M-SCORE is a consortium of surgeons and other clinical scientists sharing common interests in health services research, quality improvement, and policy issues in surgery. Despite remarkable advances in the field of surgery, we are troubled by wide variations in the use and outcomes of surgery in the United States. Surgical outcomes—and advice about who needs surgery in the first place—are influenced too strongly by where patients live and which surgeon they see. We believe that decisions about surgery should be driven primarily by current scientific evidence and the preferences of individual patients. Patients should be able to expect surgeons who have adequate experience with specific procedures, who systematically track their outcomes, and who strive continuously to adopt best practices.