The Sex Issue - The Burrill Report

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.
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The Journal of Life Sciences
november/december 2008