Pharmaceutical Industry Support Undesirable Yet Accepted by Directors of Residency Programs

Fran Lowry

February 22, 2010

February 22, 2010 — Most directors of internal medicine residency programs feel that industry support is not desirable, but many accept it nonetheless, according to new research published February 22 in the Archives of Internal Medicine.

"Over the past 2 decades, the impact of pharmaceutical industry marketing on the professionalism and prescribing practices of physicians has gained national media attention," write Laura L. Loertscher, MD, MPH, from the Mayo Clinic, Rochester, Minnesota, and colleagues. "Interactions with the pharmaceutical industry are known to affect the attitudes and behaviors of medical residents; however, to our knowledge, a nationally representative description of current practices has not been reported."

The goals of this study were to determine current attitudes of program directors toward pharmaceutical industry support of their residency programs, whether directors accepted such support, and any potential associations between program characteristics and the acceptance of industry support.

In 2006 to 2007, 381 internal medicine residency program directors were surveyed by the Survey Committee of the Association of Program Directors in Internal Medicine. They were asked whether their programs accept support of any kind from the pharmaceutical industry and, if so, why.

Those who said yes were asked about specific forms of support, including food for conferences, educational materials, office supplies, drug samples, and unrestricted educational funds, as well as types of industry involvement, such as direct contact with residents.

In all, 236 program directors (61.9%) responded to the survey. Of these, 132 (55.9%) reported accepting support from the pharmaceutical industry.

However, most of the program directors (n = 170 [72.0%]) expressed the opinion that pharmaceutical support is not desirable.

The most common forms of industry support included food for conferences (90.9%), educational materials (83.3%), office supplies (68.9%), and drug samples (57.6%). In addition, 74.2% of the programs that accepted industry support allowed direct off-site contact with residents, and 40.2% allowed direct on-site contact.

Of the programs that accepted industry support, 92 (69.7%) did so because of lack of other funding. Other reasons for accepting industry support included popularity with residents (40.9%), important educational value other than financial support (28.0%), ease of attainment (26.5%), and being encouraged by the department chair or administration to accept the support (19.7%).

The survey also found that 79 programs (59.8%) cited more than 1 reason for accepting industry support.

The proportion accepting industry support was much lower among programs with a program director who believed it was unacceptable (22.7%) than among programs with a director who believed it was desirable (72.7%) or not desirable but acceptable (71.2%).

Half of the time, the final decision to accept support was left to the program director's discretion. Other final decision makers included the chair of medicine, the hospital administrator, or an institutional oversight committee. In addition, acceptance of pharmaceutical industry support appeared to be associated with a lower rate of program graduates passing the American Board of Internal Medicine.

The study also found that 153 programs (64.8%) had established written guidelines to address the issue of potential influence from the pharmaceutical industry, but that only 69 (29.2%) had educated residents specifically about this issue.

Residency programs were much less likely to receive industry support when the program director held the opinion that industry support was "never acceptable" (odds ratio, 0.07; 95% confidence interval, 0.02 - 0.22), and programs located in the southern United States were more likely to accept pharmaceutical support (odds ratio, 8.45; 95% confidence interval, 1.95 - 36.57) compared with programs in the northeastern United States.

A limitation of the study is that responses were obtained via a volunteer survey, and therefore the residency programs of those who responded could be different from those who did not complete the survey. The authors also point out that the degree to which programs rely on pharmaceutical funding requires clarification, as does the association between geographic location and acceptance of pharmaceutical support.

"The influence of pharmaceutical industry support on medical education warrants further investigation," the authors write in their conclusion. "Although all of the underlying reasons are not yet fully elucidated, it is clear that, in the face of attention around conflict of interest with pharmaceutical support, internal medicine residency program directors have taken a less permissive stance and acceptance of industry funding has declined. Nevertheless, more than half of the residency programs surveyed continue to accept some form of industry support."

This study was supported in part by the Mayo Clinic Internal Medicine Residency Office of Educational Innovations as part of the Accreditation Council for Graduate Medical Education Educational Innovations Project. Dr. Loertscher has disclosed no relevant financial relationships.

Arch Intern Med. 2010;170:356-362.