PETER ROST: PHARMA MARKETING EXPERT WITNESS. AWP, MEDICAL DEVICE EXPERT.: Just how bad is it in doctors' offices? This bad.

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Peter Rost, M.D., is a former Pfizer Marketing Vice President providing services as a medical device and drug expert witness and pharmaceutical marketing expert. Judge Sanders: "The court agrees with defendants' view that Dr. Rost is a very adept and seasoned expert witness." He is also the author of Emergency Surgery, The Whistleblower and Killer Drug. You can reach him on rostpeter (insert symbol) Please read the terms of use agreement and privacy policy for this blog carefully.

Just how bad is it in doctors' offices? This bad.

From Pfizer's CafePharma board:

Today, 02:51 AM

Kicked out of an office for NOTHING!

Just heard that my counterpart got kicked out of an office for not leaving the leftovers at a recent luncheon. My counterpart says she was only cleaning up and she didn't so ANYTHING, but a nurse told me she was doing it to be mean to a rude receptionist who had not had lunch yet. Meanwhile I am blocked out of the office too! Can only drop samples now. Does anyone else have stories about getting kicked out of an office for nothing? Isn't this a little harsh??? Please let me know that I am not crazy!

Today, 03:41 AM

Re: Kicked out of an office for NOTHING!
Get used to it, that's how bad the industry is getting. If they say bring lunch for 30, only bring lunch for 20. don't go all out on bringing in lunch either. I only bring sandwichs to lunch (never usually pay more than $75 for a lunch). Buy extra things for yourself so it looks like you are using your budget. Hope that helps.

Today, 07:04 AM

Re: Kicked out of an office for NOTHING!
It is so out of control now that I had an office that I knew only had X number of employees demand 2X and when I only brought X they were mad. They see the lunch as part of their compensation and should be able to take food home to their families. To a point, I can sympathies, as they do not get paid much. My budget was running out and one time I took an unopened case of water for a lunch the next day and was reamed over it. It has become toxic and even though I have done this too long to move on, I decided yesterday that I have to for my own mental health. The job now is: deliver samples and deliver food. No respect, no intelligence. I have seen a change in the kind of people who do this job over my many yrs. The more intelligent people have self selected out of it, leaving only the timid and those who stay in it for a yr or two.


Anonymous seen it - done it - no more. said...

Of course it is bad. It took the completion of the evolution of Bigpharma from the classic Ethical Pharmaceutical industry, for things to get this bad.
By the way have you noticed that pharmaceutical biz is never refered to as Ethical pharma, by anyone.Not the media, public, doctors, goverments and not even pharma biz itself. They,the Bigpharma have taken its place amongst businesses like, Oil, Financials, used cars, and others that convey "bad" business from everyone's point of view, even by those who work in it, as posted by Pfizer reps.
Is it going to get better? Maybe. At least two things have to happen. 1. The aggressiveness of this biz must be reduced significantly. That will include elimination of their multiple sales forces, known as MSFoMP (multiple sales forces of mass promotion) that are the Bigpharma's equivalence of WMDs. The BP must drop this biz model that no other business on this or any other planet uses. Can you imagine; you are a buyer for lightbulbs, for instance and you have 5-10 GE sales reps coming to sell you the very same lightbulbs over and over again. Every week you have one of them in your office to sell you XYZ bulb. You buy from Anne (she is so sexy), next week or even next day there is Jhon to sell you the same bulb. And it never stops. One wonders though how and why doctors take it. Many are rebelling though and you see it in this post. This is just one but major aspects of BP aggressivenes.
2.Dishonest, unethical, illegal and even criminal behavior that is a hallmark of BP's modus operande, also must be changed. As long as those, who have hijacked the Ethical pharma and turned it into what it is today, are in charge and are able to use the "organized, planned and approved" misconduct with impunity this will not happen. Yes they pay some big fines etc etc, but no "time" is served by those responsible. Till this happens they will go on and reap the ill-aquired benefits. As someone said, in BP they have a motto,"Do the crime for you won't do the time".
For some it is still a beautiful biz.

Anonymous Anonymous said...

Dr Rost --

any comment on Anthrax scientist Bruce Ivins stood to benefit from a panic

after reading the stuff on and Washington Post, i'm not so sure.

any thoughts?


Anonymous Anonymous said...

