Factor in evaluating Physicians

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dm200
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Factor in evaluating Physicians

Post by dm200 » Thu Apr 19, 2018 1:32 pm

Are any of your current or prospective Physicians receiving significant money from drug companies?

If you believe this is a factor in evaluating such Physicians https://projects.propublica.org/docdollars/

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Re: Factor in evaluating Physicians

Post by Taylor Larimore » Thu Apr 19, 2018 1:47 pm

dm200 wrote:
Thu Apr 19, 2018 1:32 pm
Are any of your current or prospective Physicians receiving significant money from drug companies?

If you believe this is a factor in evaluating such Physicians https://projects.propublica.org/docdollars/
dm200:

Thank you for this important link. It helps explain my recent hospital pharmacy charge of $37,249.84.

Best wishes.
Taylor
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gasman
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Re: Factor in evaluating Physicians

Post by gasman » Thu Apr 19, 2018 1:48 pm

Hey,

I am on the list. $47 for bagels and Panera sandwiches from several drug/device companies.

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dm200
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Re: Factor in evaluating Physicians

Post by dm200 » Thu Apr 19, 2018 1:50 pm

gasman wrote:
Thu Apr 19, 2018 1:48 pm
Hey,
I am on the list. $47 for bagels and Panera sandwiches from several drug/device companies.
Hope you enjoyed them. I suppose small amounts like this might even indicate that a Physician is trying to stay up on available drugs.

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Re: Factor in evaluating Physicians

Post by UpperNwGuy » Thu Apr 19, 2018 1:55 pm

I see nearly every doctor from my city on this list. What am I supposed to do with this knowledge?

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Re: Factor in evaluating Physicians

Post by obgraham » Thu Apr 19, 2018 2:10 pm

I'm surprised I'm not on the list. Except I'm retired. However, several dead guys in my town are on there.

Interesting when you get to the details. A company comes out with some new device. You go and have them show you how to use it. Then you get listed as "non-accredited training", and someone on the web tries to show you are a crook.

What a great system we have here!

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Re: Factor in evaluating Physicians

Post by nisiprius » Thu Apr 19, 2018 2:20 pm

UpperNwGuy wrote:
Thu Apr 19, 2018 1:55 pm
I see nearly every doctor from my city on this list. What am I supposed to do with this knowledge?
Be aware of it; perhaps be ready to at least ask a question or two if your doctor is recommending a drug that's being advertised direct-to-the-consumer on TV, for which there are old equivalents; and hope that ProPublica's publicizing the issue results in changes, in time.

Pretty interesting to me. Going over doctor's I've seen within the last ten years, the numbers I see are: two not listed (presumably $0), $12 (my current PCP), $21, $121, $688, $790, and $15,108. I'm not going to worry about my PCP receiving $12.
Last edited by nisiprius on Thu Apr 19, 2018 2:23 pm, edited 1 time in total.
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Re: Factor in evaluating Physicians

Post by dm200 » Thu Apr 19, 2018 2:21 pm

obgraham wrote:
Thu Apr 19, 2018 2:10 pm
I'm surprised I'm not on the list. Except I'm retired. However, several dead guys in my town are on there.
Interesting when you get to the details. A company comes out with some new device. You go and have them show you how to use it. Then you get listed as "non-accredited training", and someone on the web tries to show you are a crook.
What a great system we have here!
Receiving training does not mean a Physician is a crook.

The issue, it seems to me, is the bias (especially woth drugs) of receiving compensation related to prescribing expensive drugs from the manufacturers.

Physicians usually claim to be "impartial" (I believe) - just like an "independent" financial advisor might do. What might we think if such an "independent" financial advisor was documented to be receiving many thousands of dollars (not just a donut and coffee) of payments from a particulat mutual fund company?

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dm200
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Re: Factor in evaluating Physicians

Post by dm200 » Thu Apr 19, 2018 2:22 pm

I'm not going to worry about my PCP receiving $12.


Neither would I..

