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
23 Comments
Here is a how-to from the Bible of modern medical practice--Medical Economics, on how physicians can augment their incomes, nicely in some cases by getting into the clinical trials gig. Link below:
http://medicaleconomics.modernmedicine.com/memag/Adding+ancillaries/Adding-Ancillaries-Clinical-trials/ArticleStandard/Article/detail/278021
Just for the record, Adrian Fugh-Berman is a professor of alternative medicine (placebo). It is time to end your endless promotion of her snake oil. She is against all legitimate science in order to promote her placebo views. Let’s just throw out the last 50 years of innovation and go back to leaches and amputations. This way doctors will feel better about themselves, believing they have magically healing gifts and we will all live to the ripe old age of 40.
Now you know why doctors gladly take inducements to write Rxs. Its an entitlement philosophy that the world and society owe them something. Wonder how they would feel about a mechanic upcharging them for a new engine or an engine rebuild when all it needed was spark plugs changed?
These folks need prosecution as much as pharma execs. Time is up. Listen up DOJ
Master Wayne, you nailed it!! The corruption at places like the Cleveland Clinic, National Jewish and so on is vial and something needs to be done. Big pharma/device and paid off KOL's still laughing all the way to the bank! All with monies stolen from the U.S. Treasury.
My OB-GYN neighbor complains that his income has beeen stuck in the $275,000-$325,000 range for the last five years, yet his malpractice premiums have increased despite no lawsuits. He just signed a new office lease increasing his rent by 25%. He feels that as a result he is not as financially sound as he was five years ago. The numbers don't lie.
The anti-doc faction needs to realize that pharma has molecules, but does NOT treat patients, and is NOT doctors. We need doctors and patients to complete the circle of care. We need doctors to teach our future prescribers the finer points and nuances of the drug. A number in the PI based on a stilted Phase III study does not tell you the whole story. All these considerations are for better and safer care of the patients, first and foremost. Yes, there is a profit motive as there is a profit motive when Dr Fugh-Berman teaches her anti-pharma courses but the two do not have to be mutually exclusive. Doctors have to be compensated for the time they travel, prepare, lecture, teach. Frankly given all the nonsense they have to put up with (speaker training, endless compliance training, travel in coach, paperwork, etc) the compliance validated and approved honorarium prorated on an hourly bases is less than the hourly wage of a administrative assistant. If I was a KOL offered a lecturing gig I would not take it. I could make more money moonlighting for a managed market organization reviewing patient files to deny them treatment and RX coverage. I am frankly surprised that the medical profession tolerates this drumbeat of insinuation of undue influence.
P G it isn't an insinuation of undue influence, there is direct proof that Big Pharma buys off KOL's and they can make more money speaking than practicing medicine. The public is clued in, and the term is "quid pro quo". Frankly what has pharma brought to the table in the last 10 years besides the typical XL's XR's and me too compounds? Now the game, because of liability is to pay off guys to do "CME". The Pharma industry has bastardized CME's now to the point that it is repulsive! I get the feeling you are not a long time veteran and believing whatever your management team tells you, but they are liars, thieves and criminals to the core. Remember, "Charm is deceptive and beauty is fleeting"
wow! you still say "honorarium"? that's so bad ol' days. and the going upper cap for hourly work is $500 last I checked. maybe you shouldn't pay your admins so much.
of course doctors should be properly compensated for their work. who would argue with that? but it's interesting to note that the wage stagnation that has killed the lower and middle classes is finally being felt by the lower-upper class. but we all know who made a profit last year, right?
This speaks to a larger concern about the government's emerging presence in healthcare. It's arguable that if the government has its way, physicians will be government employees, which may provide even more incentive to supplement income. Physicians have definitely experienced decreased incomes due to constraints and high liability insurance. Primary Care Physicians, for example, get the worst of it, while specialists are still able to sustain higher compensation.
I agree there is a need for clinicians to adequately "test" these compounds - not just the safety, but the value. Even the "me-too" compounds - which often are promoted on the benefits of quality of life, better compliance, etc - need to be tested to ensure the additional costs are getting the benefits. And the clinicians need to be compensated. The legitimate, "above board" fees are fair - and I do think that the docs earn every cent of those monies - however, it is the "behind the scenes, off the books,kickbacks that are destructive and are what are really influencing prescribing behaviors. I'm not sure that we will ever have an accurate portrayal of the millions of dollars that are spend in this way. The docs that accept them and the pharma companies that pay them need to be appropriately penalized. Even the Pfizer award of over $2B was inadequate relative to the dollars generated by the company. Until the fines and other penalties become greater than the financial rewards, we will continue to see this behavior and all involved will chalk it up to the costs of doing business.
