Do Doctors from High-Ranked Med Schools Prescribe Fewer Opioids?

By Paul Gaita 08/18/17

A new study examined whether there was a relationship between a doctor's prescribing habits and their medical school ranking.

Medical students listening sitting at desk at the university

Researchers from Princeton University have completed a study that suggests that doctors who receive training at Ivy League or other highly-ranked medical schools write fewer prescriptions for opioid painkillers than those who studied at lower-tier schools.

Using data on opioid prescriptions written in the United States and national rankings of medical schools, the study authors were able to link two billion opioid prescriptions to the alma mater physicians and general practitioners (GPs) who wrote them.

The researchers found that graduates of the seven lowest-ranked medical schools wrote nearly three times more opioid prescriptions than those who earned their degrees at the top-ranked medical school in the country, Harvard University.  

The study's findings clearly pointed to a need to improve physician training as a first defense against widespread opioid addiction. As study co-author Janet Currie, the Henry Putnam Professor of Economics and Public Affairs at Princeton's Woodrow Wilson School of Public and International Affairs, noted, "If all general practitioners had prescribed like those from the top-ranked school, we would have had 56.5% fewer opioid prescriptions and 8.5% fewer opioid deaths."

To investigate their hypothesis, Currie and study co-author Molly Schnell, a PhD candidate in economics at Princeton, reviewed data from two primary sources: information on more than 700,000 prescribing doctors from 2006 to 2014 from the market research firm QuintilesIMS, and medical school rankings from the U.S. News & World Report's annual list of the best medical schools in the United States.

Additional statistics were also reviewed from other databases, including U.S. and international medical schools not included in the U.S. News list.

After compiling separate data for physicians and general practitioners, they discovered a striking dichotomy in prescribing rates among the credentials of their review subjects. "General practitioners trained at Harvard write an average of 180.2 opioid prescriptions per year, those from the second- to fifth-ranked schools write 233 per year, and GPs from the seven lowest-ranked medical schools write nearly 550," said Currie.

GPs were responsible for 758.8 million prescriptions, or half of all opioid prescriptions written during the period covered in the study—while orthopedic surgeons and emergency medicine doctors held second and third place with 147.2 million prescriptions and 116.5 million prescriptions, respectively. Doctors who treated the elderly and cardiac patients, as well as pediatric physicians and GPs, wrote the fewest amount of opioid prescriptions.

To confirm their findings, Currie and Schnell reviewed additional data on hospital or clinic assignments, geographical location and timing for each of the medical professionals included in the study to determine if these criteria impacted rates of prescription. What they found was that physicians in the same specialty who graduated from different schools and worked in the same facility still wrote different amounts of opioid prescriptions; foreign-born and trained doctors also wrote varying levels of prescriptions based on regulation and training practices of their respective regions.

There were some degrees of variance in regard to specialized training and time period for schooling: doctors who received the most training in pain management after medical school showed little difference in their rates of prescription, suggesting that the training they received and not the doctors' personal preference was the deciding factor.

And those medical school graduates who received diplomas at the more recent end of the time frame also showed less difference in their prescribing practice than those who graduated closer to 2006, again confirming that training that reflected more up-to-date information on opioids was a key aspect of their decisions, and not the individuals themselves.

"A distinguishing feature of the opioid epidemic is that many overdoses and deaths can be attributed to legal opioids that were prescribed by a physician," noted Currie. "Training aimed at reducing prescribing rates among the most liberal prescribers—who disproportionately come from the lowest-ranked medical schools, could have large public health benefits."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.