Comments on: How the Massachusetts gift ban hurts primary care doctors

By: Smac

Smac — Thu, 05 Aug 2010 12:55:40 +0000

I agree wholeheartedly with Kate. I have done solo rural family medicine for 30 +years. My best learning experiences have been in pharma dinner meetings with leading speakers. Not by attending CME events, nor by reading other people’s opinion. but rather these small quiet very small group sessions where I could pick the brains of front wave thinkers. In no other venue is this possible. There is no method available now for this to happen. NONE.

The absolute neglect by bigger centers with lots of resources, of those of us who chose to look after that segment of the population that is not big city centered, is a crime. We are overloaded and the ease of some of the suggestions is showing the lack on insight into our daily world. Unfortuatley I am becoming more and more bitter to “the one solution fits all approach” by my peers. And this from family medicine where working with each patient as an individual is our speciality.

Sorry for the rant.

By: drhawk

drhawk — Fri, 30 Jul 2010 11:21:29 +0000

I remember not too long ago in residency we had a lot of drug sponsored dinners and CME, in addition to the weekly ‘grand round’ which was usually sponsored by a drug rep.

usually this consisted of a few free pens, some other type of trinket, and a 5 minute lecture on why their drug ws the best for a particular condition.

Pretty much all of us took this for what it was, an advertisement, but we did appreciate the efort involved in bringing us food, and taking the time to let us know about their product. As highly intelligent college grads, our residency director pretty much assumed that we would be able to understand the advetising for what it was.

Fast forward 4 years now I am in a small group practice, in a hospital system. my income this year is down 40+ percent. my group does not give out CME money, and the hospital has only limited grand round and CME available, none of it in my specialty. I miss the collegial ‘grand rounds’, which are really only possible with outside drug money. This year, I have had zero CME. dont have the income to do ‘cme conferences’ anymore, hell, dont even have the spare cash to join the specialty national organization this year.

I sympathise with your plight, dr atkinson, and please keep us updated as to the grand social experiment taking place in mass.

By: Sharon MD

Sharon MD — Fri, 30 Jul 2010 07:45:21 +0000

I am also a primary care physician and am keenly aware of the challenges (emotionally, physically, and personally) posed by having such a job. It *is* exhausting, and I completely understand that even organizing a pot-luck seems impossible. But rather than placing blame on a change in regulations that has taken away one of your stress-relief mechanisms, the blame should be on a system that so devalues primary care as to make our lives as miserable as they are.

I do think that you can find a way to make it work; if each member commits to coordinating one meeting per year, by finding someone interested in speaking about a topic and organizing the pot-luck and child care, you might be able to get what you need.

By: PeterW

PeterW — Thu, 29 Jul 2010 19:45:45 +0000

For fun, from the excellent Thank You for Smoking:

Senator Orlotan Finistirre: Mr. Naylor, who provides the financial background for the Academy of Tobacco Studies?
Nick Naylor: Conglomerated Tobacco.
Senator: That’s the cigarette companies.
Naylor: For the most part, yes.
Senator: Do you think that might affect their priorities?
Naylor: No. Just as, I’m sure, campaign contributions don’t affect yours.

