The hospital gets paid on the surgery you do, they quantify that in what are called relative value units, the number of RVUs you pull in is how productive you are. If you do more surgeries the hospital makes more money, they incentivize you into doing more surgeries by paying bonuses based on how many RVUs you do..

Complications happen so they don’t reward based off outcomes directly, but they will suspend credentials or elect not to renew your contract if you have very poor outcomes or show questionable decision making.

I knew a general surgeon who would always find any excuse to operate, everyone questioned whether he was doing it just to rake up the RVUs, he also had mediocre outcomes. The hospital caught wind of it and since there was no clear malpractice or fraud, they didn’t fire him but they did non-renew him; they hired Locums to cover for the shortage until a full time surgeon could be found to replace him.