People often forget that the medical profession's highest priority isn't the health of you, the patient. If you were to grab a medical ethics book you will first be told that the well being of the population as a whole surpasses any individuals rights.

Let's assume a hypothetical where doctors are ranked, let's also assume that insurance will pay for all doctors. Naturally demand for these physicians or surgeons will rise dramatically. If we take Ontario (Canada) as a case, we can see a situation where there is not a free market and physicians can't start charging more. What happens? Well wait times become significantly longer and people start waiting longer to see the best physician possible rather than having a more immediate operation with a lower ranked physician. There is, of course, increased risk the longer you wait for an operation even as simple as a hernia. But patients often don't understand that and can't make logical choices without being 'forced', for lack of a better word, and told they must do it soon with surgeon X. In this case overall population health decreases, complications, morbidity and mortality rise from delays. You also run the risk of complex patients being unable to be operated on by the best because they are too busy doing an operation on a cut and dry case. This is the case in Ontario (largely anecdotal evidence, albeit from a very large pool) where people flock to Toronto on the perceived notion that surgeons affiliated with the most academically prestigious medical school are better than those in a community centre.

It is important to ask whether the lower ranked surgeons should or should not be able, and allowed, to perform the operations, if they are unqualified they shouldn't be allows to practice. The idea of rankings to improve patient care really rests on the notion that the lower ranked surgeons have an effectively higher risk rate (note that I did not say statistically significant). Saying that complications go down from 2% to 1% with higher surgeons while significant is not effectively a difference that should affect choice. I don't know the precise numbers but this is something that must also be considered before making any judgements. While I have no vested interest, and no opinion on the matter, it is important to think why the system is the way it is rather than blindly changing things in the name of progress. This system would allow physicians to charge more in the US (due to more demand, which has it's own slew of ethical considerations) and the medical establishment is greedy to say the least. If the top surgeons could make more money with little to no harm they would.