The conclusion of the authors is that "compared with employed urologists, those who are self-employed have more resource intense practice styles with respect to imaging use." Data from the NAMCS are used to identify outpatient urology visits. The'thesis the authors really seemed to try to address was whether self-employed urologists ordered more tests because they might profit from them.The authors note that 60% of the imaging involved ultrasound. Whether this was renal, testicular, bladder or prostate ultrasound was not stated. The 3 common diagnoses investigated were benign prostatic hyperplasia (BPH), hematuria and urolithiasis. Imaging was ordered for about 20% of encounters but was ordered more often when the urologist was self-employed. Possible reasons given included dissimilar patient populations which they dismissed, defensive medicine, lack of coordination of care, "volume based incentives inherent in practice ownership" and physician ownership of the technology. They postulated that "self-employed urologists would use diagnostic imaging as a replacement for the history and physical examination rather than as an adjunct to these evaluations" and the availability of in-office testing which would provide a clear profit motive. The authors commented that perhaps ultrasound was so common because the cost to purchase is less than that of computerized tomography. They provided no evidence of what the ownership status was or that ownership affected the volume of studies ordered.
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