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Penn study finds link between physician training and brand name prescribing

Internal medicine residents are twice as likely to prescribe most expensive statins when senior physicians do

University of Pennsylvania School of Medicine

PHILADELPHIA - Physicians in training are twice as likely to order a costly brand-name statin (used to lower blood cholesterol levels) when supervised by senior physicians who prefer those medications in their own practice, according to a new study led by researchers at the Perelman School of Medicine at the University of Pennsylvania and published online in the Journal of General Internal Medicine. These findings document a link between low-value prescribing and graduate medical training, which physicians undergo after completing medical school but before they can practice independently.

As part of this study of 10,151 statin prescriptions across four sites, lead author Kira Ryskina, MD, a general internal medicine fellow at Penn, and her coauthors analyzed prescribing data from 342 resident and 42 attending physicians from 2007 to 2011. The study found that the probability of a resident prescribing a costly brand-name statin increased from 22.6 percent when residents were supervised by attending physicians who mostly prescribed cheaper generic statins, to 41.6 percent when they were supervised by an attending who mostly prescribed expensive brand name statins. The linkage was strongest for the most junior resident physicians in training. With brand name statin prescribing accounting for an estimated $5.8 billion in low-value spending annually, these findings represent an opportunity for improvement in graduate medical education to increase value in health care spending.

"These findings provide early empirical evidence that low-value practices among physicians are transferred from teachers to trainees, highlighting the importance of re-design of graduate medical education," said Ryskina. "We observed considerable variation in the prescribing practices of both attending physicians and residents, suggesting room to improve cost-effectiveness."

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The study's other Penn authors include C. Jessica Dine, MD, an assistant professor of Pulmonary and Critical Care Medicine, and Andrew Epstein, PhD, a research associate professor in the division of General Internal Medicine, along with other co-authors Esther J. Kim, BS, and Tara F. Bishop MD, MPH.

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.9 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $409 million awarded in the 2014 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2014, Penn Medicine provided $771 million to benefit our community.

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