Yesterday, The NY Times reported that drug company payments to psychiatrists in Vermont doubled last year to over $45,000 on average. In a climate of widespread worry about the nefarious influence of drug company payments on prescribing practices, the Times report only adds fuel to the fire.
... Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program.
After digging a little deeper into the matter, it appears that The Times reporter has gotten the facts wrong. The report issued by Vermont officials indicates that an average payment of $45,692 was made to just 11 of the state's psychiatrists who were among the top 100 recipients of pharmaceutical company payments to prescribers in all specialties. The Times article says nothing about the $45,000 figure referring only to the state’s top 11 recipients of drug company payments. Click on the table below to see a summary.
The Vermont report also indicates that, among the 11 psychiatrists who top the list, the median payment was $27,000. The large difference between the average and median figures suggests a trend in the way payments are distributed. It appears that a few psychiatrists receive very large payments with the rest recieving far less. Looking only at the average among the top 11 recipients yields an average figure that would be shocking, indeed, if it represented the average or even the median payment to all psychiatrists in Vermont. It does not, but this is the false impression created by the Times article.
Although the Vermont report doesn't provide information on the average payment for psychiatrists who are not among the top 11 recipients in the state, we can extrapilate from the available data and come up with what I believe is a reasonable estimate of payments/gifts a typical psychiatrist practicing in Vermont might see.
The state's report indicates that prescribers from all specialties received a total of $2,033,000 from drug makers. Of that total figure, $1,550,000 (76%) went to the state's top 100 recipients, leaving about $500,000 payed to all prescribers who were not among the state's top 100. I don't have a recent figure for the number of psychiatrists working in Vermont, but the USDHHS reported that there were 116 psychiatrists practicing there in 1998.
The Vermont report also indicated that 22% of payments to the top 100 recipeints went to psychiatrists. If the that distribution rate holds up for all of the state's prescribers, then roughly $110,000 (22% of $500,000) in payments were divided between approximately 105 psychiatrists who were not among the state's top 100 list. That would amount to about a $1 thousand payment per psychiatrist for those not among the top 11 recipients of drug company money — a far cry from the Times' figure of $45,000 per psychiatrist in the state.
Even when we include the top 11 recipients in calculating the average, the figure would be closer to $4 thousand per psychiatrist. Given the lopsided distribution of payments, I suspect that the median value of payments would still fall somewhere in the neighborhood of $1,000. Again, I'm assuming that the 22% distribution rate seen among the top 100 recipients holds up for all providers in the state. The figure might be higher or lower.
Psychiatrist Shrink Rap characterizes some of the reporting as sensationalist as he discusses his experience with pharmaceutical reps and his own prescribing practices. He has not received payment other than pens, pads and a few sandwiches for clinic staff during in-office presentations. Of the higher rates of anti-psychotic prescriptions for Medicaid patients, he notes:
It's hard to get Medicaid, you have to be sick. An episode of depression treated with Prozac doesn't do it. To get Medicaid, at least in Maryland, you have to be chronically ill (and even that isn't always enough), so a bad psychiatric illness, chronically, probably one that you need a chronic, expensive, antipsychotic medication to get. No wonder antipsychotics are a high percent of the Medicaid budget.