News in brief - May 23, 2011

Black patients on opioids receive more scrutiny than whites, study finds - Interest in nephrology dropping among U.S. medical graduates

Black patients on opioids receive more scrutiny than whites, study finds

Physicians are more likely to employ opioid risk-reduction strategies with black patients than with white patients, said a study in the May/June issue of Annals of Family Medicine.

Black patients were 1.5 times likelier than white patients to have their refills restricted and 51% likelier to have regular office visits, even after adjusting for demographics, substance abuse history and other factors, said the study of more than 1,600 Philadelphia-area patients from 2004 to 2008 (www.ncbi.nlm.nih.gov/pubmed/21555749). The study found no racial disparity in physicians' use of urine drug screens, another strategy that pain specialists recommend doctors use when prescribing opioids to high-risk patients.

"Our results raise the concern that physicians are inappropriately lax in monitoring white patients," the study said. "This laxity contradicts evidence that the risk of prescription drug abuse is greater in whites than in other racial/ethnic groups."

Interest in nephrology dropping among U.S. medical graduates

Despite rising kidney disease rates, U.S. medical school graduates' interest in nephrology has declined during the past decade, says a May 5 report in the Clinical Journal of the American Society of Nephrology.

The number of U.S. medical school graduates in nephrology fellowships dropped from 401 in 2002 to 365 in 2009. As a result, nephrology has become dependent on international medical graduates. IMGs made up 497 of U.S. nephrology fellows in 2009, up from 271 in 2002. About 25% of physicians in the United States are IMGs, while 40% of nephrologists are IMGs.

Reasons for waning interest include minimal exposure to nephrology during medical school and perceptions that the specialty is too complex, uninteresting and offers limited opportunities, said the report (www.ncbi.nlm.nih.gov/pubmed/21551020).

The report said that to help reverse the trend, clinical rotations should highlight overlooked areas of nephrology, such as critical care and transplantation, and social media should be used to emphasize the field's positive aspects.