Strong medicine: that's exactly what these doctors--identified by their peers as the best in the state--are practicing.

• Author: Martin, Edward
• Position: FEATURE

With health-care inflation of 10% or more a year, it's not surprising that rising costs are changing medicine. But an outcome many analysts didn't expect is one that patients and employers have long sought: better ways to judge doctor quality. The best doctors, the reasoning goes, provide care that reduces hospitalization, drug costs and time demands on medical staffs. "The best care also happens to be the cheapest care," says Evan Falchuk, president of Best Doctors Inc. "Many figure, 'If my care is really good, it's going to cost me a lot of money.' But good care is not only the right thing to do, it saves money."

[ILLUSTRATION OMITTED]

Falchuk's Boston-based company offers one way to evaluate doctors. It compiles the listing on the following pages. The company asked about 35,000 physicians and surgeons nationwide to grade other doctors in their specialty. Those with the highest averages--only about 5%, or 889 doctors in North Carolina--made the final list. Employers subscribe to Best Doctors for information they hope will help employees make better health-care decisions and keep down costs. Chicago-based Midwest Business Group on Health estimates that 30% of employer spending for health care is wasted on mistakes and unnecessary treatments.

[ILLUSTRATION OMITTED]

Doctors who dislike ratings or grades--they contend that medicine has too many human variables--respond better to a concept called pay for performance. It gauges how well they follow accepted procedures in treating certain diseases. A doctor might be asked, for example, if he regularly administers foot examinations for diabetics, whose circulatory problems often lead to infections and even amputations.

The state's first pay-for-performance program began in April when Blue Cross and Blue Shield of North Carolina unveiled Bridges to Excellence, a pilot project licensed from a national program of the same name. Doctors who make the cut will be noted in Blue Cross' network registry. "The concept is based on the idea that employers who pay so much for care for their employees want to know if they're getting their money's worth," says Kyle Marshall, a Blue Cross spokesman in Chapel Hill.

Though it doesn't measure whether patients get better, Bridges to Excellence, which several other Tar Heel insurers are studying, encourages doctors to adopt electronic records that can be mined to determine what procedures work best. That could be a step toward more data for employers and patients.

Another could come from the General Assembly. The N.C. Medical Board, which licenses and disciplines doctors, is pushing for broader power to expose bad ones. The board can suspend or revoke a doctor's license, but few of the approximately 1,000 complaints it investigates each year reach that level. Only if the doctor loses his license do patients have access to the information. The proposed law would let the board publicly identify doctors who've been reprimanded or censured but don't lose their licenses.

In the meantime, employers and patients will have to rely on other ways to evaluate doctors. Though no method is perfect, Falchuk says Best Doctors' ratings go more to the heart of how good a doctor is. They rely entirely on the opinion of the people who should best be able to judge a doctor's competence--other doctors.

BEST DOCTORS

A list of the top North Carolina physicians in 10 additional specialties is at www.businessnc.com.

ALLERGY AND IMMUNOLOGY

Jose A. Bardelas Jr., Allergy and Asthma Center of North Carolina, High Point; Teresa S. Bratton, Greensboro; A. Wesley Burks Jr., Duke University Medical Center, Durham; John W. Georgitis, La Fayette Clinic, Fayetteville; John T. Klimas, Carolina Asthma and Allergy Center, Charlotte; M. Louise Markert, Duke University Medical Center, Durham; Larry W. Williams, Duke University Medical Center, Durham.

CARDIOVASCULAR DISEASE

Kirkwood Adams, Heart Center at Meadowmont, Chapel Hill; Thomas M. Bashore, Duke University Medical Center, Durham; Michael A. Blazing, Duke University Medical Center, Durham; Bruce R. Brodie, LeBauer Healthcare, Greensboro; Robert M. Califf, Duke University Medical Center, Durham; G. Ray Cheely, Raleigh Cardiology Associates; Pamela S. Douglas, Duke University Medical Center, Durham; Victor J. Dzau, Duke University Medical Center, Durham; Joe Ellis Gaddy, Cardiology Specialists of North Carolina, Winston-Salem; Pascal J. Goldschmidt-Clermont, Duke University Medical Center, Durham; J. Kevin Harrison, Duke University Medical Center, Durham; Eric M. Janis, Smithfield Heart and Vascular Associates; Paul Kirkman, Wake Forest University Baptist Medical Center, Winston-Salem; Joseph Kisslo, Duke University Medical Center, Durham; William Little, Wake Forest University Baptist Medical Center, Winston-Salem; Charles Mangano, Raleigh Cardiology Center; Daniel B. Mark, Duke University Medical Center, Durham; Christopher M. O'Connor, Duke University Medical Center, Durham; Erik Magnus Ohman, Duke University Medical Center, Durham; Killian C. Robinson, Wake Forest University Baptist Medical Center, Winston-Salem; Joseph G. Rogers, Duke University Medical Center, Durham; Marschall S. Runge, UNC Chapel Hill School of Medicine; Thomas J. Ryan, Duke University Medical Center, Durham; Sidney C. Smith Jr., The Heart Center, Chapel Hill; Franklin C. Wefald, Smithfield Heart Associates; Park W. Willis IV, Chapel Hill; James P. Zidar, Duke Cardiology of Raleigh.

