Male Physicians Receive More Money From Industry Than Women Doctors

MedicalResearch.com Interview with:
“Doctors” by Tele Jane is licensed under CC BY 2.0
Kathryn R. Tringale, MAS
Department of Radiation Medicine and Applied Sciences
University of California San Diego, La Jolla

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Financial relationships between biomedical industry and physicians are common, and previous work has investigated the potential conflicts of interest that can arise from these interactions.

Data show that even small payments in the form of industry sponsored lunches can influence physician prescribing patterns. Given the concern for the potential influence of biomedical industry over practice patterns and potentially patient care, the Open Payments program was implemented under the Affordable Care Act to shed light on these interactions and make reports of these financial transactions publicly available. We recently published a paper in JAMA on industry payments to physicians that found that men received a higher value and greater number of payments than women physicians and were more likely to receive royalty or licensing payments when grouped by type of specialty (surgeons, primary care, specialists, interventionalists).

The purpose of the Research Letter discussed here was to further examine differences in the value of payments received by male and female physicians within each individual specialty. The main takeaway from this study is that male physicians, across almost every specialty, are receive more money from biomedical industry compared to female physicians. At first glance, this finding can be interpreted as merely another example of gender disparities in the workplace, which we have seen before with gender gaps in physician salaries and research funding. Indeed, this gender gap may be a product of industry bias leading to unequal opportunity for women to engage in these profitable relationships. Alternatively, these data may be more representative of gender differences in physician decision-making. Previous data has shown that industry engagement can lead to changes in practice patterns, so maybe female physicians acknowledge these conflicts of interest and actively choose not to engage with industry. Unfortunately, we cannot tease out these subtleties from our results, but our paper does reveal a remarkable gender difference among physician engagement with industry.

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Conflicts of Interest In Medical Guideline Committees Underreported

MedicalResearch.com Interview with:

Akilah Jefferson, MD, MSc Postdoctoral Fellow, Clinical Center, Department of Bioethics Clinical Fellow, Allergy and Immunology National Institute of Allergy and Infectious Diseases National Institutes of Health

Dr. Akilah Jefferson

Akilah Jefferson, MD, MSc
Postdoctoral Fellow, Clinical Center, Department of Bioethics
Clinical Fellow, Allergy and Immunology
National Institute of Allergy and Infectious Diseases
National Institutes of Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The guidelines that we looked at in this study were two that resulted in large paradigm shifts. Given their impact, we thought the question of conflicts of interest, which has been problematic among specialty societies in the past, be looked into.

We found that the levels of conflicts of interest among both guideline committees was problematic, and that conflict of interest disclosures often did not match contemporaneous conflict of interest disclosures in published articles.

MedicalResearch.com: What should readers take away from your report?

Response: We want to highlight the need for broader and more explicit adoption of Institute of Medicine (IOM)  standards for conflict of interest management.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: We recommend further research into how specialty societies are adopting Institute of Medicine standards, and barriers to adoption. Some work has highlighted how some specialty societies are successfully avoiding conflicts of interest among their guideline writing groups.

MedicalResearch.com: Is there anything else you would like to add?

Response: We hope that our study leads to positive discussions about this topic, and adoption of more standard and transparent methods of conflict of interest disclosure among specialty societies.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Jefferson AA, Pearson SD. Conflict of Interest in Seminal Hepatitis C Virus and Cholesterol Management Guidelines. JAMA Intern Med. Published online January 17, 2017. doi:10.1001/jamainternmed.2016.8439

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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MILESTONE Ratings of Medical Residents Better Able To Distinguish Competence

MedicalResearch.com Interview with:

Karen E. Hauer, MD, PhD Associate Dean, Competency Assessment and Professional Standards Professor of Medicine, UCSF San Francisco, CA 94143

Dr. Karen Hauer

Karen E. Hauer, MD, PhD
Associate Dean, Competency Assessment and Professional Standards
Professor of Medicine, UCSF
San Francisco, CA  94143

MedicalResearch.com: What is the background for this study?

Response: As part of the Accreditation Council for Graduate Medical Education (ACGME)’s Next Accreditation System, residency programs are now required to rate residents using the Milestones. Evidence of validity of Milestone ratings is needed to show whether this rating system measures meaningful aspects of residents’ practice.

In the field of internal medicine, we compared ratings of residents using the old evaluation form, the pre-2015 Resident Annual Evaluation Summary (RAES), which has a non-developmental rating scale that rates residents from unsatisfactory to superior on a 9-point scale, with developmental Milestone ratings. This was a cross-sectional study of all United States internal medicine residency programs in 2013-14, including 21,284 internal medicine residents. Milestone ratings are submitted by residency program directors working with Clinical Competency Committees. We correlated RAES and Milestone ratings by training year; correlated ratings of Medical Knowledge milestones using the two systems with American Board of Internal Medicine (ABIM) certification examination scores; and examined ratings of unprofessional behavior using the two systems.

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What Interventions Can Reduce Epidemic Physician Burnout?

