Factor in evaluating Physicians

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Broken Man 1999
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Re: Factor in evaluating Physicians

Post by Broken Man 1999 »

I'm OK with it. Last time a rep provided a meal at my wound care doctor office ( a nurse visit, didn't even expect to see him) my doc popped into my exam room, told my wife to come with him and load up on the barbeque spread. Great grub!

I will state I don't believe my PCP puts a lot of stock in the drugs the reps are pushing. Every RX I am on is generic, or out for a long time. I know there are many "newer" drugs he hasn't prescribed to me, and, frankly I have Cadillac insurance that would most likely pay with little pushback.

I agree with the statement concerning samples, a couple of older friends have been helped a great deal, as they have poor insurance. Another friend is helped through the donut hole.

As far as the advertising for the new drugs, after listening to all the possible side effects, I am OK with my drugs. I realize all the issues must be identified, but good grief!

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dm200
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Re: Factor in evaluating Physicians

Post by dm200 »

book lover wrote: 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.
Yes - I agree about TV advertising of prescription drugs to consumers.
SlowMovingInvestor
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Re: Factor in evaluating Physicians

Post by SlowMovingInvestor »

lthenderson wrote: 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.
I disagree. More information is generally better, and I would think that most members of the public are smart enough to not diss a long term trusted doctor because he or she gets $100/year from a drug company.

[ OTOH, I do think that in some areas such as back pain, there is a lot of snake oil being peddled and learning about large payments to doctors for is useful]
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1210sda
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Re: Factor in evaluating Physicians

Post by 1210sda »

Wow! One of my physicians is on the list for big bucks. Mostly "promotional speaking/other" and "consulting".

I am concerned about damaging our relationship (which is quite good right now) by questioning him on this.

What I will use this information for is to keep a wary eye on any brand name drug recommendations he makes. Not that they aren't the proper medication, but I will be more vigilant.

So far, he's prescribed only generics.

BTW, does anyone know what "promotional speaking/other" really means?

1210
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dm200
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Re: Factor in evaluating Physicians

Post by dm200 »

I looked up two previous physicians - one primary care and one specialist (Endocrinology) and each had about $1,000. Each had about a whole page list of food, etc. related to Prescription drugs. I guess that is where and how they were educated on these drugs. My current primary care and endocrinologist have only one or two.
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msi
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Re: Factor in evaluating Physicians

Post by msi »

My PCP received nearly $30k, yet I've never been prescribed a brand name drug in the 15+ years I've been seeing him. I feel so left out. :D

Don't forget to check your dentist, too. They're on here as well, though mine only received a whopping $12.
Allixi
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Re: Factor in evaluating Physicians

Post by Allixi »

1210sda wrote: Fri Apr 20, 2018 11:18 am BTW, does anyone know what "promotional speaking/other" really means?

1210
It means exactly that - going to a hospital, office group, or medical school and giving a Powerpoint lecture about some drug, device, or treatment.

Sometimes these are hosted at a local restaurant. I've been to one - food was nothing to write home about, and I wouldn't have paid more than $30 maybe for the (free) meal. Judging by their menu it probably would have cost ~$60 and yet it appears as $121 on the list :? .

Makes me wonder if the drug companies are giving inflated numbers that could be written off on their taxes somehow.
Allixi
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Re: Factor in evaluating Physicians

Post by Allixi »

There was one time (years ago) when I was a medical student, that I saw a family physician harangue about the insurance company substituting a cholesterol medication. He called it "tantamount to practicing medicine without a license". I thought, at the time, that he was just old and stubborn, but the list shows that he has since racked up $75K in speaking fees (for a different medication) in 2015, so maybe there was something more to it.

Most other doctors just don't care all that much, though specialists and surgeons are understandably fussier about equipment that they have to operate. The effect of drug company lunches is probably real, but still just one of many factors that influence prescribing patterns - FDA approval, insurance coverage, clinical data, how easy it is to use, familiarity, pt's requesting by name (because they've been influenced by advertising), etc.
quantAndHold
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Re: Factor in evaluating Physicians

Post by quantAndHold »

My ENT got a $19 gynecology device. I’m not sure what to make of that.
Yes, I’m really that pedantic.
toofache32
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Re: Factor in evaluating Physicians

Post by toofache32 »

quantAndHold wrote: Fri Apr 20, 2018 2:34 pm My ENT got a $19 gynecology device. I’m not sure what to make of that.
Times are tough....side hustle.
fsrph
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Re: Factor in evaluating Physicians

Post by fsrph »

Cycle wrote: 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.
I looked up a few high volume doctors in the closest metro area and royalty and licensing payments were included. These payments were further broken down by company, amount and date.

