Free Pharma Meals: NPs, PAs Will Get the Same Scrutiny as Docs

James F. Sweeney


July 01, 2019

In Medscape's Ethics Report 2018, 67% of physicians said they could be a paid speaker at a pharmaceutical company dinner or accept lunches from drug reps without it influencing their prescribing habits. Many respondents commented that regarding disclosures from the Sunshine Act, patients have not asked them about it and mostly don't care.

 A study published in JAMA Network Open earlier this year found that disclosure could have the unintended effect of reducing patient trust in individual physicians and the medical profession, regardless of whether the patients' doctors had received payments.[8]

A 2017 study done by University of Michigan and Duke University found that monthly payments declined by 2% on average owing to disclosure.[9]

It remains to be seen whether adding NPs, PAs, and others to the reporting requirement will have any effect.

Physicians say that few, if any, patients seem to be aware of the requirement and public database or bring it up during visits. "They don't care, and I really don't think it changes anything we do," Price said.

Support for More Sunshine

Despite the lack of clear evidence that adding NPs and PAs to required reporting will have any effect on prescribing or patient perception of the pharma industry's interaction with practices, those who have studied the matter say it's a good thing.

"If one class of prescribers is covered, they all should be," said Ross.

I don't think there is any reason it should be different for (NPs and PAs).

Timothy Anderson, MD, a researcher at University of California, San Francisco, School of Medicine, said the more scrutiny of the relationship between pharmaceutical companies and clinicians, the better. "I don't think there is any reason it should be different for [NPs and PAs]," he said.

The AANP and AAPA also support the pending reporting requirements. "We believe we should be held to the highest ethical standards, like everyone else," said AANP president Joyce Knestrick, PhD, APRN, CFNP.

Still, the reporting could be confusing, cautioned Walid Gellad, MD, MPH, head of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh. Physicians could avoid being reported by ordering their NPs and PAs to attend seminars and other industry-sponsored events, he said. He also questioned whether the data would allow patients to link NPs and PAs to the physicians for whom they work.

A Call for Consistency

Although they supported additional reporting, experts were reluctant to dictate a single policy that practices should follow with regard to interactions with pharmaceutical companies.

"I think it's up to each individual practitioner what they want to do," said Gellad.

Whatever the policy, it should be consistent within a practice for physicians and NPs and PAs, said John Cullen, MD, president of the American Academy of Family Physicians. "I do think it would be nice if we were all playing by the same rules. If a doctor supervises an NP or PA, I think they need to communicate what the rules are when it comes to accepting gifts from a pharma rep."

A clear and understood policy is the best way to avoid trouble, Cullen said, adding that the owner-physician is responsible for any problems.

"As an employer, the problems of my employees are attributable to me," he said.

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