MedicalResearch.com Interview with:

Colin P. West, MD, PhD, FACP  Divisions of General Internal Medicine and Biomedical Statistics and Informatics Departments of Internal Medicine and Health Sciences Research Mayo Clinic

Dr. Colin West

Colin P. West, MD, PhD, FACP
Divisions of General Internal Medicine and Biomedical Statistics and Informatics
Departments of Internal Medicine and Health Sciences Research
Mayo Clinic

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Physician burnout has reached epidemic levels, as documented in national studies of both physicians in training and practicing physicians demonstrating burnout rates in excess of 50%. Consequences include negative effects on patient care, professionalism, physicians’ own care and safety, and the viability of health-care systems. We conducted a systematic review and meta-analysis to better understand the quality and outcomes of the literature on approaches to prevent and reduce burnout.

We identified 2617 articles, of which 15 randomized trials including 716 physicians and 37 cohort studies including 2914 physicians met inclusion criteria. Across interventions, overall burnout rates decreased from 54% to 44%, emotional exhaustion score decreased from 23.82 points to 21.17 points, and depersonalization score decreased from 9.05 to 8.41. High emotional exhaustion rates decreased from 38% to 24% and high depersonalization rates decreased from 38% to 34%.

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COPD: Benefits of high dose N-acetylcysteine

Dr. Hoi Nam Tse,  FCCP, MRCP, MBChB Associate Consultant, Kwong Wah Hospital, Hong Kong Life member and Council member of Hong Kong Thoracic SocietyMedicalResearch.com Interview with:
Dr. Hoi Nam Tse,  FCCP, MRCP, MBChB
Associate Consultant, Kwong Wah Hospital, Hong Kong
Life member and Council member of Hong Kong Thoracic Society

MedicalResearch: What are the main findings of the study?

Dr. Hoi Nam Tse: N-acetylcysteine (NAC) is an oral mucolytic containing anti-oxidative and anti-inflammatory property. Our study demonstrated that long term use of high-dose : N-acetylcysteine (600 mg twice daily for 1 year) was a well-tolerated treatment, and it reduced exacerbations and prolonged time to first exacerbation in ‘high-risk’ COPD patients–which was defined as patients who had 2 or more exacerbations per year, FEV1<50% or both. Such beneficial effect was not obvious in the ‘low-risk’ COPD patients.

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Pulmonary Embolism: Evaluation of Age-Adjusted Threshold of D-Dimer Blood Test

Scott C. Woller, MD Co-Director Thrombosis Program Intermountain Medical Center Associate Professor of Internal Medicine University of Utah School of Medicine Murray, UT 84157-7000MedicalResearch.com Interview with
Scott C. Woller, MD
Co-Director Thrombosis Program
Intermountain Medical Center
Associate Professor of Internal Medicine
University of Utah School of Medicine
Murray, UT 84157-7000

Dr. Woller: By way of background, D-dimer, a simple blood test that is used to investigate the diagnosis of suspected pulmonary embolism (PE), and it increases with age.  Recent research suggests that the use of an age-adjusted d-dimer threshold may improve diagnostic efficiency without compromising safety. We wished to assess the safety of using an age-adjusted d-dimer threshold in the work-up of patients with suspected pulmonary embolism.

MedicalResearch:  What are the main findings of the study?

Dr. Woller: In this retrospective cohort study we identified 923 patients age > 50 years who presented to our emergency department with suspected pulmonary embolism, and had their pretest probability of PE calculated along with a d-dimer performed. All patients underwent computed tomography pulmonary angiography (CTPA). We observed that among patients unlikely to have PE, adoption of an age-adjusted D-dimer cut-off (compared with a conventional D-dimer cut-off) reduced the need for CTPA in an additional 18.3% of patients, and was associated with a low 90-day rate of failure to diagnose PE.
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Male Circumcision: Rate of Adverse Events

Charbel El Bcheraoui, PhD, MSc Acting Assistant Professor, Global Health Institute for Health Metrics and Evaluation University of Washington Seattle, WA 98121MedicalResearch Interview with:
Charbel El Bcheraoui, PhD, MSc
Acting Assistant Professor, Global Health
Institute for Health Metrics and Evaluation
University of Washington
Seattle, WA 98121

MedicalResearch: What are the main findings of the study?

Dr. El Bcheraoui: We found a low rate of adverse events associated with male circumcision from U.S. hospital settings, especially if the procedure is performed within the first year of life. The rate of adverse events increased about 10 – 20 times if the procedure was performed later in life.
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Chronic Hepatitis C: Clinical Outcome Tool

Dr. Adriaan J van der Meer Department of Gastroenterology and Hepatology Erasmus MC, University Medical Center Rotterdam, The NetherlandsMedicalResearch.com Interview with:
Dr. Adriaan J van der Meer
Department of Gastroenterology and Hepatology
Erasmus MC, University Medical Center
Rotterdam, The Netherlands


MedicalResearch: What are the main findings of the study?

Dr. J van der Meer: The main finding of our study is that the prognosis of patients with compensated HCV-induced advanced liver disease can be adequately assessed by risk scores which merely include objective variables that are readily available in daily practice. Our analyses resulted in two separate prognostic scores by which the individual patient’s risk of mortality or clinical disease progression (defined as occurence of Hepatitis C Cirrhosis (HCC), liver failure, liver transplantation or death) can be assessed.
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