The Role of the Medical School Training on Physician Opioid Prescribing Practices: Evidence from Ontario, Canada: Le rôle de la formation à la faculté de médecine à l’égard des pratiques de prescription d’opioïdes des médecins: données probantes d’Ontario, Canada

Abstract

Background: Recent research found that physicians who completed medical school training at top-ranked U.S. medical schools prescribed fewer opioids than those trained at lower ranked schools, suggesting that physician training may play a role in the opioid epidemic. We replicated this analysis to understand whether this finding holds for Ontario, Canada. Methods: We used data on all opioid prescriptions written by Ontario physicians between 2013 and 2017 from the Narcotics Monitoring System. Using the Corporate Provider Database and ICES Physician Database, which contain medical school of training, we linked patients who filled opioid prescriptions with their respective prescribing physician. Available data on Canadian medical school rankings were obtained from Maclean’s news magazine. We used regression analysis to assess the relationship between number of opioid prescriptions and medical school ranking. Results: Compared to the United States, average annual number of opioid prescriptions per physician was lower in Ontario (236 vs. 78). Unlike the United States, we found little evidence that physicians trained at lower ranked medical schools prescribed more than their top-ranked school counterparts after controlling for specialty and location of practice. However, primary care physicians trained at non-English-speaking foreign schools prescribed the most opioids even after excluding opioid maintenance therapy–related prescriptions. Conclusion: The role of medical school training on opioid prescribing patterns among Ontario physicians differs from that in the United States likely due to greater homogeneity of curricula among Canadian schools. Ensuring physicians trained abroad receive additional pain management/addiction training may help address part of the opioid epidemic in Ontario.

Is corticophobia spreading among pediatricians?—Insights from a self-efficacy survey on the management of pediatric atopic dermatitis

“…Nevertheless, considering our high proportion of pediatricians feeling average or below-average confident about TCS or OCS use, we gather that many other factors may exert influence on physicians’ confidence level when prescribing medications. These include, but are not limited to, physicians’ educational background [such as initial training ( 31 ), continuing education ( 32 ) and/or academic involvement ( 33 )], patient preferences, information sources pediatricians use, prescription habits, and experience managing a particular disease ( 32 ). The latter is further verified by our findings that first, indicate a more assertive use of TCS when pediatricians report managing a higher number of AD patients, and second, when physicians work in community clinics.…”

Attitudes and Practices Surrounding Opioid Prescriptions following Open Reduction Internal Fixation of Distal Radius and Ankle Fractures: A Survey of the Canadian Orthopaedic Association Membership

“…Opioid-based analgesia following orthopaedic surgery has been identified as an important contributor to the ongoing opioid epidemic [ 7 , 8 ]. As a result, increased efforts are made to better understand current opioid prescription practices to guide the creation of standardized opioid prescription protocols for common orthopaedic procedures.…”

“…In the United States, orthopaedic surgeons are the third-highest group of opioid-prescribing physicians, accounting for almost 8% of all opioid prescriptions in the country [ 7 ]. Similarly, Canadian orthopaedic surgeons have been identified as the second-highest group of opioid prescribers among Canadian physicians [ 8 ]. Moreover, the initial opioid prescription following orthopaedic procedures has been shown to account for an estimated 8.8% of all opioid-naïve patients undergoing surgery who subsequently develop chronic opioid dependence [ 9 ].…”