For thirty-five years, I was a practicing vascular surgeon in a four-person private vascular surgery group. For thirteen years, I also served as chairman of surgery for a large health network.

I sat in morbidity and mortality conferences and watched experienced surgeons present cases that quietly revealed patterns. I looked at internal scorecards and noticed which names appeared on the better side of the outcomes curve and which on the worse side. I had conversations with referring physicians who would offer strong opinions about which surgeons they preferred, opinions built on relationships, reputation, and the occasional case they had heard about, but rarely on systematic outcomes data.

None of this was in the patient’s chart. None of it was searchable. And honestly, very little of it was rigorous.

For decades, surgical outcomes data has lived in three places. It lives in our hospital quality committees, where it informs internal credentialing. It lives in CMS files and Medicare data, accessible to researchers but not patients. And it lives in fragments, in our memories, our impressions, our hallway conversations, without the structure to make it reliable.

Patients have never had access to any of this. Neither have most physicians making referrals. Even as chairman of surgery, I did not always have the information I needed. I would call a colleague, ask a question, lean on relationships and intuition. That is how the system worked.

That is starting to change. We should be honest with ourselves about what it will mean.

The shift has been building for a long time. CMS Hospital Compare went live in 2005. ProPublica published its surgeon scorecard in 2015 to enormous controversy. State-level cardiac surgery report cards in New York and Pennsylvania have existed since the 1990s.

Those early efforts were on the right track. They were also, by necessity, blunt. Most evaluated surgeons at the specialty level: orthopedics, general surgery, cardiothoracic. But surgeons are not uniformly skilled across every operation in their specialty. The orthopedic surgeon who is excellent at total knee replacement may be average at rotator cuff repairs. The general surgeon with strong outcomes for laparoscopic cholecystectomy may have a different track record for hernia repair. Specialty-level data is a starting point. It is not the answer.

What is different now is that the friction is gone, and the granularity has improved. Risk-adjusted outcomes data is being aggregated at the procedure level and made directly available to patients in plain language. Some comes through employer-sponsored benefits programs. Some comes through direct-to-consumer tools. The methodologies vary in rigor, but the trajectory is one direction.

The patient who calls a friend-of-a-friend to ask which surgeon to use for a knee replacement is being replaced by the patient who opens an app and sees a procedure-specific recommendation, with explanation.

I have heard three reactions from colleagues when this comes up. The first is dismissal. The data is too crude. Risk adjustment never captures the complexity of real cases. My patients are sicker than the next surgeon’s. These tools will mislead patients more than they help.

There is truth in some of these objections. Risk adjustment is imperfect. A surgeon who takes on the hardest cases will look worse on a naive ranking than one who refuses them. We should be vocal about methodological standards and push back when tools oversimplify.

But “the data isn’t perfect” is not the same as “the data shouldn’t exist.” The internal data we use for credentialing isn’t perfect either, and we have used it for decades to make consequential decisions about who gets to operate. The question is not whether to share imperfect data with patients. It is whether the imperfections are larger than those of the current system, in which patients have no information at all and choose surgeons based on geography, word of mouth, insurance network, and who they happened to see first.

I do not think they are.

The second reaction is fear, usually unspoken. What if I am on the wrong side of the curve? What if my patients see a number and decide to drive across the city to someone else?

I understand this fear. The honest response is that some surgeons are going to lose volume, and some are going to gain it, and on balance that is probably what should happen. A patient is better served by the surgeon whose outcomes data demonstrates real skill at the specific procedure they need, not the one who happens to be on their insurance panel, or the one their primary care physician trained with thirty years ago.

The third reaction is the one I think is most useful. If this is happening, how do we shape it?

This is where I want my colleagues to spend more time. Outcomes transparency is not a future debate. It is a present reality, rolling out unevenly, often by tools that surgeons themselves had no input on. The physicians I respect most are the ones getting in the room, advising on methodology, pushing back on bad measures, helping patients understand what the data does and does not tell them.

We can pretend this isn’t happening, and our patients will get their information from sources we have no influence over. Or we can engage with the transition and try to make it better than it would otherwise be.

The version of medicine in which patients walk into our offices already knowing things about us is rapidly approaching. They will know our complication rates relative to our peers, by procedure. They will know whether we tend to operate when conservative management would have worked. They will know how often our patients come back to the hospital within thirty days.

This is uncomfortable. It is also overdue.

The data has always existed. We have always known fragments of it. The only thing changing is who else gets to know, and how complete the picture has become.

I would rather meet that change as a profession that helped shape it than as one that pretended it was not coming.

Marc Granson is a vascular surgeon and physician executive.