Should Pharmaceutical Companies Fund Continuing Education for Nurse Practitioners?

Article Outline

• Support for Pharma-Funded CE
• Rationale Against Pharma-Funded CE
• Copyright

Lois Rockcastle, RN, MS, FNP-BC, has been a family nurse practitioner for over 27 years. Her first 10 years of practice were in upstate New York. For the past 16 years, she has been working in Alaska. Her career has included urban, rural, and frontier settings. Currently, she works for the Yukon-Kuskokwim Health Corporation, North Star Behavioral Health, and is an adjunct faculty member at the University of Alaska. She serves on the board of the American College of Nurse Practitioners as one of two elected state affiliate representatives.

Tom Shields, ARNP-BC, is a family nurse practitioner who has practiced in family and emergency care for several years. Tom earned a diploma in nursing, BSN, and MSN-FNP from Allen College in Waterloo, Iowa. With a physician colleague, he started Shell Rock Family Health but recently sold his ownership; he also has worked in family practices in rural Iowa. Tom currently holds a position with Emergency Practice Associates at Regional Medical Center in Manchester, Iowa, and serves on the board of the American College of Nurse Practitioners as corresponding secretary.

The recently updated Code on Interactions with Healthcare Professionals by the Pharmaceutical Research and Manufacturers of America took effect in January 2009. This new marketing code, which defines ethical standards for interactions of pharmaceutical sales representatives with health care professionals, brings the issue debated in this month's column to the forefront.

Some highlights from the newly revised code that will impact nurse practitioners (NPs) and other providers include new prescriber data usage guidelines and the elimination of non-educational gifts and out-of-office meals. Still allowed are gifts of educational items less than $100 and modest in-office meals with informational presentations. Some continuing education (CE) funding and payment for speaking/consulting arrangements are permitted under certain conditions. What is known about how patients benefit from the knowledge we gain from pharmaceutical representatives? Some studies have indicated that physicians often do not realize the influence pharmaceutical marketing has on their clinical decision-making. A recent study describing the perceptions and participation of U.S. FNPs in such marketing reported similar results.

Is there really a “free” lunch, or are we kidding ourselves? Contact Editor Janet Selway at janet.selway@gmail.com if you would like to comment on this matter.

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Support for Pharma-Funded CE 

Lois Rockcastle

Over the past 3 decades, pharmaceutical companies have played a significant role in providing information about their products and continuing education to health care providers. In the past, lavish dinners, vacations, and gifts were offered to providers — primarily physicians — because initially, nurse practitioners (NPs) were minimally recognized for their prescriptive privileges. The regulation of these gifts and educational programs has become increasingly stringent.

The funding offered for continuing education initially included speakers chosen by the pharmaceutical companies, who were often heavily biased. More recently, the funding has been in the form of unrestricted educational grants. These grants offer the opportunity for many local, state, and national NP organizations to offer quality, affordable continuing educational programs. Without this grant funding, it would be difficult for professional organizations to offer high-quality continuing education at a reasonable cost.

It can be particularly difficult for providers in remote areas, such as frontier communities, to keep up with new pharmaceutical products. While spending 10 years providing care in a frontier community, I never saw pharmaceutical representatives come to the hospital or clinics or provide a single educational dinner program.

As health care providers, we are educated to analyze the information offered, be alert to any bias, and consider the quality of the research presented in support of a product, using our skills and education to provide quality care. We need to be aware of the information pharmaceutical companies are promoting to patients in order to give them the most beneficial advice on medications.

As NPs interact with pharmaceutical companies and accept their continuing education funding, we will be able to promote our role in health care. As we do this, we can elevate our status in the health care market while keeping up-to-date on the new developments in the pharmaceutical market.

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Rationale Against Pharma-Funded CE 

Tom Shields

Pharmaceutical companies should not be involved in the continuing education of health care providers. Even if no direct bias were involved, there is an implied bias when an invested party sponsors educational programs. With growing concern over rising costs in health care, there has been an urgent attempt at transparency and reform. Part of this reform package has stimulated many nursing, physician, and pharmaceutical companies to incorporate a disclosure of vested interest to be made available to the public. These programs are not yet uniform.

Sponsorship of educational programs can be a form of product marketing, providing an avenue for pharmaceutical companies to get company and product names in front of prescribers. Continuing education is designed to alter practice standards. Bias in that education may cause improper changes in standards of practice if they are based on biased research performed solely by those with a vested interest in the product. The experts who present much of the content of continuing education are often paid spokespersons for drug companies. Even though the relationship is disclosed, it presents concerns about bias.

Although providers deny impact from pens, cups, and other labeled items that clutter space in clinics and hospitals, many health care providers have little understanding of marketing. Pharmaceutical companies depend on name recognition and familiarity of products for prescriptions to be written. If furnishing those items were not a sound business practice, the “gifts” would not be present to this extent for such a prolonged period.

As an ethical and cost-effective choice, health care providers of all backgrounds should pay for their own continuing education to remove implied or direct bias. This includes daily lunches in offices, monthly meetings for organizations, and larger clinical conferences. Only by transparency and ethical behavior will health care remain in the public trust.