None — Dear Mr. Benson:
I have been successful as a speaker as a consequence of special knowledge and skill as a teacher. Special knowledge and skill has a value. Your interest in me appears to be a consequence of my high earnings as a speaker implying that my success inherently makes me suspect or some way culpable. Is a more successful physician more suspect than an unsuccessful physician? A posting of my earnings without further explanation is sheer sensationalism and serves no purpose but to be divisive and potentially harmful to the patient physician relationship as it could needlessly undermine my patient's trust in my prescription recommendations.
My credentials on BPH are irrefutable. I am somewhat unique in that I have an academician's knowledge of this topic but have a non-academicians community based perspective making me very appealing to community-based physicians attending my lectures.
The press has argued, appropriately in many instances, that the pharmaceutical industry has involved physicians as speakers in the past as a marketing tool. That is, using a physician without particular expertise in an effort to win his favor. Fortunately, this practice has been largely abandoned. But, you guys in the press cannot have it both ways. Now that the pharmaceutical companies rely only on authorities, those of us more expert, are called upon more often to speak, and now the same press vilifies us for our increased earnings! You could have ten inexperienced speakers give six talks each, or one experienced authority give sixty lectures.
You expressed an interest in sitting down with me so that you can learn about the time, effort and work that are involved with lecturing. Unfortunately I have a full day in the operating room tomorrow and a very busy patient load so I will be unable to do so. However, in an effort to be cooperative and in appreciation of your professed desire for a balanced story I wish to share my thoughts with you.
First, when addressing my earnings over the last 18 months the denominator must be considered, which is, of course, the number of talks given, the time commitment entailed, consideration of the lost revenue from not being in the office or operating room and my significant office overhead which exists whether I am in the in the office or not.
It is so terribly important to realize that these earnings are not in addition to my practice income but are instead of my practice income, as I earn nothing from my practice when I am lecturing! Bear in mind that although I have earned more than others, I earn no more than others on a per talk basis. It is just that I do more talks.
Mr. Benson, I had little time to gather information for this letter, but I believe the earnings of the last 18 months represents ninety to ninety-five presentations. Each presentation typically involves approximately one hour of review and prep time as I review the slides and all new relevant literature on the topics. I speak throughout the state of Florida and the country necessitating a great deal of traveling. For example I frequently lecture in South Florida, Tampa, Sarasota, Naples, Mt. Dora, Jacksonville, Gainesville, etc. Average travel time is probably four to five hours. When traveling out of state, I can miss a whole day in the office due to traveling. How often I would be driving home at 11 PM or after midnight struggling to stay awake. On those occasions where I have a lunch program and dinner program, I regularly had four to five hours of wasted time in between when I would otherwise be earning revenue in the office.
I have a staff of approximately 14 with an estimated daily overhead of approximately $2,300 dollars whether or not I am there, and lost practice revenue of approximately the same when I am away. A typical honorarium for a talk does not cover this. I lecture as much for self-satisfaction as I do revenue. Those earnings you refer to also include, I believe, all my travel expenses: lodging, food, gas, and air fair.
Should you wonder how I juggle a busy practice with my lecturing, I work 70 to 80 hours per week. Further; I could not afford the lost productivity from both vacation and lecturing and use my vacation time for my lecturing. I did not take a single week of vacation in 2009 and one week of vacation, the second week of January 2010 for a cruise. This lecturing is neither a windfall or glamorous, and involves a great deal of schlepping. I am frequently on the 6 AM flight to Atlanta and the last flight back from Atlanta at 12:30 AM so as to minimize my time away from the office.
Again, a lecture will typically involve four to five hours of traveling, one hour of preparation, and a two to three hour time commitment for the event. Factoring in this time and my overhead, I estimate that I earn approximately $260.00 per hour for my speaking. Do you feel this to be excessive or inappropriate?
Finally, I would like to address the importance of these educational pursuits and the accusation that the intent is to inappropriately influence the physicians attending these lectures. I have seen it suggested that the pharmaceutical companies would not engage in activities if not to their advantage. This is a terrible cynical view. For example, I personally conducted a pharmaceutical company sponsored trial where the conclusion was that the lower cost, lower dose alternative was superior to the higher cost, higher dose alternative. The higher dose would have been more profitable to the manufacturer. I would argue that these talks have real value. Perhaps we can argue that they are mutually advantageous. The resources available to physicians for education include peer reviews articles, CME courses and these types of more intimate presentations. Only the latter allows for direct interaction and direction exchange of ideas. I feel that the pharmaceutical industry can play an important role in education physicians on the efficacy, tolerability and safety of pharmaceuticals. However, I feel strongly that this should be heavily regulated by the FDA for accuracy, appropriateness and lack of bias.
Indeed, legal compliance departments as well as the FDA approve the content of promotional talks. I believe this is appropriate. The content of these talks are inviolate and cannot be altered. Physicians can no longer modify these talks and cannot add or detract from their content. I am in agreement with this as well.
Extensive speaker training and education, including thorough discussion regarding compliance is necessary to be on a Speaker's Bureau. I take such training seriously.
Physician's should speak on those areas where they have special knowledge. I have been assured my involvement on a Speaker's Bureau is not predicated on my prescribing habits. Compensation should be commensurate with expertise and training and should take into account lost productivity from their practices. Conclusions regarding any listing of revenue must take into consideration the number of lectures given, and the loss of productivity from one's practice that travel and lecturing entails.
I agree with, accepted, industry wide revenue caps. I have never presented information with which I do not agree and never will. Nor does my lecturing activities ever influence my practice behavior or affect what is best for my patients. I welcome full disclosure and readily discuss these issues with my patients. My involvement with industry is posted in my waiting room.
Fortunately, and in large part due to media oversight, the content of talks are now more heavily regulated, monitored and free of bias. Physicians are not attending these promotional talks after a long day in the office for the specter of a piece of salmon and a glass of house wine. Rather, they truly want and need to learn of the most recent advances in medical therapy and disease state. They want to discuss case studies and exchange ideas as can only be accomplished in this setting. Nor are they naïve. They surely discern what is important and un-biased. How silly to argue that these professionals are being unduly influenced by a modest meal!
Having been a clinical investigator and national authority of the most internationally prescribed and arguably most important medication for the treatment of BPH, as well as having been a clinical investigator for both available drugs in the other therapeutic class I believe I bring invaluable insight and knowledge of disease state to thousands of physicians. I have been told that I have wonderful teaching skills, making me all the more effective as an educator. Perhaps a bargain at $260.00 per hour.
Mr. Benson, I have obviously put a great deal of time and effort in to this letter and hope you will honor this effort with an unbiased story that does not sully the reputation of a very good and hard working physician.
Sincerely,
Steven Brooks, MD Chief of Surgery, South Seminole Hospital
WFTV
