Most internal medicine residency training program directors don't prefer pharmaceutical support

Most directors of internal medicine residency training programs would prefer not to accept pharmaceutical support for the residencies they oversee, but more than half report doing so, according to an article in the February 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

"Over the past two decades, the impact of pharmaceutical industry marketing on the professionalism and prescribing practices of physicians has gained national media attention," the authors write as background information in the article. Several professional organizations have issued guidelines for appropriate relationships between physicians and the industry. Because medical residents are at a particularly formative time in their career, separate guidelines were issued in 2002 by the Accreditation Council for Graduate Medical Education (ACGME).

"Despite such attention, a nationally representative description of the current landscape of pharmaceutical industry support to residency programs is not known," write Laura L. Loertscher, M.D., M.P.H., of Mayo Clinic, Rochester, Minn., and colleagues. To assess current attitudes and practices, the researchers analyzed data from a survey of 381 U.S. internal medicine residency program directors conducted in 2006 and 2007.

Of the 236 program directors (61.9 percent) who responded to the survey:
•170 (72 percent) expressed the opinion that pharmaceutical support is undesirable.
•132 (55.9 percent) reported accepting pharmaceutical industry support.
•Those who accepted industry support did so in several common forms, including food for conferences (90.9 percent), educational materials (83.3 percent), office supplies (68.9 percent) and drug samples (57.6 percent).
•Half reported that the final decision to accept industry support rested with them, whereas the other half named another final decisionmaker, such as a hospital administrator, chair of medicine or institutional oversight committee.
•153 (64.8 percent) worked at institutions that had established formal written guidelines, whereas 69 (29.2 percent) had implemented a specific curriculum to educate residents on these interactions.

The proportion of program directors accepting industry support was much lower among those who reported finding it unacceptable (22.7 percent) vs. those who found it desirable (72.7 percent) or not desirable but acceptable (71.2 percent). 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 (ABIM), one indicator of program quality.

"In addition to the important influence of program directors, residency program practices are likely affected by institutional history, available financial support and the culture within individual academic environments," the authors write. They also note that previous studies reported funding acceptance rates of 88.6 percent in 1990. "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."
(Arch Intern Med. 2010;170[4]:356-362. Available pre-embargo to the media at www.jamamedia.org.)