Physicians

PHARMA/PHYSICIANS: Big joke-Free CME: Pharmed out doesn’t impress The Industry Veteran

THCB regulars will be missing the delicate tones of The Industry Veteran. But never fear, he’s back and none the less caustic for his lay-off from these hallowed electrons. Here’s his take on the new CME for doctors.

No doubt you saw this article in the Washington Postdescribing the efforts of PharmedOut to make no-cost, continuing medical education sessions available to physicians.  As pharmaceutical companies sponsor a large proportion of CME sessions for physicians, the ostensible purpose of PharmedOut’s campaign lies in removing Pharma’s undue influence on prescribing behavior.It seems PharmedOut.org was created through a $21 million grant from Warner-Lambert (now Pfizer).  The money represents part of Pfizer’s 2004 settlement of the whistle-blower suit involving W-L’s off-label promotion for Neurontin.

Now it’s inevitable that if pharmaceuticals are discovered and distributed through a competitive market and a gatekeeper system, the competitors will try to influence the decision makers and compromise the latter’s fiduciary responsibilities in the process.  Is it too simple to suggest, however, that regulation should remove CME as a means for undue influence over prescribing by making the damn physicians pay their own way?  Do any of the influentials who peruse THCB see a sick absurdity in the fact that physicians need to receive their CME free if they are to remain current?  I’m not aware of settlement grants going for the continuing professional education of lawyers, accountants, or other self-employed professionals.  Instead of using that $21 million to pay for health care programs for the indigent, someone thought it a good idea for six-figure physicians to receive free CME. I’ll wager a used examination glove that physicians will irrationally offer more resistance to paying for their own CME than to many other things that have a far larger impact on their wallets.  The reason is their sense of entitlement. The boys and girls who cloak their black souls in white gowns feel they’ve worked so hard and “sacrificed their 20s” (as one cardiologist told me), that society owes them and should cover their CME.I’ll say it again.  At some point genuine health care reform will require breaking the power of organized medicine, making the profession overwhelming female, and reducing it to the status of government paid professionals akin to school teachers.  Until then, efforts to control cost, increase access and improve quality will have marginal results at best.

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18 replies »

  1. Big Pharma is TERRIBLE no question. I’m an Internist and spend HALF my life prior authorizing brand name drugs (when they are needed) and oxygen forms wheelchair forms etc etc. all uncompensated.
    As for CME..you can actually get 145 hours from ordering MKSAP question and answer board review for a couple hundred bucks. MANY states require 150 hours/3 years which IMHO is ridiculous and encourages cheating. Hypothetically we could order MKSAP and collaborate online with the answers. Cheat and get almost all we need. Licensing boards punish honesty and reward cheating.
    As far as CME my bosses at community health center (poorly paid but no hospital or NH rounds) pay 2k for CME. That’s not much. just went to DC ACP internists shindig. presession and session. THAT alone costs 2k. The Hotels and food?? Don’t get me started. I paid at least 3k more than I’ll get back.
    Now the pharma barbie and ken’s at the conventions?? fuhgettaboutit! Three football fields worth of booths strict ID verification so outside world will not see what goes on.
    My studies came very hard to me. low honor student in HS even. IMG. Easier to become male nurse but who would want me then?? I’m a Dude
    PS Cardio makes 3x what I do (tough fellowship) exercise do not smoke Mediteranean diet. put the goniffs out of business
    Let US do endo and colonnoscopies. GI makes twice what we do without the misery

  2. Sorry for mislabeling the “Industry Veteran” as the “Industry Insider.”
    And physicians deserve plenty of blame for what has gone wrong with health care.
    Nonetheless, as far as I can tell, “Industry Veteran” is much more hostile to physicians than to other players in the health care arena, including big pharma. I did a search for his posts, and looked at the first half dozen or so that came up. Several called physicians, as a group, avaricious, or worse, some much worse. Only one was critical of the pharmaceutical industry leadership, and only partially.
    What seems to emerge is the sort of contempt for physicians that I suspect may be in the hearts of many of the marketers who now dominate big pharma, who see physicians as obstacles to selling more drugs to patients, and obstacles who may be all too easily fooled, tempted and manipulated. What we physicians need most to own up to is how easily we have given in to big pharma’s (and big biotech’s and big device manufacturer’s) blandishments.
    So it’s still hard for me to make sense of a so-called left-winger who still appears much more hostile to physicians as a group than to big pharma.
    Perhaps, though, by “left” here you do not mean left-wing in the traditional economic sense, but a new leftist post-modernist extreme relativist, someone who believes there is no such thing as truth, no external reality, that inconsistency is a virtue, except there is nothing virtuous, because that implies absolute values … and so paradoxically into the night?

  3. Roy. I’ve met him and unless he’s a fabulous actor who’s set up an entire life the same way that spy’s were set up as sleepers in John Le Carre novels, his life & work is not fictional. And he’s not the first to attack physicians, or at least cast aspersions on the profession. Ever read Paul Starr’s tiny book on the subject, or looked at the history of Codman, etc, etc

  4. I can understand a left-winger who is hostile towards physicians (after all, we are generally well off members of the upper-middle class), but it’s hard to make sense of a left-winger who is more hostile towards physicians than to big pharma.
    Above, Insider accused all physicians of having “black souls.” I don’t think that this had anything to do with race. Rather, he seemed to mean that physicians are collectively evil.
    I don’t recall him saying that big pharma is so bad. And he works for bid pharma. So, either there is more than a whiff of hypocrisy here, or, as I said above, “Industry Insider” is just a fictional persona.
    In any case, his ad hominem attacks on all physicians are not advancing the health care debate.

  5. Bev…he’s equally rude if not ruder about big pharma. Search Industry Veteran in my search google box (top right) to find out. You can question his working for them while opposing most of what they’re up to, but not that he’s defending them!

