Andrew R. Olenski

Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use

BACKGROUND Increasing overuse of opioids in the United States may be driven in part by physician prescribing. However, the extent to which individual physicians vary in opioid prescribing and the implications of that variation for long‐term opioid use and adverse outcomes in patients are unknown. METHODS We performed a retrospective analysis involving Medicare beneficiaries who had an index emergency department visit in the period from 2008 through 2011 and had not received prescriptions for opioids within 6 months before that visit. After identifying the emergency physicians within a hospital who cared for the patients, we categorized the physicians as being high‐intensity or low‐intensity opioid prescribers according to relative quartiles of prescribing rates within the same hospital. We compared rates of long‐term opioid use, defined as 6 months of days supplied, in the 12 months after a visit to the emergency department among patients treated by high‐intensity or low‐intensity prescribers, with adjustment for patient characteristics. RESULTS Our sample consisted of 215,678 patients who received treatment from low‐intensity prescribers and 161,951 patients who received treatment from high‐intensity prescribers. Patient characteristics, including diagnoses in the emergency department, were similar in the two treatment groups. Within individual hospitals, rates of opioid prescribing varied widely between low‐intensity and high‐intensity prescribers (7.3% vs. 24.1%). Long‐term opioid use was significantly higher among patients treated by high‐intensity prescribers than among patients treated by low‐intensity prescribers (adjusted odds ratio, 1.30; 95% confidence interval, 1.23 to 1.37; P<0.001); these findings were consistent across multiple sensitivity analyses. CONCLUSIONS Wide variation in rates of opioid prescribing existed among physicians practicing within the same emergency department, and rates of long‐term opioid use were increased among patients who had not previously received opioids and received treatment from high‐intensity opioid prescribers. (Funded by the National Institutes of Health.)

Sex Differences in Physician Salary in US Public Medical Schools

IMPORTANCE Limited evidence exists on salary differences between male and female academic physicians, largely owing to difficulty obtaining data on salary and factors influencing salary. Existing studies have been limited by reliance on survey-based approaches to measuring sex differences in earnings, lack of contemporary data, small sample sizes, or limited geographic representation. OBJECTIVE To analyze sex differences in earnings among US academic physicians. DESIGN, SETTING, AND PARTICIPANTS Freedom of Information laws mandate release of salary information of public university employees in several states. In 12 states with salary information published online, salary data were extracted on 10 241 academic physicians at 24 public medical schools. These data were linked to a unique physician database with detailed information on sex, age, years of experience, faculty rank, specialty, scientific authorship, National Institutes of Health funding, clinical trial participation, and Medicare reimbursements (proxy for clinical revenue). Sex differences in salary were estimated after adjusting for these factors. EXPOSURES Physician sex. MAIN OUTCOMES AND MEASURES Annual salary. RESULTS Among 10 241 physicians, female physicians (n = 3549) had lower mean (SD) unadjusted salaries than male physicians (

Sex Differences in Faculty Rank Among Academic Cardiologists in the United StatesClinical Perspective

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Firearm injuries and NRA annual conventions - Authors' Response

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