Do emergency medicine physicians perform ultrasound and conventional radiography in the emergency department? Recent trends from 1993 to 2001.
OBJECTIVE
To examine trends in emergency medicine physicians' participation in diagnostic ultrasound and conventional radiography from 1993 to 2001.


METHODS
The nationwide Medicare Part B Physician/Supplier Procedure Summary Master Files for 1993 and 1996 through 2001 were examined to determine the total number of ultrasound and conventional radiography examinations performed in emergency departments, except for ophthalmic ultrasound and supervision or interpretation claims. Ultrasound examinations were categorized as general, vascular, breast, echocardiography, and obstetrical. Conventional x-ray examinations were categorized as chest, skeletal, abdomen, and gastrointestinal fluoroscopy. The total volume and overall share of the two modalities and nine aforementioned categories were calculated for each year for radiologists, emergency medicine physicians, other nonradiologists, and multispecialty groups using the Medicare provider and location-of-service codes.


RESULTS
The total volume of ultrasound examinations performed in emergency departments increased from 134,533 in 1993 to 355,889 in 2001 (+164.5%). Emergency medicine physicians performed 760 (0.6%) of the examinations in 1993 and 1160 (0.3%) in 2001. Radiologists performed 87,377 (64.9%) in 1993 and 257,479 (72.3%) in 2001, other nonradiologists (primarily cardiologists performing echocardiography and vascular surgeons performing vascular ultrasound) performed 40,501 (30.1%) in 1993 and 76,649 (21.5%) in 2001, and multispecialty groups performed 5895 (4.4%) in 1993 and 20,601 (5.8%) in 2001. The total volume of conventional radiography examinations increased from 5,120,608 in 1993 to 8,054,771 (+57.3%) in 2001. Emergency medicine physicians performed 243,705 examinations (4.8%) in 1993 and 167,968 (2.1%) in 2001, radiologists performed 4,558,933 (89.0%) and 7,478,659 (92.8%), other nonradiologists performed 113,848 (2.2%) and 99,627 (1.2%), and multispecialty groups performed 204,122 (4.0%) and 308,517 (3.8%). The largest volume of examinations performed by radiologists and emergency medicine physicians in emergency departments in 2001 was in chest radiography, with radiologists performing 3,765,209 and emergency medicine physicians performing 98,851. The largest volume for other nonradiologists in emergency departments in 2001 was in echocardiography; they performed 53,943 of these examinations.


CONCLUSIONS
Emergency medicine physicians perform a very small percentage of all ultrasound and conventional x-ray examinations performed in emergency departments, with their share decreasing over the 8-year period. The fact that the participation of emergency medicine physicians in ultrasound imaging and conventional radiography in emergency departments is limited and has been decreasing makes their claim of substantial participation highly questionable.
Maitino
Andrea J
AJ
Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA. andrea.maitino@jefferson.edu
Levin
David C
DC
Rao
Vijay M
VM
Parker
Laurence
L
Sunshine
Jonathan H
JH
D000368:Aged; D004632:Emergency Medical Services; D004635:Emergency Medicine; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000639:trends; D006296:Health Services / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D006278:Medicare; D011859:Radiography / Q000639:trends*; D014463:Ultrasonography / Q000639:trends*; D014481:United States; D000078329:Workforce