The Surprising Link Between Medical School Rankings and Opioid Prescriptions

Oct 4, 2017 at 12:00am ET By Joanna Hughes

With drug overdoses involving opioids on the rise over the past two decades and the clinical use of opioids associated with spikes across everything from emergency room visits, to admissions for drug treatments to deaths, increasing attention is focused on addressing the issue. Now comes research indicating a link between physician training and opioid prescriptions. Here’s a closer look at the phenomenon, along with what it means for the healthcare system.  

The Physician Factor

According to findings presented in the working paper, “Addressing the Opioid Epidemic: Is There a Role for Physical Education?” general practitioners trained at the top-ranked medical school wrote an average of 180.2 opioid prescriptions annually compared to the 550 average opioid prescriptions written annually by doctors from the lower-ranked programs.  

And while the study also determined differences in opioid prescription levels between specialties, the underlying trend remained the same: Doctors from higher-ranked medical schools wrote fewer opioid prescriptions. In other words, the difference cannot be attributed to the type of patients being seen.  

According to Daniel Raymond of the Harm Reduction Coalition as reported by NBC News, practice setting may be a factor. Doctors trained at top medical schools are more likely to work in larger systems with more treatment options for patients compared to doctors working in smaller practices.  

Wondering how internationally trained doctors measure up? Physicians trained in Canada and Caribbean were more likely to prescribe opioids while doctors trained in Eastern Europe were less likely.  The paper’s coauthor economics professor Janet Currie told NBC News, “I think doctors in Canada and the Caribbean get training similar to the way they are trained in U.S. medical schools. They are taught to ask about pain and one of the things doctors are evaluated on is how they treat pain. That puts a lot of pressure on them to do something about patients’ pain.”  

A Mandate for Training

The takeaway, according to Currie? “If all general practitioners had prescribed like those from the top-ranked school, we would have 56.5 percent fewer opioid prescriptions and 8.5 percent fewer overdose deaths…[If] you’re trying to improve prescribing practices, then targeting the lower-ranked schools might be a good place to start.”  

Raymond echoes the potential impact of the study in “validat[ing] calls for more professional pain management training in medical schools. The important thing is making these systems work for everybody, wherever they get their health care.”

Joanna worked in higher education administration for many years at a leading research institution before becoming a full-time freelance writer. She lives in the beautiful White Mountains region of New Hampshire with her family.

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