Seniority played a role, as 43% of physicians in practice for more than 30 years said they sometimes or often prescribe brand-name drugs when generics are available, compared with 31% of doctors in practice for 10 years or fewer. Among the seven specialties covered by the survey, 50% of internists and psychiatrists said they sometimes or often prescribe brand-name drugs over generics when patients request them, compared with 17% of pediatricians and 20% of general surgeons. Also, 46% of physicians in a solo or two-person practice said they sometimes or often prescribe brand names over generics when requested, compared with 35% of those who work in a hospital or medical school.
Gender made a small difference, as 39% of female doctors reported that they sometimes or often prescribe brand-name drugs over generics for patients upon request, while 37% of male physicians surveyed reported doing so. Among doctors receiving pharmaceutical industry gifts of food and beverages in the workplace coinciding with "up-to-date" or "detailing" meetings with drug company representatives, 39% said they sometimes or often prescribe the brand-name version over the generic if a patient requests it. In comparison, 33% of physicians said they don't accept free food in the workplace.
Dr. Patrick O'Malley, deputy editor of JAMA Internal Medicine, wrote in an accompanying editorial that "systems-level interventions" are needed—such as managed formularies with physician-override capabilities—to overcome these "irrational cultural practices."
"For unclear reasons, a large proportion of physicians are reluctant to opt for the more cost-effective choices, especially if patients request brand-name drugs," O'Malley wrote, noting that there is an "immense cost" associated with prescribing brand-name drugs when generics are an option.
The study was paid for with a grant from Columbia University's Institute on Medical Professionalism.