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. 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."
And why are foreign trained doctor rates so low? Thats the real headscratcher to meit'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
Okay that explanation makes senseNot *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
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 sensejust 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.
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.
Saw this on twitter this morning. My only question was which SDN forum was going to cite this first.