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daveydoo
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Re: Factor in evaluating Physicians

Post by daveydoo »

White Coat Investor wrote: Thu Apr 19, 2018 10:27 pm But guess what? You want me to go speak to a group of docs? I expect to get paid too.
You can get paid and not have a conflict. Give medical grand rounds somewhere and get an honorarium from the institution. Get invited to a national or international meeting and get an honorarium and hotel room from the society. And talk objectively about your research. Or about anything. But when you are bought and paid for by a drug (or other) company, you are not objective. Your name should appear on a public list. It's not punishment; it's just disclosure.

We get inundated with requests from Pharma to have members of their "speakers' bureaus" come talk to us. Some have sound academic bona fides. Many and perhaps most come from HCOL coastal cities and need the side hustle to survive. Sad but true. Docs who implant devices can make six figures for "consulting" gigs, just by switching to that company's total knee or hip. It could be a little-tested or even under-performing implant, but the consulting compensation can tip the balance. The public needs to know this kind of stuff. Who among us could be truly objective if we got $100K to "believe" that the new implant is superior. And if you think you're the one who can stay objective, you haven't reviewed the mountain of evidence to the contrary.

I do think that even a pen here or a sandwich there makes a difference, as nisiprius wrote above. I remember one rep who was simply a terrific guy -- great-looking, athletic, perfect suit, affable, hilarious, cute spouse and kids, ex-fighter pilot - the whole nine yards. Even when he provided nothing tangible, the "halo effect" for the company was very real. Scary. A lot of the reps are like the "car show girls" -- presumably for the same reason. The reputable employers in my town now forbid any and all industry perks.

EDIT: The top industry-compensated doc in a field I know well got $700K in 2015 -- mostly for > 200 separate speaking engagements sponsored by nearly 30 separate companies. You might think this person won the Nobel Prize. No, this person has been a middle author on a grand total of four publications (this is easy to look up). So this person is not being promoted for his/her academic credentials or contributions to any field. This person is a mouthpiece for the industry.
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sport
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Re: Factor in evaluating Physicians

Post by sport »

Cycle wrote: 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.
Royalties are included. My orthopedist is listed at 400K. He invented a new surgical procedure. He received 193K in royalties and 36K for consulting. The rest was travel, speaking, and meals.
Jimmy Mac 33
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Re: Factor in evaluating Physicians

Post by Jimmy Mac 33 »

Ignorance is bliss.... A lot of people with no idea what they are talking about chiming in. Believe it or not, many pharma reps know more about a specific drug/disease then the HCP (especially ultra rare orphan drugs/diseases) - and the only sensible time to help educate them is at lunch. 90% of the reps out there aren't needed - but there are a few that truly help the HCP because they can provide the relevant info that would take the HCP hours to locate.
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dm200
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Re: Factor in evaluating Physicians

Post by dm200 »

Jimmy Mac 33 wrote: Fri Apr 20, 2018 3:44 pm Ignorance is bliss.... A lot of people with no idea what they are talking about chiming in. Believe it or not, many pharma reps know more about a specific drug/disease then the HCP (especially ultra rare orphan drugs/diseases) - and the only sensible time to help educate them is at lunch. 90% of the reps out there aren't needed - but there are a few that truly help the HCP because they can provide the relevant info that would take the HCP hours to locate.
Yes - may be true. BUT - would that rep ever tell you that some very inexpensive generic is just as good as (or better than) the very expensive new drug for 99% of patients with a condition?
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Re: Factor in evaluating Physicians

Post by Jimmy Mac 33 »

dm200 wrote: Fri Apr 20, 2018 3:47 pm
Jimmy Mac 33 wrote: Fri Apr 20, 2018 3:44 pm Ignorance is bliss.... A lot of people with no idea what they are talking about chiming in. Believe it or not, many pharma reps know more about a specific drug/disease then the HCP (especially ultra rare orphan drugs/diseases) - and the only sensible time to help educate them is at lunch. 90% of the reps out there aren't needed - but there are a few that truly help the HCP because they can provide the relevant info that would take the HCP hours to locate.
Yes - may be true. BUT - would that rep ever tell you that some very inexpensive generic is just as good as (or better than) the very expensive new drug for 99% of patients with a condition?
The good ones do. Unfortunately, that eliminates the 90% I mentioned.
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Re: Factor in evaluating Physicians

Post by daveydoo »

Jimmy Mac 33 wrote: Fri Apr 20, 2018 3:44 pm Believe it or not, many pharma reps know more about a specific drug/disease then the HCP (especially ultra rare orphan drugs/diseases) - and the only sensible time to help educate them is at lunch. 90% of the reps out there aren't needed - but there are a few that truly help the HCP because they can provide the relevant info that would take the HCP hours to locate.
Respectfully disagree, although this is the pharma party line. Specialists know what to use and know what works. Salespeople are there to sell. Maybe the Toyota guy really wants to get me into the best Toyota for my needs -- but he ain't sellin' me a BMW.

