Do Drs offices get incentives for prescribing certain medications?

[PatMcDuck]

I work at a peds office too, front desk. While they might not get a direct $$ for writing for particular drugs, they do get "cozy" with certain drug reps. Usually the ones who 1. Buy the staff lunch 2. give pens, pads, etc (no longer allowed) 3. Give the office samples. (the samples are a whole sticky situation, not all are given to the PATIENTS, is all I can say).

Anyway, our drs ARE writing less scripts for antibiotics in the last year or two, BUT the parents BEG for antibiotics for things as simple as a cough. (Then they call a week later complaining about the side effects, ie diaherrea). So it is difficult, the parents insist on it, I guess they are used to it. (edited to say, sometimes they really really need antibiotics for a cough! sorry this post sounds so judgmental, did not mean it like that!)

The thing to remember is that is is best to alternate antibiotics and not use the same one all the time, our doctors check this on the chart. And to say one drug "never works" seems impossible, because each bacterial infection is different, and a person would not pick up the same resistant strain over and over? We have to remind our patients, that if an antibiotic seems not to work, the child could have a viral infection...... but the DR usually tries another antibiotic of course. Certain ones work best on certain areas of the body, etc. We run labs for some to check for resistance and for elevates WBC.

And if your Dr keeps writing scripts for the newest and most expensive drugs, complain! Ask for a generic, there usually is one that works just about as well as the new drug for routine illnesses.

Lastly, feel free to switch DRs! People switch around all the time. We have people leave, and come back, it is fine with us.

 

[MSSANDRA]

Our doctors are great about asking about insurance and choosing a choice that works for your budget as well as your child needs.

I do know however that our hospital often uses a particular drug almost exclusively. One I know is the cholesterol medication. Almost every patient that is admitted to the hospital and is using cholesterol medications gets this one unless their family doctor is on staff and prescribes another one.

 

[SandrA9810]

Some doctors are pushed by parents to "prescribe something..." just so the parent can feel like their child is getting better because of the medicine. If there's nothing showing that the symptoms are related to bacteria, the kid just has to ride it out. Medications only help with the pain that goes with it, to make you feel better, even if you're body isn't better.

 

[sookie]

he is probably preferring omnicef because it is once a day. it helps for compliance in a lot of families who aren't the best at taking medicine.

that being said, ask for a different drug that is cheaper. if your child was recently on amoxil, for instance, you may need to switch drugs because you run the risk of improperly treating the infection (if you were just on amoxil and you have a bacterial infection, the bacteria is probably resistant to amoxil). so you might have to switch up the antibiotic.

you might need to remind him too that your child was just on omnicef, are you sure he wants to use it again?

hope that helps.

 

[sookie]

I work at a peds office too, front desk. While they might not get a direct $$ for writing for particular drugs, they do get "cozy" with certain drug reps. Usually the ones who 1. Buy the staff lunch 2. give pens, pads, etc (no longer allowed) 3. Give the office samples. (the samples are a whole sticky situation, not all are given to the PATIENTS, is all I can say).

Anyway, our drs ARE writing less scripts for antibiotics in the last year or two, BUT the parents BEG for antibiotics for things as simple as a cough. (Then they call a week later complaining about the side effects, ie diaherrea). So it is difficult, the parents insist on it, I guess they are used to it. (edited to say, sometimes they really really need antibiotics for a cough! sorry this post sounds so judgmental, did not mean it like that!)

The thing to remember is that is is best to alternate antibiotics and not use the same one all the time, our doctors check this on the chart. And to say one drug "never works" seems impossible, because each bacterial infection is different, and a person would not pick up the same resistant strain over and over? We have to remind our patients, that if an antibiotic seems not to work, the child could have a viral infection...... but the DR usually tries another antibiotic of course. Certain ones work best on certain areas of the body, etc. We run labs for some to check for resistance and for elevates WBC.

And if your Dr keeps writing scripts for the newest and most expensive drugs, complain! Ask for a generic, there usually is one that works just about as well as the new drug for routine illnesses.

Lastly, feel free to switch DRs! People switch around all the time. We have people leave, and come back, it is fine with us.

wow, just wow! if that happened in one of our offices we'd be having problems. and we give the samples to patients who we know are struggling or who ask. its for the patients.
and a good ped usually knows the difference between a bacterial or vial infection. so - i'm just kind of dumbfounded. i'd be looking for a new office to work in!

