Physicians are supposed to “first, do no harm.” They are supposed to put the best interests of patients first. But they are human beings, and they are subject to the same economic motivators as other humans are. They also usually come out of college and medical school with huge debts, they tend to work very long hours, they have to deal with often difficult patients, they have a nightmare of government regulations to comply with and they spend a lot of their time on administrative paperwork. Not always the most rewarding of jobs, so they can perhaps be forgiven for wanting to be well paid.
A new paper explores the extent to which “altruism” or concern for what is best for a patient, might overcome the economic desire to make money by potentially doing things not really necessary for the patient or which benefit the physician more than the patient. In this case it was taking money from pharmaceutical companies with the at least implicit understanding that the physician will prescribe more of the company’s products. 28o physicians’ behavior was tracked. Physicians were categorized as more or less altruistic based on an experiment presenting the opportunity for payments to them. Physicians who scored lower on the altruism scale were more likely to accept payments and benefits of various types from drug manufacturers. And they subsequently prescribed more drugs.
You have to ask yourself if the excess drug prescribing was beneficial for patients, or even harmful. It certainly isn’t good for health spending. I know many doctors won’t allow themselves to to be swayed by the availability of these payments, but many others do accept them and do allow their prescribing behavior to be influenced by them. In fact among the sample of physicians used for this study, only 17% had strong “altruistic” tendencies. I am sure most doctors whose behavior is clearly influenced by drug company payments have some rationalization for the appropriateness of this, but there really isn’t one. I believe strongly that drug companies, and medical device firms, should be completely banned from any in-person lobbying or “education” of doctors regarding their products and no payments or benefits of any type should be allowed. That would be one good stop to control spending and to protect patients from products they don’t need. (NBER Paper)
Spot on, Kevin. I used to help self-funded plans save money by logical changes in plan provisions and components. One GUARANTEED money saver was changing the PBM from a major carrier’s plan to an independent plan. Typical savings was 25%mof the Rx spend, or roughly 6.5% of total plan costs. Not a direct comparison to the point you so cogently made, but indicative of the waste in the system as it now exists
I miss the pens!
I recently finished listening to Malcolm Gladwell’s Revenge of the Tipping Point 2. You might find one of the chapters interesting as he covers research showing that doctors change their approach to match the group they are practicing in say if they move states or hospitals. Diagnosis and billing changes with the culture they are practicing in. If that new group diagnoses more of a certain type of issue suddenly the new doctor is too. The peer pressure is too great. It made me want to start shopping around more. I have a good doctor now but if I were to move that would be a real challenge to find someone I could trust.
Yes, I have posted several times on geographic variation in health spending which appears to be largely due to differences in physician practice patterns. Doctors tend to adopt the practice pattern of the area in which they were trained, particularly as residents or early in their careers. And most interestingly, if a doctor moves from one area to another, they relatively quickly tend to adopt the practice pattern in the new area.