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Re: Factor in evaluating Physicians

Post by obgraham » Thu Apr 19, 2018 3:03 pm

The issue, it seems to me, is the bias (especially woth drugs) of receiving compensation related to prescribing expensive drugs from the manufacturers.
Do you really think that the average physician is going to be influenced adversely by a pizza or sub-sandwich lunch for him/her and some of the office staff while a drug rep discusses his new, and admittedly often overpriced drug?

If so, the medical profession has a much bigger issue to deal with.

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Re: Factor in evaluating Physicians

Post by nisiprius » Thu Apr 19, 2018 3:10 pm

obgraham wrote:
Thu Apr 19, 2018 3:03 pm
The issue, it seems to me, is the bias (especially woth drugs) of receiving compensation related to prescribing expensive drugs from the manufacturers.
Do you really think that the average physician is going to be influenced adversely by a pizza or sub-sandwich lunch for him/her and some of the office staff while a drug rep discusses his new, and admittedly often overpriced drug?
Yes, I really think so. There's the issue of comfort, camaraderie, cronyism. It's probably not the pizza so much as it is lunch as an way to get time in the doctor's busy day to chat in a friendly way. It's all indefinite. I mean, how about the companies that give doctors those big plastic models of vomeronasal organs and gizzards and abomasums that the doctor can use in patient education? It's not so much that the gift has a retail value of $277 as that it makes the doctor just kind of feel good about the drug detail rep.

One of the things about advertising is that it influences you even if you know it is intended to influence you. The same thing for this kind of activity.
Last edited by nisiprius on Thu Apr 19, 2018 3:13 pm, edited 1 time in total.
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Re: Factor in evaluating Physicians

Post by staythecourse » Thu Apr 19, 2018 3:13 pm

dm200 wrote:
Thu Apr 19, 2018 2:21 pm
obgraham wrote:
Thu Apr 19, 2018 2:10 pm
I'm surprised I'm not on the list. Except I'm retired. However, several dead guys in my town are on there.
Interesting when you get to the details. A company comes out with some new device. You go and have them show you how to use it. Then you get listed as "non-accredited training", and someone on the web tries to show you are a crook.
What a great system we have here!
Receiving training does not mean a Physician is a crook.

The issue, it seems to me, is the bias (especially woth drugs) of receiving compensation related to prescribing expensive drugs from the manufacturers.

Physicians usually claim to be "impartial" (I believe) - just like an "independent" financial advisor might do. What might we think if such an "independent" financial advisor was documented to be receiving many thousands of dollars (not just a donut and coffee) of payments from a particulat mutual fund company?
I think those are good points for the consumer to keep in mind.

Just keep in mind a couple different scenarios. One is if Drug or Device company x wants to show you their new product or drug that may be beneficial to your patients they only real time to do it is during lunch. This is the only time that any medical office has to devout their physicians, nurses, PA's, and MA's to hearing about any new device or drug on the marketplace. Yes they buy you lunch. Think Panera not gourmet steakhouse. The second is drug or device company paying the doctor to do speaking engagements or work with them for whatever reason. Those fees are in the 5 or even 6 digits per year. BOTH of these 2 scenarios gets logged in to this system.

As a consumer I would not be worried about the first scenario, but would be VERY apprehensive of the second scenario. I think it is VERY hard to say you are impartial if you are doing speaking engagements for the company you are advocating for in your practice. This is one of the BIG reasons I have turned down every offer to talk on behalf of companies FOR MONEY. I have told each one I am more then happy to do a free public seminars to help educate the public, but won't do it for money.

Good luck.

P.s. It is funny how everything thinks doctors are rich, but can be bought by a free $5 sandwich. It is sad how much mistrust there is between doctor and patient in today's world. No one is to blame, but just sad.
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Re: Factor in evaluating Physicians

Post by BogleMelon » Thu Apr 19, 2018 3:15 pm

OP, the link you posted is nice, thanks for that, but I think it stopped at the year 2015. Or may be it is just my state database?!
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Re: Factor in evaluating Physicians

Post by new2bogle » Thu Apr 19, 2018 3:30 pm

OP, thanks for posting this.

I see the ENT I went to a couple of years ago got north of $70k in payments in just 2015.

