The Influence of Practice Structure on Urologists' Treatment of Men With Low-Risk Prostate Cancer

Med Care. 2022 Sep 1;60(9):665-672. doi: 10.1097/MLR.0000000000001746. Epub 2022 Jul 26.


Background: Vertical and horizontal integration among health care providers has transformed the practice arrangements under which many physicians work.

Objective: To examine the influence of type of practice structure, and by implication the financial incentives associated with each structure, on treatment received among men newly diagnosed with low-risk prostate cancer.

Research design: We compiled a unique database from cancer registry records from 4 large states, Medicare enrollment and claims for the years 2005-2014 and SK & A physician surveys corroborated by extensive internet searches. We estimated a multinomial logit model to examine the influence of urologist practice structure on type of initial treatment received.

Results: The probability of being monitored with active surveillance was 7.4% and 4.2% points higher for men treated by health system and nonhealth system employed urologists ( P <0.01), respectively, in comparison to men treated by single specialty urology practices. Among multispecialty practices, the rate of active surveillance use was 3% points higher compared with single specialty urology practices( P <0.01). Use of intensity modulated radiation therapy among urologists with ownership in intensity modulated radiation therapy was 17.4% points higher compared with urologists working in small single specialty practices.

Conclusions: Physician practice structure attributes are significantly associated with type of treatment received but few studies control for such factors. Our findings-coupled with the observation that urologist practice structure shifted substantially over this time period due to mergers of small urology groups-provide one explanation for the limited uptake of active surveillance among men with low-risk disease in the US.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Humans
  • Male
  • Medicare
  • Practice Patterns, Physicians'
  • Prostatic Neoplasms* / diagnosis
  • United States
  • Urologists
  • Urology*