If your doctor doesn't have "time" to learn about treating the disease you're there to see him/her for, you need a new doctor. Period. And anyone who would rely upon a lunch with a salesperson to learn about an orphan drug...[smh]. Maybe have lunch with that Toyota salesman. I'm sure it will be very objective. You will learn about every single metric in which your intended Toyota is superior to the competition (I love those charts -- cupholders, elbow room, number of radio presets!). But the other metrics will not get mentioned.
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1210sda
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Re: Factor in evaluating Physicians

Post by 1210sda »

daveydoo wrote: Fri Apr 20, 2018 3:21 pm But when you are bought and paid for by a drug (or other) company, you are not objective.
How is the patient suppose to know if his/her physician was "bought and paid for by a drug (or other) company"?

1210
staythecourse
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Re: Factor in evaluating Physicians

Post by staythecourse »

I'm curious if ANY boglehead likes their doctor>

It seems thread after thread is about finding a flaw about your physician. How many posts have I seen on this site about liking their doctor's care? The years I have spent on here has proven over and over this is a VERY biased message board against doctors. Honestly, the number of folks upset their doctor get a free sandwich is a bit unbelievable. I think many on here are a bit perturbed that they are not courted with free food and drink?

Good luck.
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Re: Factor in evaluating Physicians

Post by daveydoo »

1210sda wrote: Fri Apr 20, 2018 4:15 pm
daveydoo wrote: Fri Apr 20, 2018 3:21 pm But when you are bought and paid for by a drug (or other) company, you are not objective.
How is the patient suppose to know if his/her physician was "bought and paid for by a drug (or other) company"?

1210
That ProPublica link at the top of the thread would seem to be a great start! As others have said, royalties are a good thing -- your doc has created something and is likely a genuine expert. Most of the others are not "good." FYI, I did not look up my own doctors -- but I did look up some docs I know professionally.

I think it's more important if you are getting specialized care with an expensive medication or device or implant. If I were getting orthopedic surgery or a biologic agent (some chemo or treatment for autoimmune disease), I might take a look.
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SlowMovingInvestor
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Re: Factor in evaluating Physicians

Post by SlowMovingInvestor »

staythecourse wrote: Fri Apr 20, 2018 4:18 pm Honestly, the number of folks upset their doctor get a free sandwich is a bit unbelievable. I think many on here are a bit perturbed that they are not courted with free food and drink?
As someone who used to deal with high tech vendors as an IT manager all the time, I was courted with free food and swag all the time. In the corporate world, it's far from uncommon, and there were typically corporate policies restricting the amount you could accept (I think it was $25 or so).
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Re: Factor in evaluating Physicians

Post by daveydoo »

staythecourse wrote: Fri Apr 20, 2018 4:18 pm
It seems thread after thread is about finding a flaw about your physician. How many posts have I seen on this site about liking their doctor's care? The years I have spent on here has proven over and over this is a VERY biased message board against doctors.
I have reason to be sensitive to this and I haven't gotten that vibe. Many of the criticisms seem fair and balanced (can't believe I typed that :oops: ) and raise legitimate issues. Docs should be held to a higher standard, imo. Part of being a respected guild. I would not expect them to argue against a "fiduciary rule" for medicine, for example -- patients' needs must come first.

Sure glad I'm not a financial advisor or used car salesman, though. :D

And we're kinda rough on universities and the folks who work there. Oh, and public-sector workers. Yeah, they get unfairly clobbered on this forum.
"I mean, it's one banana, Michael...what could it cost? Ten dollars?"
quantAndHold
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Re: Factor in evaluating Physicians

Post by quantAndHold »

staythecourse wrote: Fri Apr 20, 2018 4:18 pm I'm curious if ANY boglehead likes their doctor>

It seems thread after thread is about finding a flaw about your physician. How many posts have I seen on this site about liking their doctor's care? The years I have spent on here has proven over and over this is a VERY biased message board against doctors. Honestly, the number of folks upset their doctor get a free sandwich is a bit unbelievable. I think many on here are a bit perturbed that they are not courted with free food and drink?

