Video-Vetted Vs. Non-Video-Vetted Vs. Subjectivity

Video-Vetted Vs. Non-Video-Vetted Vs. Subjectivity

To the endometriosis community, 

Over the past several months, we have had some questions regarding iCarebetter and the legitimacy of our expert lists. We have seen several posts, comments, and threads sharing various information and questions about iCarebetter and the vetting platform. We thought it might be helpful to clear the air and provide answers in case anyone has been confused. Specifically, we are here to answer these questions:  

  • Are all of the surgeons on iCareBetter video vetted?
  • Do doctors have to pay iCarebetter to be added to the expert list on the website? 
  • Is the vetting process for iCarebetter regulated?

We fully understand and appreciate the concerns about the quality of an excision surgeon and the complexity of assessing a surgeon’s skill for a patient. 

Before diving into the Video-Vetting and iCareBetter list, let’s review other options. There have been several recommendations, which include:

  • Review the surgeon’s social media profile and their surgical videos
  • Use Google to search for nearby doctors and their reviews
  • Ask surgeons how many complex surgeries they have done
  • Look at their publications
  • Lists

While many of those with endometriosis have had to do this for many years, It is obvious that these solutions are not practical or helpful for many patients, and they lack objectivity.  

For example, reading in detail about someone’s experience can be helpful. However, reading a list of Google reviews will often be one-sided or only demonstrate extreme views—those with extremely positive or negative experiences.

Having scientific publications doesn’t mean a surgeon is good. Most people have been informed that funding sources, conflicts of interest, and the quality of research are important to understand. Without having a background in healthcare or research, this can be hard for patients to understand how to do or what to look for. There are also publications that say the right things, but their intentions are not in the right place and there may be secondary gain. Many surgeons in the endo space may demonstrate a good understanding of endo, but this does not always extend in their surgical skills.

Knowing the power dynamic between patients and surgeons, it is almost impossible to get a clear answer about how many endo surgeries a surgeon has performed. Logically, it makes sense that if a doctor is only performing a few surgeries per month compared to someone doing a few surgeries per week, the physician performing more has more practice. That being said, there are other considerations that are beyond the control of the physician. 

We can go on, but you get the idea. The bottom line is that everyone has their own subjective perspective, which is based on past experiences, their own research, and oftentimes others’ influence and experiences. And we all know each individual is different and what worked for me might not work for you.

In contrast to all these methodologies, iCareBetter has only applied objective processes. We have only examined evidence to see what works.

A study in the New England Journal of Medicine used actual data to show that video-based surgical skill scores were correlated with Complications. https://www.nejm.org/doi/full/10.1056/NEJMsa1300625

iCareBetter then applied this Journal Article methodology to endometriosis surgery. We created the list of Video-Vetted surgeons after vetting their surgeries. iCareBetter started by only listing surgeons who passed video vetting. This process requires surgeons to submit three videos with specific criteria, which are then peer-reviewed by other experts in this field. The entire process is double-blinded. 

As iCareBetter is relatively new to the endo space, it took some time to build up our resources. Unfortunately, the number of surgeons submitting videos and the number of surgeons who passed was very low.  Additionally, reviewing a surgeon’s videos is very long and usually takes three months on average. At the same time, 90% of patients who used iCareBetter could not find a surgeon based on their criteria and location. In order to serve the needs of those utilizing iCareBetter to find care, we had to make a change so patients could still find a doctor who could still provide some surgical care. Therefore, we made the decision to add a second group of surgeons who are non-video-vetted. These surgeons are added based on their peers’ recommendations and their personal interests. Patients can review them on their iCareBetter profile, and we publish the reviews without filters. 

We hope that these non-video-vetted surgeons will take the steps to pass the video-vetting in the future. Meanwhile, the Video-Vetted designation is explicitly stated on the profile of the Video-Vetted surgeon, there is no fine print.

In regards to the questions about surgeons paying to be on iCareBetter,  we did begin this process by charging doctors a subscription fee to be on iCareBetter. But since over a year ago, we have given the option for a 100% discount, and surgeons can choose to be on iCareBetter for zero subscription fee. To keep the lights on, we only charge doctors if we help them with promotion or management services such as training their staff to offer better care to patients and giving them marketing strategies, all of which are optional. That said, for video vetting, the only required fee for surgeons is a one-time review fee of $400 that pays for reviewers and the cost of the review.

Currently, we have 222 providers, including surgeons on iCareBetter, and we are seeing constant interest and growth. We will continue to do video-vetting and hope that more surgeons will become Video-Vetted. We continue Video-Vetting for patients’ interest and for the purpose of transparency. 

We would love to hear your thoughts and concerns here.

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