P F Great Post, the fact of the matter is, that if the DOJ/HHS is serious about enforcement of the Parker Doctrine, the bouncing VP's from company to company who then become CEO's of other companies etc. Heads should roll! People should go to prison as examples and they should put the fear of God into them! Many dirty people who are involved in coverups at company A, then becomes CEO of company B, or perhaps President US sales for company C. Or better yet leaves company A and becomes a consultant for company A. It is incestuous!
Heck you could even get elected as the Governor of Florida!!
Bruce, mechanics are bigger ripoff artists than doctors, hard to believe I admit. BTW, you can buy the same software diagnostics that your mechanic uses so that when the "check engine" light goes on, you may indeed only need a spark plug change when your mechanic says you need a new engine. A doctor would NEVER do something so egregious.
Dear Original Industry Insider,
About your comment "My OB-GYN neighbor complains that his income has beeen stuck in the $275,000-$325,000 range for the last five years, yet his malpractice premiums have increased despite no lawsuits. He just signed a new office lease increasing his rent by 25%. He feels that as a result he is not as financially sound as he was five years ago. The numbers don’t lie."
Your neighbor "may not be as financially sound as he was five years ago", but I am sure he is not starving. "The numbers don't lie"...well how about NOT signing a lease with a 25% increase? Who forced him to do that?
How about the patients who are harmed by bad drugs and devices pushed by these doctors who are nothing more than industry shills? Bet they would love to have your ObGyn neighbor's problems...they don't have their health or their jobs, or their homes, or etc, etc.
Dear Original Industry Insider,
About your comment...
"Bruce, mechanics are bigger ripoff artists than doctors, hard to believe I admit. BTW, you can buy the same software diagnostics that your mechanic uses so that when the “check engine” light goes on, you may indeed only need a spark plug change when your mechanic says you need a new engine. A doctor would NEVER do something so egregious."
You are kidding, aren't you?
Dear Not New to Any of This,
"but they are liars, thieves and criminals to the core."!!
AMEN!
Big Pharma has paid $19.2 BILLION DOLLARS
continuing the above post...
in fines due to DOJ prosecutions!!
There should be a "Three strikes, you're out" rule for the criminal corporations who continue to lie, cheat, steal and harm thousands and thousands of patients because of GREED!!
Lana 19.2 Billion is peanuts to how much they are pilfering, and profiting. They always find a subsidiary guilty, dump them give that shell corp the death penalty, the stock goes up once settlement announced. Thus the parent company just keeps going business as usual.
Here is something you must think about with Big Corporations. They overlap boarders, and I really wonder who has more power, the Government or Big Pharma. An example of Big Corp Greed goes back to WW 2. Coca-Cola an American Corp from Atlanta Ga. gave a drink a day to every US soldier overseas! Way to go for the Red White and Blue right? Ahhh NO. You see Coke spun off a little company called Fanta and they had an orange drink. It was the Drink of the SS.
IBM used to have all those punch cards and used machines to read the punch cards long ago remember? It just so happens that the Tattooed numbers on every prisoner from the concentration camps within Germany during WW 2 had an IBM card that corresponded with them, thus IBM solds Millions and Millions of cards to the Germans during the war, and aided in the tracking sending Millions to their slave labor and death camps! Kind of makes you feel all warm and fuzzy doesn't it?
Big Pharma they are in it only for the good right? Hardly!
Lana, please clarify your question:
1) are you questioning whether mechanics are bigger ripoff artists than doctors?, or
2) mechanics will try and hit you up for a new engine when only a tunup is required. True story, although it was not my diagnostic software but another mechanic. The first mechanic was from the dealer, who tried to rip me off $4000 for a new engine whereas the problem, as found by the second mechanic was merely moisture in the spark plugs, requiring only a $150 tuneup.
I should have mentioned that my OB-GYN friend with the 25% rent markup also got an office renovation out of the deal, so not too bad. And yes he has had to downsize his lifestyle (not leasing a new Audi A8) this year because he is paying well over $100,000 in malpractice premiums this year).
Not New, IBM's punch card computing systems were also the earliest digitized mechanism utilized in presidential elections in the United States. You conveniently forgot that fact, or maybe we should go back to paper and pencil ballots because IBM sold punch card machines to the Nazi's.
Dear Original Industry Insider, Seems it's all a joke to you. Why is that?
Dear Not New to Any of This, Exactly! $19.2 billion dollars is nothing to Big Pharma. Especially when it is spread out among more than one company. J&J made $13 billion dollars in profit in 2006 alone. Why do they care who they hurt? They just keep raking in the dough with all the fraud and corruption and keep hurting people.
LK I didn't respond to OII's logic, because they obviously didn't understand my post. The Parker Doctrine has everyone really scared. I think 3 or 4 examples and you'll see some changes finally. DOJ/HHS realizes for it to stop it has to hurt!
The internet has a part to play in this by way of accountability. Something that might have been an office rumour 10years ago could now circle the globe and reach millions of people within hours. It makes everyone nervous, can we really say that bungs did't take place much more often before the advent of the internet?