AT ENDO 2017

ORLANDO (FRONTLINE MEDICAL NEWS) – Endocrinologists made up about one in four of the practitioners performing fine needle aspiration (FNA) biopsies between 2012 and 2014, according to a review of data from the Centers for Medicare & Medicaid Services.

Similarly, endocrinologists performed 25% of image-guided thyroid biopsies.

Endocrine surgeons represent only a small percentage of all practitioners performing head and neck ultrasound exams and image-guided FNA, lead author Mamoona Khokhar, MD , said during a poster presentation at the annual meeting of the Endocrine Society. This is true even though the more portable nature of ultrasound has made it easier for motivated surgeons to incorporate its use into their practice, she said.

Examining 3 years of data from a provider utilization and payment database, Dr. Khokhar and her colleagues identified the types of practitioners who performed head and neck ultrasound, as well as image-guided FNA.

In their analysis, the researchers broadly divided practitioners into surgeons and nonsurgeons. Overall, of the 14,750 median annual practitioners performing head and neck ultrasound between 2012 and 2014, 97.2% were nonsurgeon practitioners, reported Dr. Khokhar, an endocrine surgery fellow at Columbia University Medical Center in New York.

Of all practitioners performing head and neck ultrasound, most (81%) were radiologists. Endocrinologists made up 8% of the overall pool performing ultrasounds.

Breaking the surgeon group down further showed that endocrine surgeons represented 14.7% of surgeons performing head and neck ultrasound, meaning that they made up just 0.4% of the practitioner pool for this procedure. Just over half (52%) of the surgeons performing ultrasounds were otolaryngologists.

The number of practitioners performing image-guided FNA was smaller, at a median 3,695 per year during the study period. Surgeons made up 10.7% of this number. Of the surgeons who performed image-guided FNA, 10.5% were endocrine surgeons. Endocrine surgeons made up 1.1% of all practitioners who billed for FNA.

Again, radiologists made up the majority (58%) of the practitioners performing FNA, and one in four (25%) of practitioners performing FNAs were endocrinologists. Just 5% of the practitioners performing FNAs were otolaryngologists.

More endocrine surgeons performed ultrasound than advanced practice providers (nurse practitioners or physician assistants, 0.2%), pathologists (0.1%), and surgical oncologists (0.04%; P for all, less than .0001). However, advanced practice providers and pathologists both performed significantly more FNAs than did endocrine surgeons (2.1% and 1.8%, P less than .0001).

Although the raw proportion of endocrine surgeons billing for these procedures increased during the study period, the increases were not statistically significant. Dr. Khokhar and her colleagues found that the proportion of American Association of Endocrine Surgeons members who performed head and neck ultrasound grew from 59% in 2012 to 72% in 2014 (P = 0.37), while the proportion performing FNA also increased, from 36% in 2012 to 46% in 2014 (P = .40).

Surgeons, however, may face a number of obstacles in setting up office-based ultrasound, which can lead to underutilization by surgeons, Dr. Khokhar noted, adding that “the results of this study suggest that endocrine surgeons may not be fully utilizing this critical tool in their clinical practice.”

The authors reported no outside sources of funding, and had no relevant conflicts of interest.

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