COLON AND RECTAL SURGERY

Mark J. Koruda, UNC Chapel Hill School of Medicine.

DERMATOLOGY

John Albertini, The Skin Surgery Center, Winston-Salem; Charles J. Brown, Dermatologic Laser Center, Charlotte; William A. Burke, Brody School of Medicine at East Carolina University, Greenville; Jonathan L. Cook, Duke University Medical Center, Durham; Sue Ellen Cox, Aesthetic Solutions, Chapel Hill; Luis A. Diaz, UNC Chapel Hill School of Medicine; Zoe D. Draelos, High Point; Irene E. Edwards, Mid-Charlotte Dermatology and Research; Mary Farley, The Skin Surgery Center, Greensboro; Steven Feldman, Wake Forest University Health Sciences Center, Winston-Salem; Alan B. Fleischer Jr., Wake Forest University Health Sciences Center, Winston-Salem; W. Ray Gammon, Eastern Dermatology and Pathology, Greenville; James Grichnik, Duke University Medical Center, Durham; Russell P. Hall III, Duke University Medical Center, Durham; W. Dean Henrichs, Winston-Salem Health Care; Joseph L. Jorizzo, Wake Forest University Health Sciences Center, Winston-Salem; Naomi Kagetsu, Chapel Hill Dermatology; Barry Leshin, The Skin Surgery Center, Winston-Salem; Stanley B. Levy, Chapel Hill Dermatology; Amy J. McMichael, Wake Forest University Health Sciences Center, Winston-Salem; Elise A. Olsen, Duke University Medical Center, Durham; Lawrence H. Pearson, Cleveland Dermatology, Shelby; Neil S. Prose, Duke University Medical Center, Durham; Jerry L. Pruitt, Dermatology Center of Hickory; Elizabeth F. Sherertz, The Skin Surgery Center, Winston-Salem; Ronald J. Stanley, Boone Dermatology Clinic; David E. Tart, Viewmont Dermatology, Hickory; John A. Thompson Jr., Dermatologic Laser Center, Charlotte; W. Harrison Turner III, Greensboro Dermatology; Phil M. Williford, Wake Forest University Baptist Medical Center, Winston-Salem; Gil Yosipovitch, Wake Forest University Health Sciences Center, Winston-Salem.

ENDOCRINOLOGY AND METABOLISM

Denis I. Becker, Raleigh Endocrine Associates; Susan Braithwaite, UNC Diabetes Care Center, Chapel Hill; Warner Miller Burch Jr., Duke University Medical Center, Durham; John B. Buse, Highgate Specialty Centre, Durham; David Clemmons, UNC Diabetes Care Center, Chapel Hill; Jean Dostou, UNC Diabetes Care Center, Durham; David Alan Hester, Asheville Endocrinology Consultants; Richard E. Kleinmann, Presbyterian Endocrinology and Osteoporosis Consultants, Charlotte; David F. Lobach, Duke University Medical Center, Durham; Kenneth W. Lyles, Duke University Medical Center, Durham; Diana B. McNeill, Duke University Medical Center, Durham; Edith H. Miller, Carolinas Medical Center, Charlotte; K. Patrick Ober, Wake Forest University Baptist Medical Center, Winston-Salem; David A. Ontjes, UNC Chapel Hill School of Medicine; James W. Plonk, Charlotte Medical Clinic; Roberta Samelson Bracken, Presbyterian Endocrinology and Osteoporosis Consultants, Charlotte; W. Stuart Tucker Jr., Eastover Internal Medicine, Charlotte; Paul C. Whitesides Jr., Hanover Medical Specialists, Wilmington; Eugene E. Wright, Fayetteville.

GASTROENTEROLOGY

John Baillie, Duke University Medical Center, Durham; Eugene M. Bozymski, UNC Hospitals, Chapel Hill; Malcolm Stanley Branch, Duke University Medical Center, Durham; Anna Mae Diehl, Duke University Medical Center, Durham; Douglas A. Drossman, UNC Hospitals, Chapel Hill; Michael Warren Fried, UNC Chapel Hill School of Medicine; Francis G. "Frank" Gress, Duke University Medical Center, Durham; William D. Heizer, UNC Chapel Hill School of Medicine; Kim L. Isaacs, UNC Hospitals, Chapel Hill; Joseph W. Kittinger III, Wilmington Gastroenterology Associates; Kenneth L. Koch, Wake Forest University Baptist Medical Center...