  6. He is entitled to his “views” (although I am finding it VERY ironic that he works for Big Pharma and talks about “breaking the power of organized medicine.” What about breaking the power of Big Pharma??!!)
    However, he should bother to research his facts first if he wants anyone to listen to him. I, for one, will read the other 1000 posts instead from now on.

  7. Everyone….chill for a minute.
    As I’ve said many times, the Industry Veteran is what he claims to be, and is given his anonymity here for a reason. He works for big pharma but has a left-wing, generally anti-organized medicine views, which obviously would threaten his income if widely known.
    You may not agree with him; you may not like his tone; and often I don’t but I think it’s funny and well informed. So I print his pieces when he sends ones I like.
    You don’t like them? there are about another 1,000 posts on this blog. Most by me, but some by people I don’t agree with at all. GO read them instead.
    You want to write a reply. Go ahead and submit it to me.
    But come on guys, this is a blog. We’re not trying to agree on a unity statement for multi-lateral trade talks here!

  8. Well, as usual, there is just so much nonsense in “the industry insider’s” post.
    1- The Attorneys General’s grant program was not principally designed to provide free CME, as “insider” implies. See:
    http://www.ohsu.edu/cpgp/gpgoalsprescriber.cfm/
    2- As noted by “bev,” many doctors, including this one, pay for nearly all CME. But I do believe that one (of many) goals of the pharmed.out web-site was to provide access to free CME that was not supported by pharma, to compete with the free CME
    supported by pharma that is constantly waved under our noses.
    3- The notion that organized medicine is all powerful in this day and age is laughable. Enthoven’s goal of breaking the medical “guild” has long since been achieved. See:
    http://hcrenewal.blogspot.com/2006/03/consequences-of-breaking-physicians.html/
    Many physicians are demoralized, and thinking about quitting the profession. The AMA’s power is a shadow of what it once was. Health care is increasingly dominated by pharma, device, biotech, and managed care companies, hospital systems, and government, with doctors (and nurses) left out in the cold. And over-priced drugs and devices, and hospital fees, and huge compensation paid to the hugely growing corps of health care managers and executives have a lot more to do with cost and access issues than do doctors’ incomes.
    Presumably, “hospital insider” is just a persona created by somebody who wants to stir up a lot of trouble. The question is who is the author of this character, and why does the character continue to appear on this otherwise very worthwhile blog?

  9. I guess we need to ask, why is nursing female dominated and physicians male dominated. I think we see a difference in patient care and patient control attidudes. I guess also that women were blocked from becoming doctors for a very long time. Boy do I agree with jd.

  10. First, full disclosure; I am a retired female M.D. I’m not getting into a war about gender or personalities in the profession; I just want to correct the rant that docs would complain if they had to pay for their own CME. In fact, virtually all docs do exactly that, since we need multiple hours of credit per year and obtain it in various different ways. The CME that Big Pharma pays for is CME they practically beat down the hospital or office doors to pay for, just to get their foot in the door. For instance, every hospital has Grand Rounds once a week, which is free (and worth one hour of CME credit) to the physicians on that hospital’s staff. Often the speaker is a member of that staff, or a local university hospital expert, or whatever. “Big Pharma” will often VOLUNTEER, if not INSIST, on paying the honorariums (if any; many hospitals forbid one) for the outside speakers. There are other ways Big Pharma VOLUNTEERS to pay for docs’ CME, but I wanted to correct the impression that all physicians receive (and expect) all their CME credits in this manner. That’s just not factual.

  11. PCB, this is not an intellectually lazy comment, though it was crassly stated. I agree with IV and Abby: as the profession becomes lower paid it will also likely become two things: lower stress, and less male. In fact, I wrote at greater length on this point back in August 2006 on this very blog:
    …if average physician/provider incomes go down…a different sort of person will tend to be attracted to medicine. If the average physician salary were in the 70th percentile rather than the 95th percentile, I think we would see a number of changes:
    1. Many highly ambitious people would go into other professions, and those whose ambitions focus around money would go into whatever is reliably more lucrative.
    2. Many intelligent people who want to care for the ill but are currently put off by the heavy work-loads and highly competitive nature of medical school would replace those who left. The average IQ may go down a little, but I’m not worried about it threatening competency in part because we’re talking more about a personality difference than an intelligence difference. This is why I said I thought you would get more women in medicine if the salary (and competitiveness, long hours, etc.) went down.
    3. Medical school will be less of a pressure-cooker and it will either be subsidized more heavily by the govt or the cost will be reduced some other way. Otherwise, there will be a physician shortage. We may have a few years of low enrollment before med schools and the govt respond [with sufficient changes suited to the new breed of doctor].

  12. heromd,
    Certainly there are thoughtful discussions to be had regarding physician payment, and I’m by no means claiming to have all the answers.
    I was just poking fun at using the industry veteran’s inflammatory drive-by as an example of thoughtful discussion. That’s all.
    If I want that kind of rhetoric, there’s plenty of other places to go on the internet. I just don’t expect to find it in lead articles here.
    Pete

  13. making the profession overwhelming female
    I fear that this is only too true, but the feminist in me is deeply pissed off about this. Women’s work==low pay. That’s an unfair equation.

  14. Hmm . . . government employees akin to National Health in England? That system is widely criticised, right? Is there a health system you look to as a good example of something robust and replicable?

  15. >At some point genuine health care reform will require >breaking the power of organized medicine, making the >profession overwhelming female, and reducing it to the >status of government paid professionals akin to school >teachers.
    “A must read blog” where you “learn more in 10 minutes than you could reading your local paper for a week” posts this as a lead article? Huh?
    Oh, I get it. You got me.
    Matthew, quit messing with us.
    Pete

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