Kathryn A Marchetti1, Mary Oerline2, Brent K Hollenbeck2, Samuel R Kaufman2, Ted A Skolarus3, Vahakn B Shahinian4, Megan E V Caram5, Parth K Modi2. 1. Division of Health Services Research, Department of Urology, University of Michigan. Electronic address: kamarche@umich.edu. 2. Division of Health Services Research, Department of Urology, University of Michigan. 3. Division of Health Services Research, Department of Urology, University of Michigan; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System. 4. Division of Health Services Research, Department of Urology, University of Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, MI. 5. Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Abstract
OBJECTIVE: To characterize national trends in urologist workforce, practice organization, and management of incident prostate cancer. METHODS: Using Medicare claims data from 2010 to 2016, we identified all urologists billing Medicare and the practice with which they were affiliated. We characterized groups as solo, small single specialty, large single specialty, multispecialty, specialist, or hospital-owned practices. Using a 20% sample of national Medicare claims, we identified all patients with incident prostate cancer and identified their primary treatment. RESULTS: The number of urologists increased from 9,305 in 2010 to 9,570 in 2016 (P = .03), while the number of practices decreased from 3,588 to 2,861 (P < .001). The proportion of urologists in multispecialty groups increased from 17.1% in 2010 to 28.2% in 2016, while those within solo practices declined from 26.2% to only 15.8% over the same time period. A higher proportion of patients at hospital-owned practices were treated with observation (P < .001) and surgery (P < .001), while a higher proportion of patients at large single specialty practices were treated with radiation therapy (P < .001). CONCLUSION: We characterized shifts in urologist membership from smaller, independent groups to larger, multispecialty or hospital-owned practices. This trend coincides with higher utilization of observation and surgical treatment for prostate cancer.
OBJECTIVE: To characterize national trends in urologist workforce, practice organization, and management of incident prostate cancer. METHODS: Using Medicare claims data from 2010 to 2016, we identified all urologists billing Medicare and the practice with which they were affiliated. We characterized groups as solo, small single specialty, large single specialty, multispecialty, specialist, or hospital-owned practices. Using a 20% sample of national Medicare claims, we identified all patients with incident prostate cancer and identified their primary treatment. RESULTS: The number of urologists increased from 9,305 in 2010 to 9,570 in 2016 (P = .03), while the number of practices decreased from 3,588 to 2,861 (P < .001). The proportion of urologists in multispecialty groups increased from 17.1% in 2010 to 28.2% in 2016, while those within solo practices declined from 26.2% to only 15.8% over the same time period. A higher proportion of patients at hospital-owned practices were treated with observation (P < .001) and surgery (P < .001), while a higher proportion of patients at large single specialty practices were treated with radiation therapy (P < .001). CONCLUSION: We characterized shifts in urologist membership from smaller, independent groups to larger, multispecialty or hospital-owned practices. This trend coincides with higher utilization of observation and surgical treatment for prostate cancer.
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