Drs Spithoff, Lexchin, and Kitai’s thoughtful and timely column on the involvement of the healthcare and pharmaceutical industry in the ongoing learning of family physicians is a welcome contribution to the debate on who pays for continuing professional development, which is ongoing learning for doctors.
The College of Family Physicians of Canada (CFPC) agrees that physicians should know who pays for their education. We also think it’s important for everyone to understand how private sponsorship is currently the primary means of support for most continuing professional development offered to Canadian physicians. Unlike medical undergraduate or residency education, continuing education receives almost no public funding. This is a funding vacuum that the pharmaceutical industry has filled for most family physicians’ practice lifetimes. In short, in the absence of public funding, the private sector filled the void. This is not a CFPC decision but a reality with which we live.
Having said this, the CFPC Board is acutely aware of the studies cited by Spithoff et al that indicate how physician behaviours are motivated by industry messages. However, Spithoff et al are incorrect in assuming it is primarily the financial impact on the CFPC as an organization that prevents the College from moving immediately to eliminate health care and pharmaceutical industry sponsorship of continuing professional development programming. The CFPC Board has regularly considered the impact of eliminating the health care and pharmaceutical industry-supported program development/dissemination for all members, particularly those who practise in more isolated parts of the country. The Board has also wrestled with the degree to which it should dictate physician behaviour in this area, as opposed to developing continuing professional development opportunities to assist physicians in carefully managing this relationship in their professional lives.
The challenge placed before the CFPC’s Board was that in the aim of becoming independent of pharmaceutical industry support for continuing professional development, we must ensure high-quality opportunities to learn will still be available to family physicians
Accordingly, the report of the CFPC’s Task Force on Relationships with the health care and pharmaceutical industry recommended proceeding with the creation of a continuing professional development program development fund (contributions may be in the form of subscriptions to access high-quality continuing professional development or unrestricted donations to the Research and Education Foundation) to support the development, dissemination, and evaluation of accredited educational activities.
Irrespective of the timing of the decision on and implementation of the continuing professional development fund, the CFPC is committed to re-evaluating current policies on pharmaceutical industry sponsorship of accredited educational activities. We are happy to report that the Board accepted proposed recommendations on careful management of the CFPC’s relationship with the health care and pharmaceutical industry in 2013 and reaffirmed this commitment in 2015. Meanwhile, the CFPC’s Mainpro+™ program will enshrine even more stringent standards for assessment of learners’ needs and handling of evidence in accredited learning programs in June 2016.
There are two other areas the CFPC is tracking with respect to the health care and pharmaceutical industry support and involvement.
Our annual Family Medicine Forum is the largest continuing professional development meeting in Canada for family physicians. It is not only well attended but also well regarded among our members. We have started to take steps to mitigate the influence of pharmaceutical companies on the annual scientific program at Family Medicine Forum as well as clearly articulate what is education and what is marketing. For example, we’ve changed our vetting guidelines and requirements for prospective exhibitors in 2016 to ensure transparency and clarity within exhibitors’ relationships with the health care and pharmaceutical industry.
We also clearly describe the Exhibit Hall as the “marketplace” so that the Family Medicine Forum attendees are acutely aware that this affords exhibiters the opportunity to market their products and services. To ensure registrants do not have to be subjected to marketing should they so choose, we have adopted a direct access route to meals offered at Family Medicine Forum, which have traditionally been available in the Exhibit Hall. The Exhibit Hall passport contest and ancillary sessions will be reviewed and opportunities to limit influence and gain additional financial independence will be examined for implementation at the Family Medicine Forum in2016.
Finally, the CFPC’s peer-reviewed journal, Canadian Family Physician (CFP), carefully screens all advertisements and reserves the right to decline any ad deemed inappropriate or lacking in evidence of efficacy. CFP also has a strict policy on the proximity of ads relative to editorial content. It should be underscored that the digital edition of CFP without ads is available to readers.
We have a rigorous process currently in place that meets the expectations of our members. In an ePanel survey we conducted in 2015, CFP had the highest percentage of respondents (71%) saying pharma ads are acceptable as long as they are managed. While these survey results do not bear scientific validity, they serve as a pulse of our membership, and it would seem that we are abiding by the expectations placed on us by our members.
