Who We Are

Who We Are

The Center for Endocrine Surgery was founded in 2006 to provide comprehensive care to residents of Southern California with diseases of the thyroid, parathyroid, and adrenal glands. Under the leadership of Dr. Michael Yeh, the Center rapidly gained national and international prominence for delivering superior patient outcomes, advancing the art and science of surgery through original research, and training the next generation of leaders in endocrine surgery.

Today, we treat thousands of patients every year. Though we predominantly provide care to our local Southern California population of approximately 20 million people, we also serve patients from across the United States and overseas. Drs. Michael Yeh, Masha Livhits and James Wu are national and international authorities on thyroid nodules, thyroid cancer, hyperparathyroidism, and adrenal tumors, as evidenced by their service on consensus guidelines statements that define the state of the art. Our daily practice is motivated by the following priorities…

Integrity

It is important for all patients to know that surgeons generate revenue by performing operations – leading to a certain pressure to recommend surgery. As faculty members of a public university, we are partially shielded from the financial pressures facing practitioners in private practice. Drs. Masha Livhits, James Wu and Michael Yeh believe that a surgeon’s most important duty to society is to help patients avoid surgery when possible. Specifically, the risk/benefit ratio should be carefully analyzed, and surgery offered only when this calculation is in the patient’s favor. The benefits of surgery should not be “oversold” or exaggerated – rather, only the benefits that the patient is statistically likely to experience, based on the scientific literature, should be included in the risk/benefit discussion. Likewise, the risks of surgery should be objectively stated and not minimized.

We believe that surgery should also be “right-sized” to each patient individually. Too little surgery can lead to persistent or recurrent cancer, necessitating further procedures, scans, and operations down the line. Too much surgery can lead to complications that could have been avoided in the first place. This is particularly true in the treatment of thyroid nodules and thyroid cancer. Each day, we leverage our experience in surgeon-performed ultrasound to provide personalized care and deliver operations that are not too small, not too large, but just right. If you come to us for consultation regarding a thyroid nodule that is suspected or known to be thyroid cancer, much of our discussion will focus on right-sizing your operation, which involves shared decision-making with you in consideration of your individual needs and values.

Patients who come to us for second opinions often experience a change of plan from their initial opinion:

1. We may recommend avoidance of surgery, when the previous recommendation was for surgery.
2. We may recommend a smaller operation than what was originally recommended, for instance, a thyroid lobectomy for a suspicious or cancerous nodule, instead of a total thyroidectomy. This occurs very often today. In light of recent evidence, the majority of thyroid cancers can be adequately treated with thyroid lobectomy.
3. We may recommend a large operation, for example a total thyroidectomy with lymph node dissection, if we discover abnormal (cancerous) lymph nodes that were not previously noticed. This also happens reasonably often, as our surgeons are highly skilled at identifying abnormal lymph nodes using ultrasound.

Alterations of the surgical plan like these occur every day in our office. Above all, a surgeon’s recommendations cannot be influenced by financial incentives to operate, or to over-operate when a smaller operation will suffice. A surgeon’s integrity demands that the only care we can recommend is the care we would desire for ourselves or a family member.

Responsibility

Once a patient establishes care with us, we make a commitment to them. We commit to seeing the cycle of care through to completion (the restoration of full health after recovery) and providing whatever ongoing care is needed in their future. Even after patients no longer require regular visits to our office, we remain available for their questions. These relationships, which last decades and often cross generations, are likely the most meaningful aspects of our professional lives. The most effective way for us to fulfill our responsibility to our patients is by principally providing care to people who reside within driving distance of Los Angeles.

Each year, we see a number of patients who live locally but traveled elsewhere for surgery. These patients usually arrive to our office suffering from complications of surgery, having been abandoned by their operating surgeon. This unfortunate situation should be avoided whenever possible.

Evidence-based care

As university professors, we continuously read the latest scientific literature on the diagnosis and management of thyroid, parathyroid, and adrenal disease. We attend research conferences regularly and are all reviewers for scientific journals. For this reason, we are aware of new research developments well before they are made available to other doctors and the general public. Many aspects of care in endocrine surgery are rapidly evolving, most notably the management of known or suspected thyroid cancers in the era of molecular testing (genomic profiling). We actively perform our own research, and our articles have been cited more than 10,000 times as of December 2023. New research developments have the potential to improve patient care immediately. We are here to deliver best available care according to the very latest science.

Value

Value in health care is defined delivering durably positive health outcomes in a way that can be measured, while avoiding waste in the form of excessive costs, tests, and procedures. We want our patients to experience the best results and not get stuck with a big out-of-pocket bill in the end, because excellent health care should be available to all Americans. For this reason, we do not charge large up-front cash fees for initial consultations. We accept most insurance types. In some cases, small fees are requested so that we may cover our costs. We have never turned a patient away because of inability to pay.

References:
Porter ME. What is value in health care? N Engl J Med. 2010 Dec 23;363(26):2477-81. doi: 10.1056/NEJMp1011024. Epub 2010 Dec 8. PMID: 21142528.