Doctors who attend lower-tier medical schools prescribe far more opioids, study finds

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Coltuna

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There are sooooooooooooo many confounds
 
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allantois

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Just shows that you can prove anything you want with shoddy research.
 
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Overthink

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This is the first time I've seen USNWR be used in an academic context. Validation for the use of a heuristic is not good for scientific inquiry.
 
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Lucca

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My first reaction was: lol

Upon taking a look at the figures and discussion: the data is actually pretty interesting. In particular the chart where they take a look at what kind of practice environments (rural, urban, etc) physicians from different specialties and differentially ranked schools are from while also looking at opioid prescription habits.

Their claim is that something about undergraduate medical education might have something to do opioid prescribing habits down the line. My first reaction to this is that I would actually expect *postgraduate* medical education (residency) to be the most sensitive variable for prescription habits since that is really when you develop the bulk of your clinical skills and experience. It could be that medical school rank is associated with whatever this mysterious opioid-prescribing-tendency is but perhaps only because it is also correlated with postgraduate medical education (higher ranked med school grads tend to go to more academically oriented residencies, or something like that). But I'm just speculating.

it's also curious as to why docs from unranked DO schools have such insanely high opioid prescription rates. inb4 "DOs are causing the opioid crisis", "Goro is causing the opioid crisis"

this is probably the most interesting figure to most since it controls for specialty / practice environment and also controls for practice environment for just GPs.

c0x4UmD.png
 
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Overthink

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My first reaction was: lol

Upon taking a look at the figures and discussion: the data is actually pretty interesting. In particular the chart where they take a look at what kind of practice environments (rural, urban, etc) physicians from different specialties and differentially ranked schools are from while also looking at opioid prescription habits.

Their claim is that something about undergraduate medical education might have something to do opioid prescribing habits down the line. My first reaction to this is that I would actually expect *postgraduate* medical education (residency) to be the most sensitive variable for prescription habits since that is really when you develop the bulk of your clinical skills and experience. It could be that medical school rank is associated with whatever this mysterious opioid-prescribing-tendency is but perhaps only because it is also correlated with postgraduate medical education (higher ranked med school grads tend to go to more academically oriented residencies, or something like that). But I'm just speculating

I agree with you Lucca that intuitively, residency training should play the largest role in determining physician practice. I believe the paper supports this idea in part: "For pain medicine, physical medicine and rehabilitation, and anesthesiology—the specialties where all practitioners could be expected to receive specific training in the use of opioids—we see virtually no relationship between initial medical school rank and opioid prescribing, as hypothesized above."
 
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Lucca

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I agree with you Lucca that intuitively, residency training should play the largest role in determining physician practice. I believe the paper supports this idea in part: "For pain medicine, physical medicine and rehabilitation, and anesthesiology—the specialties where all practitioners could be expected to receive specific training in the use of opioids—we see virtually no relationship between initial medical school rank and opioid prescribing, as hypothesized above. This is true despite the fact that doctors who specialize in pain medicine, for example, prescribe many more opioids per physician than doctors in other specialties."

Ya, I think the authors are probably economists or something and therefore think that medical school is where you learn how to be a doctor. They are probably capturing a hidden variable that correlates well with medical school rank.

It doesnt mean the paper is not interesting. One could use it to make the argument that there is not enough opioid education incorporated into general postgraduate or undergraduate medical education, but I havent gone through medical school or residency so maybe there is plenty already!
 

md-2020

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I'm going to slot in here and predict that this thread reaches 100+ comments.
 
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Overthink

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This figure is interesting:
upload_2017-8-7_17-40-50.png


The authors speculate that the curve getting flatter over time (indicating more uniform prescribing practices) "reflects the more rapid diffusion of best practices in top schools rather than the selection of certain types of physicians" They initally hypothesized that "the selection of more qualified people into higher ranked schools" would make the curves steeper over time.
 
