I'm guessing that the bureaucracy of such a system would be a significant burden. To avoid having the system badly gamed, you'd need a second evaluation, yes?

I'm guessing that the bureaucracy of such a system would be a significant burden. To avoid having the system badly gamed, you'd need a second evaluation, yes? By a _neutral_ party, (not a doctor working in the same practice, e.g.) At added cost and time. Not to mention I've heard more than one surgeon say "That was more difficult than I expected based on the imaging ... once we got in there we found <>". I'm also arguing that it's not just a psychological resistance to a data-based evaluation system. That people understand the system would be subject to being gamed, and the overall quality of the work would actually suffer. (A bit analogous to how peer-review and the tenure game has interfered with good science practices.)