https://pssjournal.biomedcentral.com/articles/10.1186/s13037-016-0117-6

Why do surgeons continue to perform unnecessary surgery?

In 2016, the existence of unnecessary surgery remains a daunting reality that continues to expose our patients to an unjustified surgical risk [18]. For example, multiple clinical trials have shown that spinal fusions for back pain do not lead to improved long-term patient outcomes when compared to non-operative treatment modalities, including physical therapy and core strengthening exercises [19, 20]. In spite of these insights from high-quality trials, spinal fusion rates continue to dramatically increase in the United States [18]. Another relevant example is arthroscopic partial meniscectomy, one of the most commonly performed surgical procedures in the world [21]. This minimally invasive surgery allows treating internal knee damage through small percutaneous skin incisions, with a fast-track postoperative recovery period. In the United States alone, surgeons perform approximately 700,000 arthroscopic partial meniscectomies every year. Strikingly, a recently published prospective randomized controlled trial (“Finnish Degenerative Meniscal Lesion Study”/FIDELITY trial) that assessed patient outcomes after arthroscopic meniscal trimming compared to sham surgery revealed no benefit for patients from the routine surgical procedure at 12 months follow-up [22]. Actually, considering the risk for patients sustaining a severe intra- or postoperative complication, no surgical procedure should be considered “routine” from the patient’s perspective [23]. Yet, until present, a change in practice has not occurred, and arthroscopic meniscectomies continue to be performed on hundreds of thousands of patients in the United States every year [24, 25].

https://www.drugwatch.com/news/2018/03/19/jama-unnecessary-joint-replacements-cost-americans-8-3-billion/

JAMA: Unnecessary Joint Replacements Cost Americans $8.3 Billion

Talking about unnecessary surgeries we can add many other surgeries 

such as cataract surgery, hemorrhoid surgery and others including procedures such as 

endoscopies, coronary stenting, etc.

Since I was practicing internal medicine and Cardiology, 

I was on the front line questioning surgeons on behalf of my patients 

for decades. As a matter of fact, I considered preventing the unnecessary 

surgery as one of my major missions as an internist.

To make the matter more complicated sometimes the ill-informed patient

wants the unnecessary surgery in which case I spent whatever time necessary 

to persuade the patient by testing the patient-doctor trust on the line.

Fortunately, over 90% of my patients trusted me, and those few who wanted the surgery

or procedure would come around to follow my advice.

Surgeons are trained to do the surgery so it is not a surprise to see the unnecessary surgery 

happening. I used to instruct all my patients to check with me first before they decide to

see any surgeons. Many times many of my patients would see orthopedic surgeons or neurosurgeons

for back trouble and the back surgery scheduled and then let me know. Most of these patients do not

need the surgery so that I would have them see a physiatrist for conservative therapy.

Almost all of them would improve obviating the need for back surgery.

Hysterectomy is another good example.

I stopped quite a few of them. Part of the problem is that gynecologist often acts as a family doctor

so that internists don't have as much control in decision making.

The only thing I regretted while doing all this was the fact that I wound up ruining whatever friendship 

I had with my surgical colleagues. 

Funny thing is that those unnecessary surgeries feed into the American economy. Not only surgeons

but also anesthesiologists live on it. Nurses and other hospital employees have stable jobs. How

about companies that make medical instruments? Pharma makes medications that aid healing like

antibiotics and pain medications. All kinds of lab tests need to be done perioperatively.

However, the expense is the patients' lives. If it is a kind of business model,

it lacks ethics. I feel sorry I was the part of it. The American health care system is not very sound. It needs to be reformed. Coronavirus revealed its inconvenient truth. Didn't it make us choose human lives or the economy?

Your observation is indeed cogent, I should say.

Unfortunately, MDs do not have much political influence 

and are an extreme minority in this society and will be dictated 

every which way by multiple parties including the insurance industry,

big pharmaceuticals, whatever.

As a result, as you pointed out, MDs will remain in survival game

trying to maximize their effort turning their medical knowledge into

cash with their medical ethics left behind as an afterthought.

We see this happening all around us.