Quick When You’re Sick

Recently in the media, issues have been addressed regarding the specialty of primary care or family practice doctors and the shortage of them in the U.S. In summary, reasons for the shortage that exists are due to the specialty not being that profitable for a doctor compared with other specialties. As a consequence, the doctors view the specialty as not a desirable choice apparently quite often, although the specialty is greatly needed in the health care system and for the public health.
As a layperson, I view primary care as ultimately a specialist in nothing in particular, yet knowledgeable in a large variety of medical areas, which I believe, makes them very valuable to those patients seeking restoration of their health. Furthermore, there is a comfort level with those in this specialty compared with other specialties, one could speculate. So the shortage of primary care doctors is in fact disappointing. Perhaps most disappointing is the atrophy of the doctor-patient relationship unique with such doctors.
Yet one possible solution is what is known as retail care clinics, and their popularity was increasing not long ago for a variety of reasons. And their eventual need has yet to be determined and is only speculated by others at this time. Of particular note of most of these types of clinics is that are normally staffed with nurse practitioners, who are, like doctors, more thorough than others, but are favored by many as a vocation and sought as treatment providers progressively. The growth of such clinics may have slowed, but not necessarily the benefits of these clinics.
First, I’ll offer a definition of a retail clinic: A retail clinic is a medical treatment facility that is usually located in a convenient location, such as a shopping area, and are smaller than most doctors’ offices in regards to geographical space. Usually, these clinics are staffed with a nurse practitioner that often have the ability and authority to provide the same quality care as a primary care physician, and do so with the same standards regarding accountability and autonomy. If you happen to go to one for what may be considered a mild ailment, for example, for such conditions as allergies or the flu, you will notice a unique and pleasant paradigm towards your care at such a clinic in comparison with present medical offices that are possibly demoralized if not largely apathetic:
These urgent care light clinics are normally and amazingly quick for a patient treated at such a location. You are normally in and out of there within a half hour or so. This includes a thorough assessment and treatment regimen offered. Unlike typical doctor offices, these clinics are walk-in clinics, so there is no over-booking of patients, which is what typically occurs at current offices of doctors, as many are focused on daily volume of patients, as they are usually a member of a large health care system that instructs these offices in such a way.
With these convenience care clinics, you actually dialogue with your health care provider more so than you have experienced in a traditional doctor’s office due to other doctor offices often being incredibly busy from seeing too many patients during a typical day for reasons described above. And this is not to imply that the health care providers at typical doctor offices do not care about you and one’s particular health issues, yet possibly is due to limited resources, possibly.
The cost of going to such a retail clinic, which is sometimes termed an ‘urgent care light’ clinic or convenience care clinic, that have already been mentioned, is usually about ¾ or less than the cost of a typical primary care doctor visit, I understand
You will likely notice no decline in the quality of care that you receive. In fact, likely you will experience greater quality on many different levels, both on a personal and clinical level, yet this premise lacks certainty due to the many variables involved.
Critics of such clinics include the American Medical Association and various medical societies, yet in my opinion, they are simply vexed because of the invasion of these clinics on their turf and their infiltration into their group without being invited, perhaps.
If it is discovered that you need greater medical care or attention than the retail clinic can provide for you during your visit at their urgent care light clinic, you will most likely be referred to a nearby location that can provide the care you are determined to need by the clinic’s heath care provider, who has likely has some familiarity and possibly some relationships with the hospitals and others in the medical community for which they serve.
So most patients of these retail clinics are pleased with the care they receive from them, which is why they continue to grow in number under different names, as they have become franchises, yet the concept of this pay as you go health care is fairly new, only the future will tell if this method is preferred by those seeking minor restoration of their health.
These retail clinics, it appears, provide possibly provide a response to the shortage of primary care doctors that some believe exist, and possibly are an answer to other problems that exist in the health care system in the U.S., which includes wait time and frequent distant relationships from their other health care providers. One could conclude that the retail clinics seem in a way more authentic than the dominant structure, and may be more beneficial ultimately for the public health, with exceptions, of course.
Dan Abshear
“Compassion is the basis of all morality.” --- Arthur Schopenhauer
Author’s note: What has been written is based upon information and belief

Anonymous Anonymous said...

