Why physicians prescribe costly medicines

Does your doctor often prescribe costly, big brand medicines? The decision may have to do with his training.

The kind of medicines (cheaper or costly) a doctor prescribes is influenced by the prescriptions made by senior physicians who supervised them during the training, says a study.

The results represent an opportunity for improvement in graduate medical education at a time when in India the government is emphasising on physicians prescribing generic medicines instead of brand names to make healthcare more affordable for the masses.

The study, published online in the Journal of General Internal Medicine, found that physicians-in-training are twice as likely to order a costly brand-name statin (used to lower blood cholesterol levels) when supervised by senior physicians who prefer those medications in their own practice.

These results document a link between low-value prescribing and graduate medical training, which physicians undergo after completing medical school but before they can practice independently.

The study found that the probability of a resident prescribing a costly brand-name statin increased from 22.6 percent when residents were supervised by attending physicians who mostly prescribed cheaper generic statins, to 41.6 percent when they were supervised by an attending who mostly prescribed expensive brand name statins.

The linkage was strongest for the most junior resident physicians in training.

"These results provide early empirical evidence that low-value practices among physicians are transferred from teachers to trainees, highlighting the importance of re-design of graduate medical education," said Kira Ryskina, a general internal medicine fellow at University of Pennsylvania.

"We observed considerable variation in the prescribing practices of both attending physicians and residents, suggesting room to improve cost-effectiveness," Ryskina said.