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NEWS 12 The Journal of Life Sciences november/december 2008
in sample form, in such instances, are left paying the price when they have to fill a prescription. Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America, says free samples provide doctors valuable first-hand experience with new medicines and can help patients quickly find the best medicine for them. The Wake Forest study overlooks the fact that America’s physicians prescribe medicines based on a wide range of factors, not simply receipt of samples, he says. “Clearly, free sample medicines lead to better treatment and improved quality of life for millions of Americans, regardless of their incomes,” he says. But Sidney Wolfe, director of Public Citizen’s health research group and editor of the consumer web site Worstpills.org, says quantitative studies on drug sampling like the Wake Forest one are relatively new. The research provides mounting evidence on the downside of sampling, he says. “Having to spend extra hundreds or thousands of dollars a year because the doctor prescribed an expensive brand name drug instead of giving you an equally effective and safe generic drug is just not good for patients,” he says. EDUCATION Income Inequality —Daniel S. Levine Study links the primary care doctor shortage to fact that other specialties pay a lot more. The medical establishment generally agrees the improvement of primary care is a desirable goal, as it leads to lower infant mortality rates and lower death rates overall. In fact, an increase of one primary care physician is associated with a 5 to 10 percent decrease in deaths per 10,000 people, according to Dr. Barbara Starfield, a professor at Johns Hopkins Bloomberg School of Public Health who studies primary care’s benefits. But despite the obvious value of primary care to society, the specialty seems to be shrinking rather than expanding. The reason? It pays a lot less than lucrative specialties, leading to a growing shortage of primary care doctors, a recent study finds. Offering an average salary of $185,740—the lowest of 13 key medical specialties—family medicine had just 42.1 percent of its residency positions filled by U.S. graduates of medical schools, says study author Dr. Mark Ebell, a professor at the University of Georgia. That was the lowest percentage of all residency positions. By contrast, with an average salary of more than $400,000, radiologists (88.7 percent) and orthopedic surgeons (93.8 percent) had the highest percentage of filled residency positions among U.S. graduates. “Certainly, the income disparity among the specialties has grown compared with what it was 20 years ago,” says Ebell, who published his results in the September 10 issue of the Journal of American Medicine. “The primary care specialty is not an attractive lifestyle for many students.” Primary care includes pediatrics, family medicine, and general internal medicine. Ebell compared 2007 starting salaries for specialties with the percentage of medical school graduates choosing them and found a strong direct correlation between higher overall salary and higher residency fill rates with U.S. graduates. In the past decade, the number of U.S. graduates filling family practice residencies has fallen 50 percent, Ebell says. Both U.S. and foreign graduates of international medical schools have helped close the gap, making the total filled positions in family medicine residencies 88.3 percent. But that’s still the lowest fill percentage, with orthopedic surgery and radiology residencies having 99.7 percent and 100 percent fill rates, respectively. Salary disparity alone does not account for the decline, Ebell says. In the past 20 years, a med student’s average debt has quadrupled to $140,000 from $35,000 he says, making the The average family physician makes $185,740 versus more than $400,000 for the average radiologist. 1 3 The Journal of Life Sciences november/december 2008
Page 1 and 2: NOVEMBER / DECEMBER 2008 The Sex Is
Page 3 and 4: Agenda October 8 & 9, 2008 Module A
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Page 27 and 28: Leadership. Education. Action. CHI
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Page 41 and 42: The medical establishment generally
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