By: Kate Atkinson MD

Kate Atkinson MD — Thu, 29 Jul 2010 19:14:00 +0000

To ANM: I suspect that your ‘industry’ isnt primary care medicine. Just the time involved in organizing a potluck is prohibitive to me at this point in my career. weeks go by with mail remaining unread in our household for want of time and energy. I have piles of medical journals next’ to my desk at the office and my bed at home which i struggle to read before my patients are quoting them to me. This journal club was one of the few professional things i did that was just for me. We DO continue the meetings paying our own ways (and dividing the cost of the speaker and students) but–as i mentioned in the article–all the NPs have been priced out, the retired doctors and many of the primary care docs as well.But it was more than paying for the meal which was lost–it was someone organizing the venue and the overhead projector, doing setup etc. most of the doctors would run in late from the office and have this great talk and interaction and then home to tuck kids in . It is not possible to explain to someone who isnt in primary care medicine how many pulls there are for us–this week i had a 50yo die suddenly, a 92 yo break her hip and 3 calls from families needing home visits due to change in medical condition. Each of these prompted a myriad of phone calls from family members needing to speak directly to me . I n addition to seeing 100 patients a week and making sure that all 4 kids have rides to their prospective camps, is enough to drive me over the edge some weeks. I am constantly trying to be all things to all people and NOT to burn out and to pay the bills, and remember to leave a check for the babysitter and the plumber. .. our local hospital is a 40 minute drive for me and the meetings they have are on days when i dont have childcare. I am not ‘crying’; clearly i am not wounded by this, simply saddened. I have a great job and a great family but not enough hours in the day to do it all. My point in sharing this experience was to point out that those of us in rural areas have been hit the hardest and our needs NOT even considered in the process. THis legislations was not just about pens and pads from drug companies. Insurance companies promote certain medications to us, often using misinformation in order to try to save themselves money. Pharmaceutical companies do the same in order to make us order their medicines. I like to believe that i am an educated professional who takes BOTH of these inputs into consideration and ultimately decides what is best for the patient, not what is best for me or the drug rep OR the insurance company.

By: Elizabeth

Elizabeth — Thu, 29 Jul 2010 18:41:59 +0000

Maybe you could find a couple of daycare teachers who would be willing to watch a big group of kids at a more reasonable price than individual sitters for every participant?

By: Sharon MD

Sharon MD — Thu, 29 Jul 2010 18:26:35 +0000

I agree with A.N. above. I meet with a similar group of doctors about once a month for journal club. It’s pot-luck, the location rotates among different houses, and those who can’t make baby-sitting arrangements bring their children and they generally manage to occupy themselves in another room (the babies stay out front, and there’s generally a good mix of ages of children so that a few can be trusted to keep an eye on the others). The best part is that we are beholden to nobody, and it really is do-able for everyone if they make an effort.

Those “gifts” were helping us while they were hurting our patients. It’s time to move on and find new ways to take care of ourselves and our patients.

By: anonymous

anonymous — Thu, 29 Jul 2010 17:52:53 +0000

why does one person have to foot the bill?
everyone can pay for themselves, and i’m sure they selected reasonable restaurants. $100/ mo seems like it would do it. less if they stopped bringing in speakers and did the education themselves.
it’s a lot of money but not a lot for that kind of emotional support and camraderie. i have a hard time buying that it is too expensive to maintain, but i certainly can understand if people have priorities that are more pressing. sometimes these meetings fade away, even with support. and sometimes if the only way they can survive is with external support, it speaks to the commitment level of all the participants (which may not match those of the organizers, who i am sure tried very hard to make it work).

By: A.N. Mousse

A.N. Mousse — Thu, 29 Jul 2010 17:10:04 +0000

When the women in my industry want to meet – we get together at one of our homes on a rotating basis, pot luck style. There are about 20 of us. It doesn’t require a large cash outlay – buying our own food (even pre-made – as many of us don’t have the time for home cooking) and BYOB. Babysitting can be expensive, but we manage to keep those costs down by getting a consensus on the timing for our next meeting. With enough lead time, husbands (even ex-husbands) can be scheduled for babysitting duty. Other women in other professions manage to meet and support each other and learn from each other – we even get guest speakers. Seems you could do it, too. Just because you’ve become accustomed to someone else picking up the tab, doesn’t mean you can’t find workable solutions to this challenge. Can’t really cry over this on your behalf. It just doesn’t wash.

By: docguy

docguy — Thu, 29 Jul 2010 16:11:23 +0000

Dr. Green, I also have uptodate, although it is 400 dollars a year, so if people are short on cash, it’s a pretty big expense

I’m a specialist and I don’t think I could foot the bill for 16 doctors/NPs at a restaurant. what’s that bill going to be maybe 1500 too 1600 dollars…

also I think that the point of the letter was that the meetings were more for social and information sharing or practice than about the drug sponsor and without this funding source the meeting goes away.

I wonder occasionally about my fp comrades in the community, if they don’t go to the hospital and they are solo practice how do they ever get interaction with other docs. I guess you could join the county medical society, ours only costs a thousand a year, that’s a pretty big bill for me..