 

[tlenzendorf]

I work at my kid's pediatricians office for a large hospital that is affiliated with the University of Wisconsin(the UW Hospital). Our physicians get absolutely no incentive for using certain medications. We haven't been allowed to take anything from the drug reps(pens, foods, tickets, magnets, etc) in 5+ years now. If our doctors have any affiliation with the drug companies they must have a sign up in the waiting room and their patients are sent a letter. It's extremely strict. We aren't allowed to have samples of anything, either.

 

[VroomVroomLightning]

I know with my insurance that if the doctor writes out for a certain medicine we are usually given the "generic" but we are fine with that because it works just the same. During the fall and winter months I get bronchitis at least once a month if not more. Each time I am given a z-pack and it works its magic each time. So maybe the doctor is prescribing it over and over because it is making your daughter better each time. But if you feel that she doesn't need it this time I would just not waste your money and see if the fever goes away on its own.

 

[Halbleib1]

According to Dr. Oz they do. He also said that drug reps. see Drs. more than patients do. He did a whole show about it and about how people are taking so many heart meds. in particular that are not needed and in fact increase the risk of heart attack rather than reducing it. If you are taking too many meds. they actually counteract each other and put you more at risk for the disease/condt. that you are trying to prevent; as well as put you at risk for other diseases/conditions that you do not already have.

 

[princessmorgan]

Thanks again for all the replies, all the information is so interesting. DD had a better night and had a low fever this morning. I didn't give her antibiotics, because I just didn't feel like she needed it. I called another doctor in the practice this morning and she agreed that I should wait and see if DD gets better on her own. DD has done a lot better today and I didn't have to give her tylenol or motrin all day, so I'm assuming it was something viral.

None of my DD's have ever been prescribed amoxicillin at this practice. Sometimes I ask about it and the Dr. scoffs and says, oh no, that won't be good for this. I guess I have noticed a lot more about each charge, because we opted for a health fund this year. So technically we have not paid a penny out of pocket for anything, but once we reach a certain amount, then we pay 100% of everything until we reach a certain deductible. I'm sure with all the lab work for this visit we will have reached that limit. I never paid a lot of attention to health care costs when I just had to pay a co-pay for everything. It has really been eye opening.

 

[jcano]

According to Dr. Oz they do. He also said that drug reps. see Drs. more than patients do. He did a whole show about it and about how people are taking so many heart meds. in particular that are not needed and in fact increase the risk of heart attack rather than reducing it. If you are taking too many meds. they actually counteract each other and put you more at risk for the disease/condt. that you are trying to prevent; as well as put you at risk for other diseases/conditions that you do not already have.

Don't believe everything you see on TV....especially from Dr. Oz.

 

[sukhakuli]

Dh is a Pediatrician (now specialized), and no, we don't get any money if he prescribes a drug. He hardly ever sees drug reps, actually. We don't even get pens. I do have one coffee cup that says "Check for Chicken pox" and another that proclaims "Creamy Wash" on the front, but after 7 years of practicing medicine, that's all we got, lol.

Don't believe Dr Oz, either, he's a sell out.

 

[disfan07]

At my internists office it is against the rules to accept anything from drug reps at all and definitley no incentives. They are in a medical group that is part of a very large non-profit hospital here. Accepting anything from drug reps is grounds for disciplinary action and possibly termination depending on what it is. That applies to all the doctors in that medical group.

However, the offices do have drug samples. Not a lot but some, but they are supplied solely by the hospital. They are mainly for medicaid patients. But I have gotten samples before to try out when we have been searching for the proper medication because my docs. don't want me paying for a months worth of meds when we will know after a week or so if they are or are not working.

 

[WheelCEO]

I remember before I started my own business, I managed a restaurant. We were in a large medical district and every wednesday we would get bombarded with reps from drug companies sending 100's of dollars worth of food to every doctors office in the area.. another form of a kick back

 

[shaylahc1]

Doctors may or may not get kickbacks....but they certainly get "goodies" like free catered lunches, and other "treats". My current doctor is actually a real gem---he will prescribe meds if I ask for them, but he always tells me to not fill it "unless I have to". I do think some docs have a certain antibiotic they tend to like a lot---I know Zithromax was the star of antibiotics in the 1990s, and some docs still like it as their "go to" antibiotic. The problem with amoxicillin is that it has been so overused that it often doesn't work anymore. Many germs are now resistant to it, so taking amoxicillin (especially in a kid who is often on stronger antibiotics) is just pointless.