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Re: Factor in evaluating Physicians

Post by jpa » Thu Apr 19, 2018 3:32 pm

4th year med student here, graduating next month--

My experience during 3rd/4th year rotations, in many private practice offices, is that most physicians are incredibly annoyed by Drug Reps. They come around 2-4 times/month wanting to show your their brochures, or even just to get a signature to prove to their bosses that they're actually out on the road. Oftentimes, the doc would just ignore them as they're behind with their patients and the reps would try to make small talk with me :?

Practically NO doctors are "going to lunch" with them. A doctor may eat a sandwich from a platter that the rep brought for the entire office (mainly nurses, secretaries, assistants eat this)...and even then that's either forbidden or only ~1/month in most offices by my estimation.

TL;DR from my experience, this is a non-issue for 98-99% of physicians .

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Re: Factor in evaluating Physicians

Post by Pajamas » Thu Apr 19, 2018 3:43 pm

nisiprius wrote:
Thu Apr 19, 2018 3:10 pm
I mean, how about the companies that give doctors those big plastic models of vomeronasal organs and gizzards and abomasums that the doctor can use in patient education?
Nisiprius, your doctor has plastic models of gizzards and abomasums in the office? :shock:

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Re: Factor in evaluating Physicians

Post by SlowMovingInvestor » Thu Apr 19, 2018 3:47 pm

Among the doctors with the top payments, there is a family medicine doctor who received $43M !

That intrigued me enough that I looked it up to find the doctor and her husband (also a doctor) sold a company to Abbot Labs. I actually think its quite creditable if the doctor continues to practice family medicine (one of the lowest paying disciplines) after making that much money. [ And absolutely nothing wrong with that ethically, just the number is eye-popping]

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Re: Factor in evaluating Physicians

Post by 123 » Thu Apr 19, 2018 3:53 pm

I have sometimes taken elderly family friends to see their doctor who has a small practice with maybe 3 other physicians. I am constantly amazed at the parade of what I presume are pharmaceutical sales reps that stop by the office asking to see one of the physicians just about every time I am sitting in the waiting room. Most of the time the receptionist just tells them to go away but they inevitably depart after leaving some kind of reading material, sometimes a package, for one of the physicians. For the pharma companies to support such a sales force there is obviously a big mark-up in the price of their products.
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Re: Factor in evaluating Physicians

Post by CFIT » Thu Apr 19, 2018 4:01 pm

I think that it does influence physicians even if it is not buying them off with cash. It places the companies and their representatives as pals or allies of the doctor who will be looked at more favorably than an entity that has not provided a meal.

I saw the same situation with IT vendors when I was an IT manager and never partook of the hospitality.

Like corporations donating money to politicians, why would they do it if there was no benefit?
obgraham wrote:
Thu Apr 19, 2018 3:03 pm
The issue, it seems to me, is the bias (especially woth drugs) of receiving compensation related to prescribing expensive drugs from the manufacturers.
Do you really think that the average physician is going to be influenced adversely by a pizza or sub-sandwich lunch for him/her and some of the office staff while a drug rep discusses his new, and admittedly often overpriced drug?

If so, the medical profession has a much bigger issue to deal with.

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Re: Factor in evaluating Physicians

Post by Allixi » Thu Apr 19, 2018 4:03 pm

staythecourse wrote:
Thu Apr 19, 2018 3:13 pm
P.s. It is funny how everything thinks doctors are rich, but can be bought by a free $5 sandwich. It is sad how much mistrust there is between doctor and patient in today's world. No one is to blame, but just sad.
It's actually still a pretty good relationship in the US.

Try going to China to get a sense of REAL mistrust between patients and doctors' profit motives.

When I gave talks/presentations/reports in residency, I'd always say "I WISH I had some financial conflicts of interest to disclose" :D

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Re: Factor in evaluating Physicians

Post by PharmVest » Thu Apr 19, 2018 7:22 pm

While I don't think the vast majority of physicians will be swayed by Drug reps and lunches. I do think this is an issue worth discussing or knowing about. I'm a pharmacist that (about 8-10 years or so ago) had some influence (but no direct authority) over my hospitals drug formulary.