Good luck.
The vibe I get is that people don’t like the financial aspects of the US medical system. That’s different than not liking your doctor.
Yes, I’m really that pedantic.
Broken Man 1999
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Re: Factor in evaluating Physicians

Post by Broken Man 1999 »

This year I met a young lady who represented a medical device company (specifically a new type wound vac) when I had a large, deep hole in my left heel. She was at EVERY appointment I had (every two days) until the wound closed. Each time she was there, she provided training to one of the office wound care nurses, with the doctor's blessing. My insurance paid for the device, but the wound care center was a satellite of a nearby hospital, and the hospital put the device on hold to evaluate. The rep said not to worry, and provided free devices whilst the hospital worked thru their issues. Ultimately the issue was resolved, and I can tell you the folks who were involved in my case were very happy with the results. So the center ended up with a better educated staff, the care was successful, as I certainly benefitted.

Fact is, before she was there they only had a couple of folks trained, when she left there were many more competent nurses. I gave her permission to use pictures of my wound if she desired, to illustrate to others the progress of the process/device.

I go back to 1999 with my wound care doctor, and he told me she was so knowledgeable that he trusted her with his staff. He is the practice, a dinosaur nowadays, I guess. Rep is an awesome, bright young lady, great representative and face of her company. I imagine she will end up either as an MD, NP, or PA when she wants more location stability for her career.

So far a free meals, after my last visit I will be treating the staff to something. Seeing individuals over a long time gives a person the opportunity to see the compassion of so many of the medical staff, you get to know them over time.

I know how hard my PCP works to get me care, and how hard his staff works to finding a source/location for any of my needs. I occasionally have my wife drop off a tray of pastries or bagels for his staff. Oops, maybe that's why I get such good care...

I can only judge doctors by my experiences, and I can tell you I have seen many from my PCP to my various needed specialists, and I've ran across only one that I wouldn't see again.

Win-win, IMHO.

I like to see two groups happy, and prosperous: airline pilots, and any doctor I see.

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Re: Factor in evaluating Physicians

Post by eye.surgeon »

I could cut pharmaceutical costs in the US by 25% within a year with a one sentence Bill : "no prescription medication can be marketed directly to consumers". This will never happen by the way. Instead there is a 10 inch thick rulebook about a doctor eating a sandwich or taking a pen.

I don't know if I am on this list or not but I do know that after 16 years of private practice the more I see being spent marketing a drug the less likely I am to prescribe it, out of principle.
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mt
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Re: Factor in evaluating Physicians

Post by mt »

I am down for $11. Honestly I do not know where that came from, because I purposefully avoid company sponsored events.

The spine surgeons in my town are down for tens of thousands of dollars. Some of that may be for training on new systems. I'll have to ask them next time I see them.
oxothuk
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Re: Factor in evaluating Physicians

Post by oxothuk »

book lover wrote: 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.
Election-season TV ads are worse.
Osterix
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Re: Factor in evaluating Physicians

Post by Osterix »

I am not on the list but am in my final year of residency. I prescribe only a few medications in my field, however I am in a surgical field that has a sales rep in the OR nearly every case. I disagree that having a rep take me and other surgeons out to a meal affects my choice of surgical implant. Many hospitals have a contract with device manufacturers that limits your implant choices as a surgeon. However, I will choose an implant that I think is best suited for a given case no matter my relationship with the sales rep. I honestly don’t like when a rep stops by in clinic though as it definitely disrupts the workflow for the day.
toofache32
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Re: Factor in evaluating Physicians

Post by toofache32 »

Broken Man 1999 wrote: Fri Apr 20, 2018 5:24 pm This year I met a young lady who represented a medical device company (specifically a new type wound vac) when I had a large, deep hole in my left heel. She was at EVERY appointment I had (every two days) until the wound closed. Each time she was there, she provided training to one of the office wound care nurses, with the doctor's blessing. My insurance paid for the device, but the wound care center was a satellite of a nearby hospital, and the hospital put the device on hold to evaluate. The rep said not to worry, and provided free devices whilst the hospital worked thru their issues. Ultimately the issue was resolved, and I can tell you the folks who were involved in my case were very happy with the results. So the center ended up with a better educated staff, the care was successful, as I certainly benefitted.

Fact is, before she was there they only had a couple of folks trained, when she left there were many more competent nurses. I gave her permission to use pictures of my wound if she desired, to illustrate to others the progress of the process/device.

I go back to 1999 with my wound care doctor, and he told me she was so knowledgeable that he trusted her with his staff. He is the practice, a dinosaur nowadays, I guess. Rep is an awesome, bright young lady, great representative and face of her company. I imagine she will end up either as an MD, NP, or PA when she wants more location stability for her career.