I actually have found that in the past few years doctors are getting really selfish about writing prescriptions. They insist EVERYTHING is "just a virus" which often means I have to make 2 or 3 trips to the doctor just to get them to finally admit it wasn't "just a virus" and maybe the kid does have a sinus infection/ear infection/chest infection after all. I would much rather have a doctor that overdispenses prescriptions (because it's always up to you whether or not you want to fill it) than having to go back repeatedly to beg for a script while your kid suffers for 3 weeks, not recovering from their "virus"

I do think it would be perfectly acceptable to ask your ped to prescribe something else if the Omnicef is too expensive. I would just flat out say "this one has a $60 copay, can we try something else that is less expensive?" Your doc might surprise you by giving you some free samples or prescribing something generic.

I personally think your doctor is fine. Overly cautious, perhaps (with the Xray order when the kid wasn't coughing) but you also have to remember that docs are terrified of getting sued---they would much rather er on the side of caution rather than risk a patient dropping dead and then being sued because they "didn't do enough".

 

[tink_lover]

Doctors in some areas of the country might still get free lunches and dinner from drug reps but that will soon change when the Sunhine Act goes into effect.

 

[Daisy5115]

 

[MSSANDRA]

And sometimes the more expensive antibiotic is really not more expensive. DS19 went though a really rough period with sinus infections before we had surgery. Most meds would not touch them. Omnicef was less used then and it worked! Problem was, out practice has lot of doctors and they were all trained to try other drugs first. So when we added two or three co-pays and two or three drugs that would not touch the stuff, omnicef turned out to be cheaper. Ds was pretty little and he would go in and ask the dr for omnicef

 

[MoonFaerie]

I'd say wait it out. It sounds like your DD has been on antibiotics too much already. I wouldn't use a doctor that puts kids on antibiotics 'just in case.'

Antibiotic over-use isn't good. It's how we end up with drug-resistant organisms. A Dr should know this. I'm only a pre-med undergrad Sr, and I've learned it in class & done experiments in lab with antibiotics.

 

[disfan07]

Antibiotic over-use isn't good. It's how we end up with drug-resistant organisms. A Dr should know this. I'm only a pre-med undergrad Sr, and I've learned it in class & done experiments in lab with antibiotics.

The problem is, some doctors (especially some pediatricians) get so sick of patients and/or parents requesting (or in the case of some of my docs patients...demanding) antibiotics everytime they come in. My doctor is both an internist and a pediatrician and she sees this all the time.

And the way she has had to deal with some of these people is to give them the antibiotics just so they leave. She has also told some patients that if they don't like the way she practices medicine, she is happy to give them a recommendation for another doctor. When it is a repetative thing, she does not sit quietly and take it. She's only been out of residency for about 8 years and she is so drained from some of this already.

My doctors general rule of thumb is that if they have ruled out a bacterial infection, give it at least a week. If it does not get any better in a week or gets worse within that week, then antibiotics would be the next step. She also does NOT make you come back in to get antibiotics. If she saw you, and you call a week later saying that you or your child is not getting better, she will write a prescription and fax it in for you. She said that most of the time, she doesn't hear from them again and the next time they see her they tell her that she was right about the virus.

I actually have found that in the past few years doctors are getting really selfish about writing prescriptions. They insist EVERYTHING is "just a virus" which often means I have to make 2 or 3 trips to the doctor just to get them to finally admit it wasn't "just a virus" and maybe the kid does have a sinus infection/ear infection/chest infection after all. I would much rather have a doctor that overdispenses prescriptions (because it's always up to you whether or not you want to fill it) than having to go back repeatedly to beg for a script while your kid suffers for 3 weeks, not recovering from their "virus

"


Yeah but then of course when the meds.stop workign they will blame the DOCTOR for always giving them prescriptions which causes them to be ineffective.

Under the majority of situations, doctors SHOULD NOT be prescribing medication, "just because" or "just in case". That's not the way they should be practicing medicine on a daily basis.

 

[anabelle]

I absolutely loved our pediatrician. He was such a common sense guy. He never prescribed anything if he didn't think that it would benefit. My oldest had a terrible time with ear infections when he was a baby. He was going to have to get tubes when he suggested that we switch to soy milk, because in some cases bad ear infections were actually milk allergies. It worked. He was such a mellow guy that he can put any scared mommy at ease. If for any reason you feel like your doc is not the doctor for you, switch. You can interview doctors if you like.