Let's Talk About The Physician's "Tail" Risk
I spent several days with 3500 practicing emergency physicians in the Washington Convention Center last month. We have a close relationship with emergency medicine for several reasons:(1) our origins are in that specialty, since our founder was and is a practicing EM doc
(2) one out of every two EM docs in the US uses Challenger Corporation training materials to prepare for their certification exams and maintain their certification
(3) over 10 % of the EM residencies in the US have use the Challenger Program for Residencies (CPR) to teach, evaluate, monitor, grade and remediate their residents in trainng.
Morover, Corey Slovis, Rob Darling and Randy King--three of the best regarded EM physician leaders in the US-- serve on our Physician Advisory Board. I consider these docs and hundreds more who have become Challenger Lifetime Subscribers and/or Challenger investors to be close friends and sources of advice and input about physician perceptions and concerns. I would think it could be in the interest of anyone who makes a living serving the physician community or serving the public vicariously through the physician community to schedule a few days of informal interaction with their foremost physician clients.
So, what do these physicians talk about when they let their hair down? Just like everybody else in the world, they worry about finances and they worry about risk. However, the physician has an additional risk factor that most of the rest of us don't have....because they are channels for treatment, reassurance and ongoing sustenance for their patients. One of the topics that came up time and again in these discussions was the dissatisfaction, even disdain, held by the EM community for industry. Remember, these guys on average write over half a million dollars each in prescriptions every year, but they feel the pharmaceutical companies take them for granted. Worse yet, they feel "talked down to" by people who have little understanding and appreciation for the "tail" of their risk.
What do they mean by "tail"? This is a risk management term that has to do with the long-term risk of bad outcomes from a current activity, such as a drug administration, for example. Any insurance company knows about the "tail" when it prices insurance coverage for physicians. What is the risk over time of a future lawsuit for actions taken today? You might imagine that this risk is a smoothly declining curve as time passes, but you would be wrong! The curve actually depends on the condition treated, patient characteristics such as age and morbidity at time of treatment, and such factors as the local or regional culture of litigation where treatment occurs. For example, litigation risk is mile-high in Florida and Georgia for emergency physicians, but relatively low in Tennesseee--for the same cases!! So, the curve can actually rise again in future as downstream consequences of inappropriate treatments become manifested.
When a pharmaceutical company promotes a medication to the emergency physician communty, a knowledgeable sales and marketing department would be prepared to talk about "tail" risk for the adopting physician, by location and by condition. The Vioxx fiasco ought to be a bellwether indicator of what can go wrong, for all parties, when industry ignores, or worse yet conceals, the tail effects of new medications, devices and practices in the course of promotion. That is just a conspicuous example.
Emergency physicians seldom have the luxury of contemplation when it comes to presenting urgent or emergent conditions. They need to be able to rely upon their tools and their medications for effect and to be able to convey to their patients the potential side effects and consequences of what they are doing. It is a simple matter of disclosure. Disclosure, not some countervailing or offsetting addtional treatment, is the best antidote to increased litigation risk.
Where this all leads to is the issue of the credibility of educational and training material that industry provides or sponsors to physicians. Based on my experience in DC, and hundreds of other encounters over the last year with individual physicians in practice and academics, commercial CME and things of that kind are increasingly held in disregard, even when the physicians receiving these "free" benefits use them to meet some annual or institutional education requirement. That is, the physician will use these things to meet an immediate requirement, but he or she will DISREGARD the substance of the content when it comes to making patient-care decisions. As shown by a study reported three months ago in Med Ad News, CME that is sponsored by a univeristy or specialty society is considered credible by thirty percent more physicians than those who consider industry-sponsored CME to be credible. Practicing docs want to see the "brand name" and logo of a well-regarded medical institution on an educaitonal offering, and they are more likely to rely on that content and training for future decisions.
There is an opportunity here for industry if leadership is prepared to take a longer term view and to invest in partnering with credible source institutions. That is what we have done at my firm, Challenger Corporation, where we jointly sponsor our CME offerings with major medical universities and selected specialty societies. If you look at our product line at www.chall.com/products.htm, you will see a roster of institutions that we work with. By doing so, as opposed to trying to become a commercial CME sponsor in our own right, we have been able to build an educational franchise with the best-selling electronic boards and re-certification
courses in emergency medicine and family medicine, and with an increasing presence in several other specialties. It is a method and a model worth deeper consideration in the face of increased regulation and decreasing credibility in the public and physician community.
Bob Sweeney, PhD, MS
CEO and President
Challenger Corporation
posted by Robert E. Sweeney, DA, MS @ 8:39 AM
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