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SuaveCardigans

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it's also curious as to why docs from unranked DO schools have such insanely high opioid prescription rates. inb4 "DOs are causing the opioid crisis", "Goro is causing the opioid crisis"
And why are foreign trained doctor rates so low? Thats the real headscratcher to me
 

moggat

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Looking at those error bars I just hear my old PI in the back of my head: "if it's not significant, a trend is just wishful thinking".
 
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Lucca

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And why are foreign trained doctor rates so low? Thats the real headscratcher to me

Not *that* weird since US docs prescribe wayyyyyy more opioids than docs in any other country. (80% of global supply of opioids are consumed in America).

Americans still lead the world in something: Use of highly addictive opioids

So foreign docs (who are also foreign trained) are probably less likely to prescribe opioids and might resort to other modalities. Carib grads are obviously Us trained so they are comparable to other US trained counterparts from MD/DO schools (paper breaks this down in the figures). But other foreign docs vary depending on the country they are from, on average being equal or lower than US MDs.
 
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SuaveCardigans

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Not *that* weird since US docs prescribe wayyyyyy more opioids than docs in any other country. (80% of global supply of opioids are consumed in America).

Americans still lead the world in something: Use of highly addictive opioids

So foreign docs (who are also foreign trained) are probably less likely to prescribe opioids and might resort to other modalities. Carib grads are obviously Us trained so they are comparable to other US trained counterparts from MD/DO schools (paper breaks this down in the figures). But other foreign docs vary depending on the country they are from, on average being equal or lower than US MDs.
Okay that explanation makes sense
 
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Lucca

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Okay that explanation makes sense

just me speculating tho. My comment is based on the assumption that the real important variable is opioid education in residency training. Could be wrong. I dont know enough about the methods in this paper to really understand how convincing those trend lines are. Error bars are big, but that doesn't always mean a trend is garbage. It can certainly mean that in some datasets. And I didnt check to see for p-values between means / medians or if that was in the paper.
 

SuaveCardigans

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just me speculating tho. My comment is based on the assumption that the real important variable is opioid education in residency training. Could be wrong. I dont know enough about the methods in this paper to really understand how convincing those trend lines are. Error bars are big, but that doesn't always mean a trend is garbage. It can certainly mean that in some datasets. And I didnt check to see for p-values between means / medians or if that was in the paper.
The reason I found it so surprising too was that FMGs end up practicing rural primary care at a high rate, which is obviously a lot of the problem areas. So I would have expected them to be same/slightly higher based on that. But different training backgrounds makes sense
 

Tenk

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Your prescribing tendencies are determined by your residency. Your residency is determined in part by your school and that is what they are picking up here.

To put it another way: How many opiates do medical students prescribe again? Oh that's right. Zero.
 
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cactusman

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I'm going to slot in here and predict that this thread reaches 100+ comments.
If your prediction fails you can always sneakily bump every few days.
 
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P0ke

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So if I don't prescribe any opiates, my schools ranking will go up? Brb, telling all my classmates.
 
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WingedOx

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My first reaction was: lol

Same.

Saw this on twitter this morning. My only question was which SDN forum was going to cite this first.
 
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Gilakend

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Your prescribing tendencies are determined by your residency. Your residency is determined in part by your school and that is what they are picking up here.

To put it another way: How many opiates do medical students prescribe again? Oh that's right. Zero.

Next study: "Low MCAT correlates with more prescribed opioids"
 
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Lucca

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Same.

Saw this on twitter this morning. My only question was which SDN forum was going to cite this first.

has to be pre-allo, it has to do with med school rank.

If the study found that docs with lower Step 1 scores prescribed more opioids, this wouldve been posted on allo 5 m after publication.
 
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CyrilFiggis

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As someone who views USNWL ranks with a massive grain of salt, I think the better metric would have been STEP 1 scores. I can't tell if they're trying to gauge the quality of the education or the quality of the educated.
 
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