Practice Patterns for Physicians and Non-Physician Providers Performing Common Spine Procedures 2018-2022

Background and/or Objectives: Spine procedures, including interventional pain management and diagnostic imaging, are performed across multiple specialties, reflecting the diverse approaches to spine care. Understanding the distribution of physicians performing these procedures, along with their specialty backgrounds and fellowship training, is essential for assessing workforce trends and identifying potential gaps in expertise. This study aims to analyze the practice patterns of physicians performing spine procedures from 2018 to 2022, focusing on specialty representation and the role of subspecialty training.

Design: Cross-sectional study. Pain fellowship status was obtained using Python code to search the physician websites and the board websites.

Setting : Outpatient.

Participants : Providers who perform sacroiliac joint (SIJ) injections (CPT:27096), nerve blocks (CPT:64451) and radiofrequency ablation (RFA; CPT:64625), interlaminar epidural injections (ILESI; 62321,62323), medial branch blocks (CPT:64490-64495); RFA (CPT:64633-64636), transforaminal epidural steroid injections (TFESI; CPT:64479, 64480, 64483- 64484), genicular nerve block (CPT:64654) and genicular RFA (64424) on Medicare patients.

Interventions: None.

Main Outcome Measures: Physician gender, location (state; rural-urban-commuting area code designation), specialty and sub-specialty certification, number of services provided and Medicare payment.

Results: The number of services performed decreased by 24.6% from 2018-2022. Lumbar TFESI was the most common followed by lumbar ILESI, and SIJ nerve block being the least common. Almost all procedures were performed by physicians, with NPs/PAs performing < 1% of procedures (SI Joint and lumbar ILESI being the most common). The most common national provider identification listed specialty was pain, followed by anesthesia and PM&R. Pain fellowship trained physicians performed 60-88% of the listed procedures, averaging at 76%, and this proportion did not significantly change 2018-2022.

Conclusions: The number of spine procedures is declining and they are primarily performed by physicians, trained in pain medicine. Future studies should evaluate if there are outcome differences depending on fellowship training.