PHILADELPHIA - Physicians in training are twice as likely to order a costly brand-name statin (used to lower blood cholesterol levels) when supervised by senior physicians who prefer those medications in their own practice, according to a new study led by researchers at the Perelman School of Medicine at the University of Pennsylvania and published online in the Journal of General Internal Medicine. These findings document a link between low-value prescribing and graduate medical training, which physicians undergo after completing medical school but before they can practice independently.
As part of this study of 10,151 statin prescriptions across four sites, lead author Kira Ryskina, MD, a general internal medicine fellow at Penn, and her coauthors analyzed prescribing data from 342 resident and 42 attending physicians from 2007 to 2011. The study found that the probability of a resident prescribing a costly brand-name statin increased from 22.6 percent when residents were supervised by attending physicians who mostly prescribed cheaper generic statins, to 41.6 percent when they were supervised by an attending who mostly prescribed expensive brand name statins. The linkage was strongest for the most junior resident physicians in training. With brand name statin prescribing accounting for an estimated $5.8 billion in low-value spending annually, these findings represent an opportunity for improvement in graduate medical education to increase value in health care spending.
"These findings provide early empirical evidence that low-value practices among physicians are transferred from teachers to trainees, highlighting the importance of re-design of graduate medical education," said Ryskina. "We observed considerable variation in the prescribing practices of both attending physicians and residents, suggesting room to improve cost-effectiveness."
The study’s other Penn authors include C. Jessica Dine, MD, an assistant professor of Pulmonary and Critical Care Medicine, and Andrew Epstein, PhD, a research associate professor in the division of General Internal Medicine, along with other co-authors Esther J. Kim, BS, and Tara F. Bishop MD, MPH.
Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.
The Perelman School of Medicine is consistently among the nation's top recipients of funding from the National Institutes of Health, with $550 million awarded in the 2022 fiscal year. Home to a proud history of “firsts” in medicine, Penn Medicine teams have pioneered discoveries and innovations that have shaped modern medicine, including recent breakthroughs such as CAR T cell therapy for cancer and the mRNA technology used in COVID-19 vaccines.
The University of Pennsylvania Health System’s patient care facilities stretch from the Susquehanna River in Pennsylvania to the New Jersey shore. These include the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Chester County Hospital, Lancaster General Health, Penn Medicine Princeton Health, and Pennsylvania Hospital—the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.
Penn Medicine is an $11.1 billion enterprise powered by more than 49,000 talented faculty and staff.