven by cutting-edge research, such as new surgical strategies and devices. If you’re interested in participating in clinical trials, make sure to include academic medical centers in your search, as clinical research is an important part of what they do.
🚩 Because multidisciplinary groups are more likely to be active in clinical trials, you may have access to treatment options that aren't available to the general public yet. Try to find a group that participates in clinical trials and see if you are eligible.
Helpful Search Terms
You can also find surgeons by including commonly searched terms that are connected to colorectal surgery. These terms are driven by patient concerns and priorities, and may help you identify areas that you’d like your surgeon to excel.
Ostomy
Colorectal surgery can include an ostomy, which creates a temporary or permanent hole leading to the outside of the body. This hole is used to pass stool or urine into a pouch while you recover or as a permanent adjustment because of changes in your anatomy.
An ostomy can have an enormous impact on your life, including emotional and psychological challenges. If you're hoping to avoid the need for an ostomy, you may want to search for surgeons or programs specializing in "ostomy avoidance" or "ostomy-sparing surgery."
Pouch Surgery
Colorectal surgery for conditions like ulcerative colitis can require the removal of the colon and rectum. The surgeon must then create a new rectum using a portion of the small intestine. This new rectum is called a “pouch.”
These procedures are very complex, and the best outcomes are associated with colorectal surgeons who perform them regularly. So look for surgeons that specialize in these procedures.
Revision Surgery
These procedures are complex, and they can fail if not done correctly the first time. When this happens, revision surgery may be necessary to fix the issue. There are colorectal surgery programs that specialize in fixing failed surgeries, so add that to your search if you’re looking to have revision surgery to avoid an ostomy.
So I Found Some Surgeons I Feel Comfortable With… Now What?
It's time to start making appointments. Reach out to your top choices for what's called a surgical consultation, or consult. Skilled surgeons are in high demand, and colorectal surgeons are in short supply, so keep in mind that sometimes it can take some time to get scheduled. When making the appointment, their care team will ask what you're looking for, so be ready to explain your needs. But don't worry: you don't need to know exactly what surgery to ask for; the surgeon will be able to explain your options when you meet them.
During My Consultation, What Should I Ask?
In a word: everything. This meeting is your chance to learn about your surgical options, but it's also your opportunity to learn about the surgeon: their approach, their demeanor, their experience, and their understanding of your condition. Bring notes if you're concerned about remembering complex medical terms. Here are some helpful questions to consider:
- About the Surgeon
- How many colorectal surgeries have you performed? How many do you perform each year?
- Based on the procedure you would recommend for me, how many times have you performed that specific surgery?
- Do you only perform colorectal surgeries?
- Have you done a colorectal fellowship? Do you have any board certifications?
- Who is part of your care team? What specialists do you work with?
- What professional societies do you belong to?
- Are you involved in clinical trials that I might be able to participate in?
- About Your Procedure
- What will my procedure involve?
- What are my risks? What complications have you seen?
- Will I need to use an ostomy bag after the procedure?
- Will I need to stay in the hospital? If so, for how long?
- What will I feel after my surgery?
- How long after the surgery will I start to feel better?
- How much scarring will there be?
- Is a minimally invasive or robotic approach an option for me?
- What support will I need during recovery and beyond?
- How much will this procedure help me?
- How will this surgery affect my life?
- For Cancer Care
- Will I need chemotherapy or radiation therapy before or after the procedure?
- How will we know if all of the cancer was removed?
- How effective is this procedure? What are the chances of a recurrence?
- Do you work with a team to monitor changes before and after the surgery to remove the cancer?
🚩 No question is silly or useless if it helps you feel more confident about the procedure. Be wary of any surgeon that won't take the time to answer your questions.
Do They Take My Insurance?
Money might not seem important when your health is at stake, but surgery can be very expensive. Avoiding another stressful element can help you focus on your health. So verify that they accept your insurance, even if their website states they do. Nothing is more frustrating than finding a surgeon who's a great fit, only to learn that your insurance won't cover the procedure. Some insurance plans also require a referral, so talk to your primary doctor about what you'll need.
Should I Get a Second Opinion?
Absolutely. Even if you think a surgeon is perfect for you, a second opinion can make you feel more confident about your decision. It can also help you become better educated about the procedure and your options. Second opinions can often be done with telehealth appointments, so they may not be as challenging to schedule.
🚩 Be wary of any surgeon that discourages you from getting a second opinion. An ethical surgeon will encourage you to get all the information you can and to consider every option.
Word of Mouth
Do you know anyone who has had the surgery performed by the surgeon you're considering? It can be helpful to get feedback from someone who has been through the procedure and recovery process. Keep in mind that everyone's health circumstances are unique, so their experience won't be the same as yours. But speaking with others can help you feel better informed about the real-world results and can give you some insight into how the surgeon and their team treat their patients.
Word of mouth can also be a great way to find a surgeon you might not have considered, especially if someone you know had a positive experience working with them. But make sure to then research the surgeon for yourself.
Online Patient Forums
The emotional toll of living with colorectal conditions like cancer, IBD, or ulcerative colitis can be significant, and even treatment can be stressful and may not provide the results you are hoping for. Online patient forums and support groups can be helpful places to learn about other people's experiences and share what you're going through with a supportive community.
🚩 Looking at online reviews or forums can also give you a sense of the experience other patients had while working with a specific surgeon. But it's important to remember that online reviews are often skewed towards patients unhappy with their results. And forums can be flooded with bots, making it harder to know which reviews are legitimate. So, you should take these sources with a grain of salt.
What Other Factors Should I Consider?
The decision to have surgery is about you and your health, so you should consider what's important to you. If you've reduced your options to a few surgeons who have convinced you they will provide the best care possible, practical considerations may help you make the final decision. These include:
- Do you want a doctor that can perform a surgery at a hospital closer to home? Or is it worth it to travel for your procedure?
- Do you want to work with a surgeon that has a relationship with your specialists, to make it easier to coordinate your care?
- Is finding an in-network surgeon a priority because of your health insurance?
- How urgent is your health issue? If you had to wait to schedule your surgery for an opening on a surgeon's calendar, is it worth the wait?
- Am I able to pay for a procedure out of pocket if my insurance doesn't cover it?
Once you have settled on a surgeon who can perform the procedure you need, where you want it, and when you want it, it's time to focus on getting ready for your procedure. That means following all instructions your surgical team gives you.
Colorectal surgery can be a life-saving operation that can dramatically improve your quality of life by addressing your symptoms. Choosing the right surgeon can help you look and feel like your best self.