Not news. Injections are a lot like opioids, a small # providers
account for the vast majority of their use.
J Bone Joint Surg Am. 2008 Aug;90(8):1730-7. doi: 10.2106/JBJS.G.00858.
Geographic variation in epidural steroid injection use in medicare patients.
Friedly J1,
Chan L,
Deyo R.
Physician Supply
Physician supply was determined by counting the number of
distinct providers who performed the injections (‘‘injection
providers’’) in each health referral region during the year 2001.
The density of injection providers was determined by calcu-
lating the number of injection providers per 1000 Medicare
enrollees at the state and health referral region level. Health
referral regions with high rates of steroid injections were as-
sociated with higher densities of physicians performing the
procedures (r = 0.79, p < 0.001). The physician supply was
further examined in two distinct health referral regions, one
with a very high injection rate and another with a very low
injection rate. In the health referral region with a high injection
rate, there were twenty-five physicians performing injections
per 1000 enrollees. However, only a small percentage of phy-
sicians (3.4%, or two physicians) accounted for 43% of all in-
jections performed, and one of those two physicians accounted
for 30% of all injections performed in this area. In contrast, in
a health referral region with a low injection rate, there were
fewer injection providers (3.8 per 1000 enrollees) and
two
physicians accounted for 39% of all injections performed in
the area.
We also examined the number of injections provided per
patient by individual providers to try to better understand the
variation in practice patterns. There was an enormous range in
the number of injections performed per patient by individual
providers during the study year (range, one to forty injections
per patient per year; median, 1.3 injections; mean [and stan-
dard deviation], 1.6 ± 0.9 injections).
Only a very small per-
centage of physicians performed a large number of injections
per patient per year, with only 0.06%, or twenty-four physi-
cians, who performed ten or more injections per patient per
year. Over 75% of physicians performed two or fewer injec-
tions per Medicare patient per year.
