Good doctors are sorely needed. Experienced surgeons are needed by so many communities. Unfortunately, some of those who can serve you very well are being eliminated from practice by peers, for varying reasons. Often times the reasons are political or economical, and the easier (though malicious) way is to use the hospital peer review process to eliminate them.
Here is how it works. Almost always, those physicians/surgeons who are willing to take sicker patients and, therefore become experienced in treating higher risk patients, will have a higher incidence of complications than those who choose to treat only less complicated cases. Bingo! This applies to surgeons in particular. In a hospital environment that is hostile to a certain surgeon, such a higher rate of complications comes quite handy to trigger a peer review. They may even use fancy (but not totally reliable) statistical models to show that they stratified for the higher risk, and found that the particular surgeon's rate of complications is "unacceptably" higher than the norm. Notice that treating sicker patients can cost a hospital more money, particularly if the patient is uninsured or has an insurance that does not pay well. So, a peer review would be initiated to address "concerns" about the practice of that particular doctor. The final outcome of the peer review process cannot be simply letting the physician/surgeon go to look for practice elsewhere.
The way the punitive quality assurance system in the US is set up mandates reporting adversarial and disciplinary actions to the National Practitioners Data Band. The regulations in the US, do not require whatsoever any constructive peer review process, which is not fair to the patients nor their doctors. Anyway, if a hospital administration or the powerful staff of a hospital gang up to eliminate a doctor, and they play the sham peer review game right, they probably have no choice but to destroy the career of that physician and remove the shammed doctor from practicing altogether. That surgeon cannot practice almost anywhere. As a result, the community at large is deprived from the services of a surgeon/physician who has more experience, and whose services are therefore more valuable, than the peers. When such experienced surgeons are eliminated, you are left with the newbies or those who evade doing surgery on difficult cases.
Dear patient, there is a pressure in some hospital environments that doctors avoid treating your complicated issues and sending you elsewhere. Even if there is an experienced physician/surgeon on staff, such an expertise will not be appreciated and may very well be harshly punished in a sham quest for "quality".