The ongoing controversy over financial ties between physicians and the pharmaceutical industry centers, of course, on concerns that medical practice may be unduly influenced. Throughout the debate, many doctors regularly express frustration and indignation that the public may believe their judgment can be swayed by freebies, fees or other forms of compensation for their time and efforts.
Meanwhile, some physicians do complain they are insufficiently compensated. In general, there are numerous reasons - years of intense and costly education and training; stressful interactions with insurers over procedures, payments and billing; rising malpractice insurance premiums; increasing second-guessing from patients who scour the Internet, and long hours, among other things.
Consequently, a recent survey by Medscape found that 48 percent of specialists feel they are unfairly compensated and 52 percent of primary care doctors feel the same way. To some, this may be a 'glass-half-full' scenario - roughly half of all doctors continue to feel compensation matches their efforts. But might the percentages also suggest some docs could be vulnerable to financial overtures?
After all, doctors are human, too (please, no jokes). Moreover, there have been various studies over the years exploring financial relationships between the medical community and industry (see here). Some say recent scrutiny is forcing change; others maintain the problem persists and doctors need to recognize the issue will not go away.
We asked two people who track this topic for their response. One is Adriane Fugh-Berman, who runs the Pharmed Out program at Georgetown University that seeks to educate physicians about industry marketing (and hosts its annual conference tomorrow), and the other is Jack Lewin, who is ceo of the American College of Cardiology.
Here is what Fugh-Berman had to say: "It is interesting that almost half of docs don't feel fairly compensated, when we are, according to the US Census, the highest-earning income group. The higher level of dissatisfaction among primary care docs make sense; they work longer hours and are paid less than specialists, which isn't fair.
"In general, I think the dissatisfaction is with the job, and maybe no amount of money can compensate for the burden of long hours, frustration with payers, paperwork, decreased autonomy, and fear of lawsuits. It's difficult practicing under a standard of perfection, and many physicians feel isolated. Medical training is brutal.
"Those who make it through may feel both underappreciated and entitled, a combination that leaves them very vulnerable to pharma's blandishments. Gifts payments and, most importantly, sympathy ("you doctors work so hard") elicit gratitude and loyalty, as they are meant to. Many docs lack a sense of community with other docs. As a profession, we need to take care of - and teach - our own, without accepting industry solicitations."
And here is what Lewin had to say:"Given that physicians have been economically challenged in the last decade as compared to the good old days, and that incomes have not been increasing and in fact for many doctors compared to cost of living increases, have been decreasing…one would think that physicians are tempted to look for outside sources of revenue and, therefore, may be more susceptible from pharma and device industry folks. I don’t think that’s actually happening, though.
"Public policy has shifted so that physicians are less likely to want to take any kind of perk from industry...It's going to be publicly reported...For those who are doing research, the relationship with industry, in terms of funding, remains important, but those who are engaged in participation, in terms of education, I think most doctors are reluctant to accept funding in that regard.
"We feel very comfortable building firewalls protecting against bias and accepting funding grants from industry…but we do so with strict adherence to guidelines to make sure industry funding is not biasing activity itself…If we thought you couldn’t do it without accepting some bias from industry, we wouldn’t do it...
"The rare exceptiions who maybe are willing to receive funding for things – travel, expense, tuition for courses – are under a lot of scrutiny from their peers and patients. That wouldn’t have been the case 10 or 20 years ago…Everybody is feeling somewhat impinged these days…Medicare flat over a decade while costs are going up to a few percent each year."
pic thx to jerome kassirer