We had one drug rep who did bring lunches from time to time for the departments journal club meetings or other staff educational meetings. It was a drug rep with an expensive drug that was necessary in the hospital but didn't have any generic equivalents, etc. Every one felt this was fine since the journal clubs, educational meetings had nothing to do with the drug or company, etc - the drug rep was just "being nice" since our hospital used his drug. No one saw a problem with this for a long time.

Eventually, we were talking about what might happen when the drug did become generic (or a competitor would give a better deal on the drug, etc). More than one person mentioned that they'd feel bad "hurting" the drug rep's business and job since he'd been so nice to us for so long and we stopped using this drug.

It was pretty obvious what we had to do after that conversation. We stopped all interaction with all drug reps and made a "zero tolerance" policy for accepting anything, no matter the situation. Times are quite a bit different now, but I think even if you aren't "swayed" to use a drug you wouldn't otherwise - there is a component of building rapport that might make you less likely to use a different agent. Physicians are professionals, but they are humans also.

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Re: Factor in evaluating Physicians

Post by jayk238 » Thu Apr 19, 2018 7:45 pm

Theres too many assumptions here.

Yes the concept of advertising and influence weigh heavily for even trivial gifts such as pens and small meals and the research seems to show this.

But what I disagree with is the impact it has specifically to the average practicing clinician.

As someone else mentioned above most of the time doctors are too busy. Have I seen doctors cozied up too much to pharm reps? Yes but they weren't nearly as ethical as others to begin with. Most of the doctors I work with spend the least amount of time they can with the drug rep, quickly sign off and eat a quick bite. And a lot of the times they eat after the drug rep leaves.

My point is, there is rarely the micro-influences that researches seem to fall over each other about. These things don't really influence us because of our time issues.

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Re: Factor in evaluating Physicians

Post by UpperNwGuy » Thu Apr 19, 2018 8:39 pm

I will withhold any opinion on the doctors, but I have strong opinions on the pharma reps. I have sat in doctor's waiting rooms and watched the pharma reps come in and try to set up lunches for the entire doctor's office. The whole process is absolutely slimy. Before I retired, I was an executive in a large government organization, and I was bombarded by equally slimy visits from vendors trying to sell products and services to my organization. What I see in the doctor's reception areas brings back too many bad memories of my work environment.

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Re: Factor in evaluating Physicians

Post by JVV » Thu Apr 19, 2018 8:48 pm

I don't think drug/medical device companies would spend their money unless they felt like they were getting something out of it. It is more than the cost of Panera lunch, it is the rep's time that the companies pay for as well.

Even small gifts have influence - https://www.bmj.com/content/354/bmj.i4189

Everyone thinks they are immune to the effects of small gifts and advertising - almost all are wrong.

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Re: Factor in evaluating Physicians

Post by tic » Thu Apr 19, 2018 9:06 pm

Physician here. Knowing that drug and device companies spend tens of billions of dollars annually on marketing to physicians, and knowing that there is a zero percent chance they would spend that money unless they were confident they were generating at least that much money in additional sales, I refuse to take so much as a bagel from a drug rep. I won't even go to their dinners and just not eat the free food, lest my name show up on some list like this and lead my patients to question my motives. I will allow each rep one meeting (I have even driven in on my day off) to make his/her spiel to make sure I'm educated on the product. I usually grill them will uncomfortable questions about the outrageous cost of their product and tell them I'm not going to use it. After that meeting, I will never talk to them again.

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Re: Factor in evaluating Physicians

Post by DiehardDoc » Thu Apr 19, 2018 9:32 pm

Physician Couple . Database states we have received $100 and some change from some drug companies in 2014 and 2015. When did they spend money on us? Drug reps are not allowed in our office.We don't attend any drug sponsored talk/dinners either.It appears that they are counting stuff that they send in mass mail to all doctors like samples of benadryl, tylenol etc. From our point of view, this database is probably inaccurate for most practicing doctors like us.

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Re: Factor in evaluating Physicians

Post by rjbraun » Thu Apr 19, 2018 9:37 pm

dm200 wrote:
Thu Apr 19, 2018 1:32 pm
Are any of your current or prospective Physicians receiving significant money from drug companies?
A neurologist I saw a couple of times shows $125K. That's even more than I think was listed the last time I checked the list! Not just food, obviously, but speaking fees, consulting fees, travel, lodging ...