We have expended a significant amount of resources on understanding the potential consequences and benefits of this issue. This is not merely a cost-benefit exercise as some assume, but a set of questions that the College takes very seriously. We are certain that, like their 35,000 colleagues, Dr Spithoff et al will be reassured to know that the CFPC’s Board is taking an evolutionary approach and is proceeding with handling health care and pharmaceutical industry funding in a way that meets the expressed opinions of members.
The Task Force’s report is available at: http://www.cfpc.ca/ProjectAssets/Templates/Resource.aspx?id=8446.
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CMPA: Good Practices Guide
“It is a privilege to practise medicine in Canada — a profession that is dedicated to helping people.
“To be accountable is to be professionally responsible or answerable.
“As a physician, it is your ethical and professional responsibility to advocate for improvements in care.”
“Every healthcare professional or trainee is accountable to: patients, hospital or facility, university or school, provincial/territorial professional regulatory body.
Every healthcare professional should: maintain knowledge and skills, be professional, comply with sound policies, stay healthy — and practice only if healthy to do so.” This implies personal responsibility.
Ethically, healthcare workers are accountable to their patients.”
Who comprises the CFPC membership that wants Pharma supported medical education? Why are their collective desires to have their medical education paid for of more relevance that ensuring “quality patient-centred care?” Clearly, there are family physicians who heartily disagree with the CFPC’s rationale and are questioning the motives and transparency of the CFPC leadership decision.
The CMA code of ethics states very clearly,
“The primary objective of professional interactions between physicians and industry should be THE ADVANCEMENT of the HEALTH of Canadians.
The practising physician’s PRIMARY OBLIGATION is to the PATIENT.
Relationships with industry are INAPPROPRIATE if they NEGATIVELY AFFECT the fiduciary nature of the patient–physician relationship.
Physicians MUST AVOID ANY SELF-INTEREST in their prescribing and referral practices.
Physicians SHOULD ALWAYS maintain professional autonomy and independence.
Physicians with ties to industry HAVE AN OBLIGATION TO DISCLOSE those ties in any situation where they could reasonably be perceived as having the potential to influence their judgment.”
The CFPC’s motives are questionable, at best. Promoting the integrity of physician practice should be it’s top priority.
ProPublica [USA] puts the relationships between physicians and Pharma in clearer perspective.
Ultimately, the CFPC membership is accountable to patients. The expectations of the CFPC’s membership are secondary to the CFPC’s vision:
“To support family physicians through certification, advocacy, leadership, research, and learning opportunities that enable them TO PROVIDE HIGH QUALITY HEALTHCARE for their patients and their communities.”
To support family physicians through certification, advocacy, leadership, research, and learning opportunities that enable them TO PROVIDE HIGH-QUALITY HEALTHCARE for their patients and their communities.”
Canadian Medical Protection Association: Using medications safely
The good news from the ePanel cited in this article is that 87% of family physicians who responded to the survey indicated that they will accept paying more for education that is independent of the pharmaceutical industry.
I found the responses to the question about journal advertisements difficult to understand. It is vague to say that pharmaceutical advertising is “acceptable as long as policies and procedures are in place to manage it” since the policies and procedures are not specified. This response might lead people to believe that the policies and procedures will be effective.
The alternative response was worded awkwardly and contains two negatives (although not clearly a double negative): pharmaceutical advertising is “unacceptable as long as the cost of changing is not significant”. I had to read that response a few times to understand what it meant. That response received the smallest fraction of responses in the entire survey.
87 % of family physicians are willing to pay more $50 or more for education that is independent of the pharmaceutical industry. It would only cost $43 to remove ads from the Canadian Family Physicians.
I hope that the CFPC will soon align its policies and activities with the expectations of family physicians and the people they serve.
Bravo, CGPC! It’s great to see your efforts to allow opportunities other than big funded pharma to have some presence with your members.
I hope MT is poised to be there.
CFP “reserves the right to decline any ad deemed inappropriate or lacking in evidence of efficacy.” But how often is this right exercised? I was unimpressed to see an ad for a “medical homeopathy course” in a recent issue. Is this not the very definition of “lacking evidence of efficacy?”