So far a free meals, after my last visit I will be treating the staff to something. Seeing individuals over a long time gives a person the opportunity to see the compassion of so many of the medical staff, you get to know them over time.

I know how hard my PCP works to get me care, and how hard his staff works to finding a source/location for any of my needs. I occasionally have my wife drop off a tray of pastries or bagels for his staff. Oops, maybe that's why I get such good care...

I can only judge doctors by my experiences, and I can tell you I have seen many from my PCP to my various needed specialists, and I've ran across only one that I wouldn't see again.

Win-win, IMHO.

I like to see two groups happy, and prosperous: airline pilots, and any doctor I see.

Broken Man 1999
Sounds like the Pico VAC. I use that and DermaClose. Never gotten a meal from the rep.
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Re: Factor in evaluating Physicians

Post by tooluser »

1) The placebo effect is real and substantially effective, even if the patient knows they are being given a placebo.

2) The television show "Survivor" has been on the air for almost 20 years. Almost every season has a young, attractive, female contestant who is a pharmaceutical sales representative.

:confused
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Re: Factor in evaluating Physicians

Post by Cycle »

sport wrote: Fri Apr 20, 2018 3:42 pm
Cycle wrote: 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.
Royalties are included. My orthopedist is listed at 400K. He invented a new surgical procedure. He received 193K in royalties and 36K for consulting. The rest was travel, speaking, and meals.
That is interesting. I work in the device industry and collaborate with docs that are showing surprisingly low payments on this site, especially considering they are coinventors on some of our patents. Like the figures are a fraction of what I expected. Perhaps we don't pay them any royalties per the consulting agreement.
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katnok
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Re: Factor in evaluating Physicians

Post by katnok »

jpa wrote: 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 .
Agree with this. I run out of the office as soon as I can if there's a drug lunch. There are other ways to get to know about the drugs they are trying to market.

Believe it or not, most physicians are not influenced by the marketing, and many if not all are smart / ethical enough to prescribe a drug based on it's cost/effectiveness etc.
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Re: Factor in evaluating Physicians

Post by jambadoc »

quantAndHold wrote: Fri Apr 20, 2018 2:34 pm My ENT got a $19 gynecology device. I’m not sure what to make of that.
Nasal Speculum?
jambadoc
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Re: Factor in evaluating Physicians

Post by jambadoc »

Woo Hoo! Didn't make the list. Although, when searching for myself, I see one of our interventional cardiologists on the list for almost $700k. Maybe I shouldn't be so happy about not being on the list. :D

I see a lot of my former residents on for a few dollars here or there that I remember getting a lot of invites for nice dinners put on by drug reps. I guess having little kids and having to pay for babysitting saved me from that.
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Re: Factor in evaluating Physicians

Post by carolinaman »

One of my docs got $42k. He has given no indication of influence to me. When insurance dropped one of my meds, he recommended I try OTC drugs. I asked whether an expensive medical procedure would help my condition. He felt my current treatment with the aforementioned med was more appropriate. I do not know what the $42k represents, but I have confidence in him and will continue to use him.
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Re: Factor in evaluating Physicians

Post by a_movable_life »

My last job at a decent sized hospital my Manager (The medical director) and I changed the policy to no reps. My office was directly accessible from the rest of the building and once or twice we had reps "Just stopping by." My response "Where is your visitor sticker indicating you are a vendor? Please go to security, also all pharma rep interactions have to be approved by the medical director."

At this locums position the reps bring in food twice a week. I'm keeping my mouth shut as the support staff that they are feeding to get at me and the two other Nurse Practitioners would make my life a living hell if I took away their "Free" food 2x a week.

The one company's rep was really pushy with the RN when she told him I don't meet with reps trying to get in my office to speak with me. I'm staying away from him because my response to really pushy people is pretty abrasive. Plus calling his manager and complaining won't do anything. One of their many metrics is "Prescriber contacts." If I could what would be really effective is "Ok so X pharma is not allowed on site anymore."
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Re: Factor in evaluating Physicians

Post by LadyGeek »

I removed several off-topic posts. As a reminder, see: General Etiquette
We expect this forum to be a place where people can feel comfortable asking questions and where debates and discussions are conducted in civil tones. Discussions are about issues, not people. If you disagree with an idea, go ahead and marshal all your forces against it. But do not confuse ideas with the person posting them.

At all times we must conduct ourselves in a respectful manner to other posters. Attacks on individuals, insults, name calling, trolling, baiting or other attempts to sow dissension are not acceptable.
This thread has run its course and is locked.
Wiki To some, the glass is half full. To others, the glass is half empty. To an engineer, it's twice the size it needs to be.
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