Opioid Prescribing Patterns of Board-Certified Emergency Physicians Compared With Other Physicians Practicing Emergency Medicine Among Medicare Part-D Beneficiaries Between 2018 and 2020 in the United States

TL;DR

Board-certified emergency medicine physicians prescribed fewer opioids than non-certified physicians in U.S. emergency departments from 2018 to 2020.

Contribution

This study is the first to analyze opioid prescribing patterns of board-certified emergency physicians compared to non-certified ones using Medicare data.

Findings

Board-certified emergency physicians prescribed significantly lower average opioid doses than non-certified physicians.

Non-certified physicians prescribed up to 4 times more opioids per beneficiary for common medications like hydrocodone/acetaminophen.

The study found consistent lower prescribing rates across multiple opioid types for board-certified physicians.

Abstract

There is limited knowledge regarding whether board-certified emergency medicine (EM) physicians have different opioid prescribing rates compared to other physicians working in emergency departments (EDs). This study aims to determine if opioid prescribing rates differ based on board-certification status compared with other physicians practicing in an ED setting.

An IRB-approved, cross-sectional analysis was performed on the Medicare Part D Prescribers by Provider and Drug datasets from 2018 to 2020 to determine prescribing rates of EM physicians by board-certification status with the American Board of Emergency Medicine or the American Osteopathic Board of Emergency Medicine. EM physicians prescribing opioids to 11 or more Medicare beneficiaries per calendar year in EDs were included. The average total day supply (TDS) of opioids per beneficiary for the 4 most common opioids (acetaminophen/codeine, hydrocodone/acetaminophen, oxycodone/acetaminophen, tramadol) was estimated using generalized linear models with Poisson distribution, log-link, and individual clustering and compared by board certification in EM status. Incident rate ratios (IRR) were used to describe the association between board certification in EM and the average TDS of opioids.

A total of 29,144 physicians were included in the study, with 23,720 (81.4%) board-certified by the American Board of Emergency Medicine or the American Osteopathic Board of Emergency Medicine and 5424 (18.6%) certified by another specialty board (eg, family medicine [48.6%], internal medicine [17.3%]). Physicians working in EDs, who were not board-certified in EM, prescribed a higher average TDS compared with board-certified EM physicians: acetaminophen/codeine (TDS, 10.8 vs 4.0; IRR, 2.7 [95% CI, 2.3-3.2]); hydrocodone/acetaminophen (TDS, 15.2 vs 3.8; IRR, 4.0 [95% CI, 3.7-4.4]); oxycodone/acetaminophen (TDS, 19.8 vs 4.4; IRR, 4.5 [95% CI, 3.8-5.3]); tramadol (TDS, 20.1 vs 5.3; IRR, 3.8 [95% CI, 3.5-4.1]).

Board certification in EM was associated with lower opioid prescribing rates. The average TDS of opioids per Medicare beneficiary was lower for board-certified EM physicians compared to non-EM board-certified physicians staffing EDs between 2018 and 2020.

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