The big industry of big pharma ads

From Harper’s January 2018 index:

Amount the US pharmaceutical industry spent in 2016 on ads for prescription drugs: $6,400,000,000

Number of countries in which direct-to-consumer pharmaceutical ads are legal: 2

$6.4 billion? Holy moly, what a depressing figure. Think about how much healthcare that would buy.

In case you’re curious, our partner in crime is New Zealand.

In case you’re still curious, permitting DTC advertising is a terrible idea that can only be satisfactorily explained by the power of lobbying.


Longtime readers know that I don’t do ads, guest posts, or push products. I do however share a coupon or referral code or two for something people might actually want if it results in someone saving money (and not just me making a few bucks).

Which brings us to SmashUSMLE. The bottom line is that if you’re interested, the coupon code BW10 saves you 10%.

I don’t think most people need to be interested at this point.

While SmashUSMLE has Step 1 and Step 2 CK qbanks, it’s essentially billed as a curriculum-replacement tool with hundreds of hours of video lectures. It’s got all the trappings: It has the FRED qbank software. It has accelerated video playback options. It has a phone app.

It’s competing with pricey options like DIT and Kaplan. And while it’s cheaper than both of those, it still costs a fortune ($395 for 1 month, $795 for 3 months). There is a 15-day free trial, however, so if you were planning on doing an expensive course, you wouldn’t lose anything by trying. 15 days is actually a really generous trial; you could get a lot of value for free if you remember to cancel it if you don’t think it’s worth the dough. The solo qbank product option is cheap ($59.99 for a month), but the competition on that front is really stiff.

From my brief review sampling, the qbank lacks polish. Questions use the clinical vignette format but do not ape the USMLE house-style particularly well. A UWorld replacement it’s not.

As for the videos, I would never ever personally be interested in buying a video course, so my intrinsic bias probably precludes a fair assessment. Like DIT, they follow First Aid. The style is pure casual whiteboard—like a friend trying to teach you in a room in the back of the library—which I imagine is nice and approachable for students feeling overwhelmed. But, again, these felt a bit on the unpolished side of the spectrum. I’m not sure I could imagine spending the 100+ hours it would take to watch them all even at 2x speed. The free sample online is representative, so you can make your own decisions.



Renewed ExamGuru Code

ExamGuru, the original qbank dedicated to the shelf exams, has just released a new emergency medicine product (currently clocking in at 302 questions). So EG now covers all the core shelf exams + EM (but not, say, neurology), and you can still buy the same total package organized for Step 2 CK (2600+ questions) for dedicated prep. While there have always been plenty of resources for most shelf exams, family medicine and non-core rotations can sometimes be a bit harder to approach. Peds, for example, was also little thin on UW (at least back in my day).

Everyone still needs UW as far as I’m concerned. But for those who enjoy question-based learning and need more review, EG remains a viable adjunct. Code BW15 takes 15% off your purchase, as well as earns me a few bucks.


Medscape resident survey, embarrassingly interpreted, again

Medscape’s newest resident compensations survey is out and discussed in “Most Residents Say They Deserve Big Raise, Survey Shows.”

The main thrust is fine, discussing that today’s residents feel more underpaid than generations past, which is no surprise given the proliferation of mid-levels who work alongside them making considerably more (and likely combined with the envy caused by their better-off friends parading happily on social media [when #YOLO, #FOMO can be devastating]).

But then this:

Resident salaries in 2017 vary considerably by specialty. Trainees in hematology lead the pack, at $69,000, while family medicine residents bring up the rear, at $54,000.

The gender gap in resident pay is negligible. Men averaged $57,400 or 1.2% more than women, who received $56,700.

Ugh. Who writes up these Medscape survey articles? I even wrote about the same misleading fake resident gender pay gap back in 2014.

To summarize:

All trainee salaries are based on PGY year and location. There are absolutely no differences between specialties or genders of trainees of the same seniority. Any differences are related to the differing duration of training between specialties as well as the geographic spread of the relatively small sample.

Ultimately, any attempt to differentiate annual salaries by specialty is intrinsically misleading. Any differences that can be created between genders or specialties are simply reflective of different numbers of respondents at different levels of seniority within the PGY scale. The difference between a family practice resident and a “hematology resident” is that almost every family medicine resident finishes in three years while any hematology fellow will be at least a PGY4 or higher. The fact that hematology “led the pack” and not—let’s say—cardiology or gastroenterology just means of the respondents of the survey, slightly more senior hematology fellows answered compared to their other IM-fellowship peers.

There is a real gender wage gap in medicine, but it does not apply to residency. As I discussed almost exactly three years ago, any differences in gender pay during training are related to the known disparities in gender representation among certain fields, particularly surgical specialties (which have longer training lengths and thus get “paid more”). Now, if we want to talk about the “gender surgeon gap,” that would be a different and worthy story. Because there are fields in which women are underrepresented—that’s the story when it comes to residency. Not a misinterpretation of the statistics.

This sort of willfully misleading interpretation has no place on a website that caters to physicians. Medscape should know better. And, reading some of the comments suggests that some readers (primarily the nonphysicians) do latch on to these “differences” despite simply being a distraction from the real issues at play.