He was a "nice guy", but I must say that he prescribed me some meds that didn't necessarily make so much sense to me when I googled them. More importantly, they struck my sister, an MD, as odd, to say the least, when I happened to mention them to her. I never took any of them, by the way.

To his credit, he did call me one evening and was very thorough in reviewing some test results, iirc.

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Re: Factor in evaluating Physicians

Post by UpperNwGuy » Thu Apr 19, 2018 9:49 pm

tic wrote:
Thu Apr 19, 2018 9:06 pm
Physician here. Knowing that drug and device companies spend tens of billions of dollars annually on marketing to physicians, and knowing that there is a zero percent chance they would spend that money unless they were confident they were generating at least that much money in additional sales, I refuse to take so much as a bagel from a drug rep. I won't even go to their dinners and just not eat the free food, lest my name show up on some list like this and lead my patients to question my motives. I will allow each rep one meeting (I have even driven in on my day off) to make his/her spiel to make sure I'm educated on the product. I usually grill them will uncomfortable questions about the outrageous cost of their product and tell them I'm not going to use it. After that meeting, I will never talk to them again.
I like your approach!

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Re: Factor in evaluating Physicians

Post by Floyd1000 » Thu Apr 19, 2018 9:56 pm

My wife and I are both doctors. I checked the list and she received $242, I received $0. I always knew I was the more ethical of the two of us!

Just kidding. I think she got a free meal.

If this is an ethical dilemma, who is to blame? Are doctors always to blame, or could we blame pharmaceutical companies, lawyers, MBAs, politicians, and a judgmental but uneducated public who want to label doctors as rich and greedy but overlook the fact that less than 10% of health care dollars go to those who provide care to patients?

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Re: Factor in evaluating Physicians

Post by Miriam2 » Thu Apr 19, 2018 10:09 pm

nisiprius wrote: I mean, how about the companies that give doctors those big plastic models of vomeronasal organs and gizzards and abomasums that the doctor can use in patient education? It's not so much that the gift has a retail value of $277 as that it makes the doctor just kind of feel good about the drug detail rep.
Pajamas wrote: Nisiprius, your doctor has plastic models of gizzards and abomasums in the office? :shock:
. . . and Nisi's doctor has vomeronasal organ models? :shock:
The vomeronasel organ (VNO) is an auxiliary olfactory sense organ that is found in many animals. It is close to the vomer and nasal bones.
Well, Nisiprius is an animal (not a plant) and apparently has vomer and nasal bones.
What animals have vomeronasal organs?

The functional vomeronasal system is found in many animals, including all snakes and lizards, plus many mammals, such as mice, rats, elephants, cattle, dogs, cats, goats, pigs, giraffes and bears. Salamanders perform a nose-tapping behavior to presumably activate their vomeronasal organ.
Nisiprius - what kind of doctor are you seeing? :confused

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Re: Factor in evaluating Physicians

Post by White Coat Investor » Thu Apr 19, 2018 10:27 pm

When the list came out I decided it wasn't worth a sandwich to be on it. As you'll notice, I'm not on the list.

A few of my partners are on there for $12-65 from Xarelto (a blood thinner we use all the time.) The local GI doc is on there for $75K. Looks like he did some promotional speaking for some drug companies. I think that's where the large amounts come from. But guess what? You want me to go speak to a group of docs? I expect to get paid too.
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Re: Factor in evaluating Physicians

Post by TheNightsToCome » Thu Apr 19, 2018 10:34 pm

tic wrote:
Thu Apr 19, 2018 9:06 pm
Physician here. Knowing that drug and device companies spend tens of billions of dollars annually on marketing to physicians, and knowing that there is a zero percent chance they would spend that money unless they were confident they were generating at least that much money in additional sales, I refuse to take so much as a bagel from a drug rep. I won't even go to their dinners and just not eat the free food, lest my name show up on some list like this and lead my patients to question my motives. I will allow each rep one meeting (I have even driven in on my day off) to make his/her spiel to make sure I'm educated on the product. I usually grill them will uncomfortable questions about the outrageous cost of their product and tell them I'm not going to use it. After that meeting, I will never talk to them again.
"... nowing that there is a zero percent chance they would spend that money unless they were confident they were generating at least that much money in additional sales, I refuse to take so much as a bagel from a drug rep."

