Seniority of primary care physicians is associated with a decrease in PSA ordering habits in the years surrounding...

Area of Science:

• Urology
• Preventative Medicine
• Health Services Research

Background:

• The 2012 United States Preventative Services Task Force (USPSTF) recommendation advised against prostate-specific antigen (PSA) screening.
• Primary care providers (PCPs) trained post-2012 may have different screening practices compared to more senior physicians.
• Understanding factors influencing PSA screening is crucial for optimizing prostate cancer detection and management.

Purpose of the Study:

• To evaluate the impact of the 2012 USPSTF recommendation on PSA screening practices among PCPs.
• To examine how physician seniority and individual opinions influenced PSA screening.
• To analyze trends in PSA screening relative to time since residency completion.

Main Methods:

• Retrospective review of 54,684 PCP-directed PSA orders from January 2010 to July 2015 at a tertiary care academic institution.
• Assessment of PSA screening proportions relative to unique male ambulatory clinic volume before (2010-2011) and after (2013-2015) the USPSTF recommendation.
• A survey was administered to PCPs to assess attitudes toward the USPSTF recommendation and correlate with seniority and actual screening habits.

Main Results:

• Overall PSA screening proportions did not significantly change between the pre- and post-recommendation periods.
• A significant negative trend was observed in PSA screening proportions as time since residency completion increased (R² = 0.308, P = 0.007).
• Physician survey responses showed no correlation with actual screening practices but indicated a paradoxical positive association between physician seniority and stated preference for PSA use.

Conclusions:

• PSA screening practices remained largely consistent for physicians practicing before and after the 2012 USPSTF recommendation.
• Time since residency completion was inversely associated with PSA screening rates, suggesting less experienced physicians screened fewer men.
• Provider opinions on PSA screening did not strongly correlate with their actual clinical practice, highlighting potential disconnects between attitudes and behavior.