So, You Want To Be A Doctor

Lately in the media, others have said and appear to express concern about the apparent shortage of primary care doctors in particular. Typically, the main reason believed and speculated by others for this decline of this health care profession specialty that historically has been the apex of our health care system is lack of pay of this specialty when compared with other specialties chosen by potential physicians while in training, as the annual salary of a PCP is around 130 thousand a year on average, others have concluded may be the national average and factors in payers both of a private and public nature.
Yet considering the additional attention of shortages of students in some medical schools as well, as conceived by others, one could posit hat this professional vocation that has been one viewed in the not so distant past in the U.S .
Viewed as one with great esteem and respect may not be desired as a vocation by many, that requires commitment and dedication, as reflected in their training regimen in the U.S. that consumes about a third of their lifespan. Such reasons for this paradigm shift may include:
Primary Care Doctors perhaps more than other physician specialties seem to be choosing to practice medicine under the direction and financial security of one of the many and newly created health care systems These regional and nationally created systems are typically composed of numerous hospitals and clinics under combined ownership- frequently of a private nature that is not dependent upon their beliefs as it is perhaps on their profit motives and intentions. Yet their approach and etiology of their views regarding the restoration of the health of others are usually similar with such mergers of multiple medical facilities, which are presently preferred to save costs, it has been said, and therefore these systems have not been protested by a largely uninformed public.
Conversely and in addition, this system of increasing popularity is not necessarily a desired method to practice medicine as a primary care physician, often stated by them as members of their employer that has the power to limit and dictate how they practice medicine. This is because, among other reasons, such doctors have largely unexpected and unanticipated limitations regarding their patients’ heath provided by them. This is further aggravated by possible and unreasonable expectations of their employer, such as mandating that doctors they employ are required to see as many patients as theycan in a day, and there have been cases of physicians being fired by a health care system- along with financial rewards for seeing more patients a day than what is determined as average visits by others. Such requirements likely and potentially affect or alter the clinical judgment determined by physicians employed in what may be viewed as authoritarian employers, which would limit the medical care they provide to their patients, as well as the quality of this care. Also, such health care systems may have their own managed health care system that may be determined by factors not in the best interest of the patients of doctors employed by the health care system.
The primary etiology and stimulus for a doctor to practice medicine in this way is due to their frequent inability to provide and employ ancillary staff, combined with the increasing premiums for their mandatory malpractice insurance, which may make doctors financially unable to work independently.
Malpractice laws and premiums, which is determined in large part on a state level, are an issue with those required to have this adverse aspect of their professions. Also, these premiums become more expensive for doctors, depending on the perceived risk of their chosen specialty. For example, the premiums of an OB/GYN doctor are usually higher than one of a specialty viewed less risky for lawsuits, such as Dermatology, perhaps. Plaintiffs win about 25 percent of the time on average a half a million dollars. 95 percent of these cases are settled out of court.
In addition, the issue of medical malpractice is also frequently a catalyst for a doctor to practice what has been called defensive medicine, which basically means that the health care provider is prohibited from relying upon their subjective factors in their assessment of their patients, which in itself raises the question of what the point was of all of their training in the first place. Because if a doctor practices medicine in such a way, it typically involves what may be considered as unnecessary diagnostic testing for their patients to rule out what may be unlikely disease states of their patients’ medical conditions. This waste of medical resources is further validated by the legality reflected in the tone of the notes a doctor usually annotates or dictates with their patients.
Such restrictions and limitations imposed on today’s primary health care provider are usually not fully illustrated during their training for this profession, which is one that has been viewed as one that is quite noble and of great responsibility on a societal level. It seems that this perception and vocation that now is greatly misperceived due possibly to being deformed by others who may have profit as their motive for the health care they may dictate to doctors they may employ in some way, which often and likely is in conflict with their motives as doctors and how they wish to deliver needed health care to others. This may be why this medical profession may no longer be viewed as distinct from other vocations, in large part, as it seems that presently the profession of a doctor has been reduced to one dependent on the financial stability and growth of its employer, which may alter how the doctors perceive what is expected of them as well, which may affect the importance of how they view their profession, as it has been said that overall, doctors are somewhat understandably more cynical and demoralized, which may be replacing the pride they historically have viewed their callings as doctors, as well as the perceptions of patients in the U.S. Health Care System.
Further complicating and vexing to these restrictions is the usual financial state of the individual physician, as theynormally have to pay off the debt acquired from attending medical school and training, which averages well over 100,000 dollars today after their training is completed, it has been estimated, along with this debt amount presently is about 5 times higher than it was only a few decades ago.
Conversely, there are some who believe that doctors in the U.S. are over-paid and are compared with some corporate monster, who behaves based upon the premise of greed. In spite of how they are judged, physicians are likely not absent of financial concerns- which may be of more of an issue than many other professions, comparatively speaking, in addition of taking on more responsibility that is of greater importance compared with other vocations. Such realistic variables should be factored in when one chooses to judge the profession of a physician. On the other hand, no physician should view their jobs as no different from any other venture capitalist when rationalizing their income and motives related to this exceptional vocation as a physician, as others are more dependent on their judgment.

It has been determined by others, and suggested often and lately, that many of today’s physicians practicing medicine in the United State do not recommend or speak favorably of their professions compared with their typical views of their profession in the not so distant past. While this self-perception physicians may have of a negative nature may be somewhat understandable it is also and potentially unfortunate for the health of the public in the future, and the nature normally associated with the medical profession which could deter ideal medical care for others
There have been cases where doctors do in fact change careers, and get into vocational fields such as medical communications or corporate medical companies. Also, expert witnessing is another consideration for those who choose to leave their profession. Finally, other choices considered include consulting and research. The training of doctors fortunately leaves them with options not involved directly with the flaws of medical care, but this is bad for us as citizens, overall. The etiology of their departure from their designed profession is largely due to the negative state perceived by themselves as well as others of their profession as medical doctors.
Then again, not all doctors are deities. Like others, some are greedy and corrupt, which complicates others in this profession in relation to how their vocation is viewed by others and based on limited judgment and analysis. Yet citizens overall should determine what sort of health care they desire, and it seems that often they fail to voice this right as a citizen.
For perhaps Primary Care Physicians in particular, the medical profession and those who provide medical care clearly needed by others to some degree appears to be absent as a desired path of today’s careerist. The authentic reasons for what many believe to be a negative perception of possibly the entire health care system may never be known, yet many would agree that most U.S. citizens are understandably concerned with the state of this system of great importance to society. Yet need to be active more in assuring this necessity is more aseptic.
“In nothing do men more nearly approach the Gods then in giving health to men.” --- Cicero
Dan Abshear
Author’s note: What has been written has been based upon information and belief of a layperson, yet also the assessments of a patient.


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