When assessing a specialist, busier is often better

The Massachusetts Board of Registration in Medicine lists 1,230 licensed physicians who specialize in treating cardiovascular disease, along with 72 cardiac surgeons. So when your heart needs treatment, how do you pick the right specialist?

When it comes to medical specialties, volume matters, said Dr. Adolph Hutter, a Massachusetts General Hospital cardiologist who is past president of the American College of Cardiology.

Hutter said patients and their primary care doctors should seek specialty care from doctors and hospitals that perform the highest number of procedures per year, whether they be cardiac angioplasties, kidney transplants, or hip replacements.

''If you are going to go to a big referral center, and something goes wrong, you are going to get a lot better care than if you go somewhere where they only do three of these things a year," Hutter said. ''High-volume physicians tend to do a better job."

Typically, patients get specialist care through referrals from their primary care physicians. They can also get recommendations from relatives or colleagues who have had a good experience with a particular specialist, Hutter said.

People who call a specialist without referral will most likely have to wait longer to get an appointment, he said.

In cancer care, picking the right specialist could mean access to experimental treatments, said Dr. Bruce Chabner, director of Mass. General's cancer center.

''If you have an unusual tumor, or a tumor that is not treated very well by standard therapies, you may want to take part in a clinical trial, and you have greater access to trials if you go to an academic medical center," he said.

Another major consideration in shopping for a cancer specialist, he said, is making sure the oncologist is fully aware of changes in a rapidly evolving environment.

''In general, people in our specialty are very knowledgeable and well-informed," he said.

They have to be. Their patients are reading up on the latest treatments on the Internet.

''Patients are coming in to see us with much better background information these days," Chabner added. ''They go on line and find information about the cancer they are dealing with."

Christopher Rowland can be reached at crowland@globe.com.