Clinic-Owner Urologists Perform More Surgeries Than Peers

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A new study finds that Florida urologists who own outpatient surgery clinics perform more kidney-stone surgeries than their colleagues do, raising questions about whether some of the physicians are more concerned about profits than they are about patients.

“With ownership, the potential for a conflict of interest exists,” said lead study author John Hollingsworth, M.D., a clinical lecturer in urology at the University of Michigan.

Still, Hollingsworth said there are other possible explanations for a discrepancy in surgery rates between doctors who own clinics and those who do not. Only further research, he said, will reveal the role that clinic ownership plays.

Kidneys stones — solid crystals in urine — strike an estimated one in seven Americans during their lifetimes. They can cause extreme pain as they block the flow of urine and account for about 500,000 emergency-room visits in the United States each year, Hollingsworth said. 

In some cases, urologists advise patients to take it easy and let the stones pass on their own. Doctors can also perform surgeries to break up the stones.

The new study, published in an upcoming issue of the journal Health Services Research, examines surgeries at physician-owned clinics known as ambulatory surgery centers. The clinics are controversial because physicians collect a share of profits in addition to their professional fees, potentially giving them a greater motive to perform unnecessary procedures.

Study authors examined a database of outpatient kidney-stone surgeries performed in Florida from 1998 to 2002. After adjusting their figures to reflect the influence of factors like the types of patients who received care, they found that clinic-owning urologists performed an average of 39 kidney-stone surgeries per year, compared with 23 among non-owners, Hollingsworth said.

Why are doctors with an ownership stake performing more surgeries? The “more insidious possibility” is that clinic owners perform more surgeries because they have a greater financial stake, Hollingsworth said.

However, it is also possible that the clinics are more efficient, allowing more surgeries to be performed, he said. Alternatively, he added, the urologists might perform more procedures because they specialize in them.

In fact, a busy surgeon might be a better surgeon, suggested Christopher Saigal, M.D., an associate professor of urology at the UCLA School of Medicine.

He said urologists who perform large numbers of surgeries have lower complication rates.

Owning a clinic can provide other benefits, Saigal said. For example, physician-owners do not have to wait for operating rooms to become available, as in a hospital, because they are in charge of their own clinic. In an urgent case, “you can just do it,” Saigal said.

Health Services Research is the official journal of the AcademyHealth and is published by John Wiley & Sons, Inc. on behalf of the Health Research and Educational Trust. For information, contact Jennifer Shaw, HSR Business Manager at (312) 422-2646 or . HSR is available online at http://www.blackwell-synergy.com/loi/hesr.

Hollingsworth JM, et al. Urologist ownership of ambulatory surgery centers and urinary stone surgery use. Health Services Research online, 2009.

Source: Health Behavior News Service

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