Growing thyroid surgical volumes: A blueprint for practice-building in an academic environment

We sought to define elements that are essential to building a high-volume, referral-based head and neck endocrine center; to meet these goals, we undertook a retrospective analysis of referral patterns and surgical volumes in an academic medical center. Some specific factors contributing to program building were investigated. Outcome measures included surgical volumes, geographic origin of referrals, and prevalence of internet referrals. Thyroidectomy annual surgical volumes at the primary institution (all surgeons included) increased during a 4-year period by 38%, from 78 to 108. The proportion of referrals coming from outside the institution grew from 31.6% to 65.5%. Individuals who self-referred by internet contact increased from 0 to 10 per year. Overall departmental thyroidectomy volumes (at all operative venues) increased by 241%, from 69 to 166. The factors that were thought to contribute most to an increased surgical volume were public thyroid screening events, public symposia, same-day availability and "one-stop shopping," online accessibility, state-of-the art offerings (IOPTH, LNM, endoscopic surgery, outpatient surgery, office ultrasound), and inauguration of a multidisciplinary thyroid center. Although the nature of practice dynamics prevents meaningful analysis to determine the precise origin of growth, several specific measures were thought to be critical to achieving clinical expansion, including formation and institutional recognition of a thyroid center of excellence.