I agree. I never talk with the reps and never take their food or any other offering. They all know to give me a wide berth.

Yet, this website says that I accepted $77 in gifts! Not sure how this was figured.

"I will allow each rep one meeting (I have even driven in on my day off) to make his/her spiel to make sure I'm educated on the product."

A drug rep is the last person I'd rely on for education.

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Re: Factor in evaluating Physicians

Post by hmw » Thu Apr 19, 2018 10:44 pm

I got $150 over 2 years. The big payment to docs are usually for speaking fees, and consulting.

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Re: Factor in evaluating Physicians

Post by toofache32 » Thu Apr 19, 2018 11:07 pm

Very interesting, and after viewing my own profile as a surgeon, I can see how this doesn't really tell the whole story in the slightest bit. Is this different info from the CMS Sunshine act website that has been around for years? I'm on the list for a total of about $1500 over a 3 year period. The biggest chunk was $500 for "travel and lodging" when a company who makes bone plates/screws I use flew me to their headquarters in Florida. I helped them design a new instrument which will soon make it to the market. I received no real compensation for this other than hoping I can talk my hospital into buying this instrument to help me do better surgery. They will make tens of thousands of dollars selling this....maybe I should have asked for a piece of the pie. Another big transaction on my list was for a cadaver course we arranged with the local med school to teach our residents surgical techniques. It was an entire Saturday so the plate/screw company brought in lunch for us. Interesting that they also bought the cadavers for around $5000 total, but it seems those were not added to my profile. Another "transaction" for $99 I had to think about....I participated in a multi-center trial on cadaver nerve grafts for a sensory nerve. We followed patients for 1 year post-operatively and measured their nerve sensation progress with a nerve testing tool that costs about $99. I didn't know it at the time, but they gave me that tool for free but now I see they submitted this $99 as payment. I still have it on my desk as a paperweight now that the study was concluded and published last year. Interestingly, that company has a new rep covering my hospital. She showed up a couple weeks ago with her nerve graft product and was fairly pushy and annoying. She pulled out a scientific published article from one of our medical journals to show me and said "this research shows how patients can achieve up to 80% of nerve recovery in only a few months." I glanced at the article and said "yeah I know....I wrote that paper." and circled my name on it. I said "Know your audience" and walked off.
Lastly, I've got several $30-80 entries which are dinners. I hate doing dinners because I would rather go home with my family, but these were dinners where the plate/screw companies wanted to show me their new products that are about to show up in my hospital and see if they would be useful to my surgeries. Some were, some weren't.

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Re: Factor in evaluating Physicians

Post by barelybarefoot » Fri Apr 20, 2018 12:44 am

I’m an MD not on the list but that’s partly because I work for megacorp that has very strict policies about drug rep interactions. I do pick up free schwag at meetings especially models of things I use to educate patients. Can’t use ‘generic’models since they’re the only product available. But, went to a meeting recently and trying to keep costs down opted to try and share a cab from the airport. Nice young man agreed to share with me, I got off at his 5 star hotel where he proceeded to decline my half of cab fare since it was on pharma. I walked from there to my 2 star hotel.

I must say I’m glad my hospital does not allow drug reps in otherwise you bet i’d be there to grab a free effortless meal during the 5 min of ‘lunch break’ have from patient care.

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Re: Factor in evaluating Physicians

Post by quantAndHold » Fri Apr 20, 2018 1:33 am

The last time my dog was at the vet, a drug rep came in and left cookies. Is there a similar list for veterinarians?

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Re: Factor in evaluating Physicians

Post by SGM » Fri Apr 20, 2018 4:08 am

Years ago a young attending would try to shame the residents who were receiving pens and eating sandwiches provided by drug reps. That young attending with self assessed "superior morals" was later sanctioned by the State Board of Physicians for illicit drug use. :twisted:

Advertising of drugs directly to the public may be more harmful than pharmaceutical reps trying to influence physician prescribing practices. Good physicians keep a skeptical attitude towards drug claims. Post-marketing research often turns up adverse effects and drug interactions that were unknown at the time the medications were approved.

