Blogs / Reality Base

We’re back from a brief holiday hiatus, just in time for some heartening news to kick off 2009: As of Jan. 1, the Big Pharma companies have all agreed to stop producing and issuing the gobs of free loot—everything from pens to mugs to flashlights to T-shirts—they’ve been passing out to doctors for years.

Critics poo poo the measure as little more than lip service, a PR move that doesn’t address the far bigger issue: that the drug industry and medicine are hopelessly financially intertwined. (Want proof? Exhibits A, B, and C.) Doctors, meanwhile, brush off the idea that logo-ed pens and Post-Its could alter their prescribing habits.

Still, there’s plenty to be said for the influence of everyday objects, not to mention the power of advertising. Surround yourself with enough Burger King merchandise, and you’d be amazed at how often you start craving Whoppers. Wouldn’t the same principle apply when it comes to physicians and drugs?

(Full disclosure: RB is the child of two doctors, and our childhood desk was filled to overflowing with pens, paperweights, magnets, notepads, and countless other booty emblazoned with words like Diflucan, Avandia, and Provigil. We never went to med school, but we’d probably prescribe Lipitor simply because of their awesome mousepads.)

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Not only are doctors becoming increasingly, frighteningly scarce, but they’re also hating life. A recent survey of 11,950 primary care docs and specialists done by the Physicians’ Foundation found that 60 percent would not recommend medicine as a career, while 42 percent said professional morale is either “poor” or “very low.”

The reasons for all this depression can be boiled down to insurance companies and policy headaches:

“The reported reasons for the widespread frustration among physicians include increased time dealing with non-clinical paperwork, difficulty receiving reimbursement and burdensome government regulations. Physicians say these issues keep them from the most satisfying aspect of their job: patient relationships.”

Food for thought, Obama? As for all those Medicare cut proposals being thrown around, 82 percent said their practices would be “unsustainable” if pay cuts were made. A whopping 94 percent reported that the time they spend on non-clinical paperwork has gone up in the past three years, with 63 percent saying the paperwork leads to less time spent on each patient.

And of course, there’s the shortage, which is already alive and well: 78 percent of the physicians surveyed believe there’s an existing dearth of primary care doctors, while 49 percent say they plan to reduce the number of patients they see, or even stop practicing over the next three years. Yikes.

Related:
RB: Get Thee to Medical School!

The American health care rule for prescription drugs is generally: Ask (or just go online) and ye shall receive.

But with an economic meltdown comes serious resource reallocation, and lost jobs and slashed earnings/net worths mean less money to pay for all those Trazodone and Ativan refills. Consequently, as the New York Times reports, consumers are cutting back on prescription drug use in an effort to curb spending. And the effects are already hitting drug companies: Pfizer says that sales of Lipitor, the world’s largest-selling prescription med, has seen sales drop 13 percent in the third quarter, and Merck just announced it’s slashing 7,200 jobs.

Of course, there are plenty of reasons why this is bad:

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The doctor shortage is looming in our future, and the exodus of top scientific talent out of the U.S. may be just a few years away. But imagine the scenario if you added a domestic war, ethnic violence, and an unstable (relatively speaking) government to the equation. Cue the current situation in Iraq, in which legions of educated workers—including doctors and other health professionals—are high-tailing it to safer pastures, as Newsweek reports. And who can blame them: Since the U.S. invasion began, doctors have been prime targets for violence, including assassination, ransom kidnapping, and torture.

Unsurprisingly, around 30,000 doctors, plus some dentists and pharmacists, have fled the country as a result, and despite the fact that things have calmed down since the near-chaos of 2006, only about 800 have returned. To put that number into perspective, the total population of Iraq is around 28 million, compared to over 300 million in the U.S. The expected American doctor shortage, which could be enough to throw our health care system into crisis, is projected to be 50,000 to 100,000 doctors—not that much more than what Iraq has already lost.

Then there’s the other urgent dilemma: With all the experienced doctors fleeing the country, who’s left to train the med students?

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