The impact of physician factors on treatment recommendations in sports medicine.

Abstract

The aim of this study is to evaluate differences in treatment of musculoskeletal injuries based on primary care sports medicine physician characteristics. Retrospective review of treatment provided at a walk-in orthopedic clinic was extracted by chart review. Treatment patterns were compared by chi-square test including primary specialty (Emergency Medicine (EM), Family Medicine (FM), Orthopedics (OR) and Physical Medicine and Rehabilitation (PMR), and Internal Medicine (IM) and Pediatrics (Peds)), gender, and years of experience. Additionally, associations between physician characteristics and treatment recommendations were evaluated using multivariate logistic regression. Treatment options evaluated were advanced imaging, medications (including pain medication, oral steroids, muscle relaxers, etc.), steroid injections, physical therapies, durable medical equipment (DME), activity restrictions, and surgery or follow-up. A total of 461 patient encounters were included. The frequency of medication recommendations among providers varied significantly with physician gender, primary specialty, and experience. Medication utilization was highest among male physicians and OR/PMR physicians. Physicians with more than 10 years of experience prescribed less medication compared to physicians with 0-5 years of experience. Physicians with greater than 10 years of experience recommended physical therapy more often than physicians with less experience. Data suggests there are differences in documented treatment recommendations based on the residency completed prior to sports medicine fellowship, physician gender, and experience. Increased diversity within Sports Medicine fellowship classes, such as including both males and females as well as FM trained physicians and EM trained physicians, can bring additional perspectives and experience to patient care.