We had a limited amount of free drugs that we could give to indigent patients, but drug reps were not allowed to talk to physicians in the last two facilities I worked at.

Although retired, I still attend Grand Rounds and complete AMA approved continuing medical education courses. I enjoy the intellectual and social stimulation and like to keep up with some interesting research.

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Mrs.Feeley
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Re: Factor in evaluating Physicians

Post by Mrs.Feeley » Fri Apr 20, 2018 4:33 am

I looked up my physicians in that database. One appears to have received thousands of dollars from a medical equipment maker. Clicking through for details I see that most of the money was dispersed in increments of $15-$30 for travel to classes, dozens of them, for learning how to use a robotic surgical device. Since he recently saved my life using that robotic surgical device I am really, really, really grateful to whoever paid his cab fare or whatever to the classes.

I was however distressed by the reimbursements for his meals while attending those classes. One day he got only $3 worth of meal reimbursements. Another day only $7. There is one day where he appears to have eaten only $2 worth of food. Good heavens, he is a probably-still-growing young man, he needs more food than that! :shock:

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oncorhynchus
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Re: Factor in evaluating Physicians

Post by oncorhynchus » Fri Apr 20, 2018 4:39 am

Much to my surprise, I ended up on the list for less than $10. Only thing I can think of is the lunch period I spent watching a webinar about Eliquis right after it got its FDA approval for treatment of venous thromboembolic disease. No food was involved, just the presentation on the web.
Funny thing is, I work for the federal government, and am pretty limited to a set formulary of pre-approved medications. Drug reps haven't been around for years now; more likely they're not trying to influence doctors, but insurance companies to put the drugs on approved formulary lists.

I also think that direct-to-consumer advertising is way more problematic than supposed fat kickbacks from Big Pharm to practicing physicians.

o
-- Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime. --

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Re: Factor in evaluating Physicians

Post by Swansea » Fri Apr 20, 2018 5:14 am

A friend, whose wife is a PA, used to get invited with her by drug reps to very upscale restaurants. The the rules changed, and only the medical professionals were invited.
I can spot a drug rep at a medical center in a heartbeat. It is a combination of demographics, stylish dress, and the inevitable cart with their handouts. Oh, and sometimes the multiple cups of coffee and donuts for the staff give them away.

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Re: Factor in evaluating Physicians

Post by Chip » Fri Apr 20, 2018 5:24 am

My GI doc received 170k. Do I win a prize? :shock:

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Re: Factor in evaluating Physicians

Post by samsoes » Fri Apr 20, 2018 6:39 am

obgraham wrote:
Thu Apr 19, 2018 2:10 pm
I'm surprised I'm not on the list. Except I'm retired. However, several dead guys in my town are on there.

Interesting when you get to the details. A company comes out with some new device. You go and have them show you how to use it. Then you get listed as "non-accredited training", and someone on the web tries to show you are a crook.

What a great system we have here!
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Re: Factor in evaluating Physicians

Post by Nthomas » Fri Apr 20, 2018 6:52 am

We had a monthly meeting in fellowship where we presented interesting cases with other fellows in the area that was sponsored by big pharma who provided food and we were told to sign in even if we did not partake in the food. I now see that those meals resulted in me being listed. Not a huge deal as it is < $300 but not an ideal situation if you aren't able to opt out and it is a fellowship requirement.

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Re: Factor in evaluating Physicians

Post by samsoes » Fri Apr 20, 2018 6:53 am

Floyd1000 wrote:
Thu Apr 19, 2018 9:56 pm
My wife and I are both doctors. I checked the list and she received $242, I received $0. I always knew I was the more ethical of the two of us!

Just kidding. I think she got a free meal.

If this is an ethical dilemma, who is to blame? Are doctors always to blame, or could we blame pharmaceutical companies, lawyers, MBAs, politicians, and a judgmental but uneducated public who want to
doctors as rich and greedy but overlook the fact that less than 10% of health care dollars go to those who provide care to patients?
The blame can be at least partially attributed to the labeling of the general public - those being served - as uneducated and judgemental.
"Happiness Is Not My Companion" - Gen. Gouverneur K. Warren. | (Avatar is the statue of Gen. Warren at Little Round Top @ Gettysburg National Military Park.)

book lover
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Re: Factor in evaluating Physicians

Post by book lover » Fri Apr 20, 2018 7:11 am

The incessant drug company advertising on T.V. gets my goat, my family Doc getting donuts or lunch not at all.

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Cycle
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Re: Factor in evaluating Physicians

Post by Cycle » Fri Apr 20, 2018 7:35 am

Everything you'll find on there is peanuts compared to if they get a royalty on the device or drug they are giving. That would generally be if they invented some portion of the device and have a patent. I'm pretty sure royalty payments aren't included in this.

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Re: Factor in evaluating Physicians

Post by carolinaman » Fri Apr 20, 2018 7:47 am

nisiprius wrote:
Thu Apr 19, 2018 3:10 pm
obgraham wrote:
Thu Apr 19, 2018 3:03 pm
The issue, it seems to me, is the bias (especially woth drugs) of receiving compensation related to prescribing expensive drugs from the manufacturers.
Do you really think that the average physician is going to be influenced adversely by a pizza or sub-sandwich lunch for him/her and some of the office staff while a drug rep discusses his new, and admittedly often overpriced drug?
Yes, I really think so. There's the issue of comfort, camaraderie, cronyism. It's probably not the pizza so much as it is lunch as an way to get time in the doctor's busy day to chat in a friendly way. It's all indefinite. I mean, how about the companies that give doctors those big plastic models of vomeronasal organs and gizzards and abomasums that the doctor can use in patient education? It's not so much that the gift has a retail value of $277 as that it makes the doctor just kind of feel good about the drug detail rep.

One of the things about advertising is that it influences you even if you know it is intended to influence you. The same thing for this kind of activity.
Doctors need to learn about new drugs and this is a way to do that. They need to have a discerning eye recognizing that the sales pitch is biased but it still may be a good product and the doctors should always be looking for new drugs that can help their patients.

As a senior technology manager, an important part of my job was to learn about new technology products and services. I met often with vendors pitching their products, sometimes at lunch. I did not take everything vendors said as gospel but these meetings were helpful in understanding how new technology could help our organization. I see this as similar to what many doctors do about drugs.

Those buying goods and services from vendors or prescribing expensive drugs should always be careful about receiving favors from vendors. Small things like a meal here and there are no big deal but expensive gifts and favors cross the line of acceptability.

I suspect there are some doctors who do not do due diligence on these drugs. My doctors are very sensitive to drug costs, especially when insurance does not cover it. I think we need to be careful about painting the entire medical profession with one paint brush.

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Re: Factor in evaluating Physicians

Post by glock19 » Fri Apr 20, 2018 7:48 am

Lot of trashing of drug reps and big pharma here. However, no one seems to object when, as patients, the physician dispenses "drug samples" provided by the drug reps. Also, many companies provide patient education materials.

There is certainly nothing ethical about a health care provider being paid off to prescribe a drug, but I doubt a lunch here and there is going to do it.

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Re: Factor in evaluating Physicians

Post by darrvao777 » Fri Apr 20, 2018 8:02 am

I’m on there as well for food and beverage charges but from a while ago

I’m so antisocial now I duck out the back when reps come

Would rather pay for my own lunch and enjoy it peacefully outside of the hospital rather than get roped into boring conversation over a usually crummy meal (really? Salad? The material is dry enough, bring something worthwhile!)

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Re: Factor in evaluating Physicians

Post by lthenderson » Fri Apr 20, 2018 8:05 am

My spouse has never accepted anything from a drug rep and yet she is on there for about $50 a year. She does invite diabetes patients to a after hours meeting once a year (in which she doesn't get paid) and invite drug reps to present the latest and greatest diabetes control devices to the patients. The reps aren't allowed to actually make any sales and they can't hear each other's pitches but they sometimes bring cookies for those listening to them.

That's the trouble with random people posting lists like these with absolutely no qualifications as to what the charges are. They end up lumping the innocent with the guilty so everyone loses.

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