June 15, 2008 Chicago, ILLINOIS, USA Bob Miglani Senior Director, External Medical Affairs – International Pfizer’s Medical Partnerships Initiative (MPI)

June 15, 2008

Chicago, ILLINOIS, USA

Bob MiglaniSenior Director, External Medical Affairs – International Pfizer’s Medical Partnerships Initiative (MPI)Office of the Chief Medical OfficerPfizer Inc.

Email: [email protected] Phone: 1.212.733.4113

2008 Research FindingsWorld Medical Association Special Forum

AMA Annual Meeting

What Are Doctors Really Thinking Worldwide?

Perceptions and Attitudes of the Medical Profession in North America, Europe, Asia

2

Introduction

1. Ageing demographics and economic constraints put an unprecedented strain upon health systems around the world

2. Everyone is talking about health reform but no one has theperfect solution

3. Pfizer works with and support Doctors on many levels and wants to work with you on helping to find an approach

4. As such, the Medical Partnerships Initiative (MPI) was created in 2004 as a research program to better understand in more detail: Needs, Expectations and Issues of Doctors (NOT PRODUCT RELATED)

– What are Doctors really thinking? How are Doctors’ roles changing? How are Medical Leaders/Associations getting engaged on Health Reform?

5. MPI research helps to richen the dialogue with Doctors and Medical Associations/Societies and offers insights and analysis, from aglobal perspective

3

Physician Voices Are Becoming More Prominent

4

Belgium Doctors Take to the Streets

NO MORE

PAPERWORK!

5

Spanish Physicians Strike for More Time with Patients

Physicians Demand an Increase to 10 Minutes for the Time Spent with Physicians Demand an Increase to 10 Minutes for the Time Spent with Each Patient and a Maximum Patient Load of 1,500Each Patient and a Maximum Patient Load of 1,500

Physicians Demand an Increase to 10 Minutes for the Time Spent with Physicians Demand an Increase to 10 Minutes for the Time Spent with Each Patient and a Maximum Patient Load of 1,500Each Patient and a Maximum Patient Load of 1,500

Primary care physicians threaten a strike for June10. The walk out will be called officially if Osakidetza does not

agree to their requests. The “10 minutes” platform claims that there

should be more staff and more means.

Primary care physicians threaten a strike for June10. The walk out will be called officially if Osakidetza does not

agree to their requests. The “10 minutes” platform claims that there

should be more staff and more means.

Ten minute platform. Ambulatory clinics close

their physicians’ agenda to avoid collapses due to

Thursday’s strike.

Ten minute platform. Ambulatory clinics close

their physicians’ agenda to avoid collapses due to

Thursday’s strike.

HealthLoses

pulse and motivation

HealthLoses

pulse and motivation

At least ten minutes per

patient(A ruling pending

in Andalusia)

At least ten minutes per

patient(A ruling pending

in Andalusia)

We Want 10 Minutes!

6

French Doctors Are Burned Out

GIVE US RELIEF

7

Germany: Massive Strikes Across Country

Dr. Frank Montgomery

Do You Work for Free as Well?

More Work + Less Money = Demotivation

From Demigod in White to the Nation‘s Fool

8

Pfizer’s Medical Partnerships Initiative Offers a Robust Database of Content

Patients, Public, Pharmacists, Nurses Patients, Public, Pharmacists, Nurses SurveysSurveys

Patients, Public, Pharmacists, Nurses Patients, Public, Pharmacists, Nurses SurveysSurveysPhysician SurveysPhysician SurveysPhysician SurveysPhysician Surveys

World Medical Association European Leaders Forum, Prague, Dec. ’05

Israeli Medical Association Medical Leaders Meeting, Dead Sea, Israel, Jan. ’06

European Forum of Medical Associations and WHO, Budapest, April ’06

Numerous US events/forums in 2007 Washington, D.C., Florida, Chicago, etc.

Mini-Conference with Network of Policy Physicians INSEAD/WMA Leadership Training Program, Dec. ’07

2004 2005

1,550 Doctors in Europe, Canada, Turkey, South Africa

2006 1,200 Doctors in Europe/Canada 300 Doctors in the U.S.

2007 1,000 Doctors: 500 Europe &

Canada, 500 in the U.S.

Events/Forums of EngagementEvents/Forums of EngagementEvents/Forums of EngagementEvents/Forums of Engagement

Research/Articles/Media ClippingsResearch/Articles/Media ClippingsResearch/Articles/Media ClippingsResearch/Articles/Media Clippings

Clippings of Major U.S., European news media Articles from JAMA, BMJ, Lancet, etc.

Desk research and statistics Reports from credible institutions Personal Interviews with Medical

Association Leaders in several countries

2008 1,741 Doctors in 13 countries

North America, Europe, Asia

2005 Germany and Belgium: Public poll after

Physician strike/demonstrations, 500 interviews in each country

2006 Europe: Public Survey of 3,000 interviews U.S., Canada, Mexico: Public Perception

of Doctors; 3,000 interviews

2007

Global: Nurses survey in 10 countries, 1,000 interviews (Done for ICN)

U.S. & Europe: Public Perceptions of Physicians, 1,500 interviews

2008 Europe, Australia, US: 700 Pharmacists Europe, US, Canada: Patient perceptions of

Physicians, 1,800 interviews

9

Aggregate sample size n=1,741 (±2.3%) Surveys in 13 countries Comprehensive, representative sample frames

stratified among GPs and Specialists Dataset is post-weighted to represent actual

distribution of doctors across markets & specialty Conducted by APCO Insight

Aggregate sample size n=1,741 (±2.3%) Surveys in 13 countries Comprehensive, representative sample frames

stratified among GPs and Specialists Dataset is post-weighted to represent actual

distribution of doctors across markets & specialty Conducted by APCO Insight

2008 Research - Methodology OverviewGlobal Quantitative Research Program – 1,741 Physicians Interviewed

ASIA n=630 (±3.9%)China n=125 (±8.8%)India n=130 (±8.6%)Korea n=125 (±8.8%)Japan n=125 (±8.8%)Australia n=125 (±8.8%)

EUROPE n=768 (±3.5%)Germany n=138 (±8.4%)France n=127 (±8.7%)UK n=125 (±8.8%)Belgium n=126 (±8.8%)Portugal n=127 (±8.7%)Netherlands n=125 (±8.8%)

NORTH AMERICA n=343 (±5.3%)US n=248 (±6.2%)Canada n=95 (±10.1%)

Quantitative ResearchQuantitative ResearchQuantitative ResearchQuantitative Research

10

2008 Research Goals

The medical The medical profession in profession in

general and their general and their practices in practices in particularparticular

The medical The medical profession in profession in

general and their general and their practices in practices in particularparticular

Provide an objective insight into doctors’ current perceptions of:

Factors influencing Factors influencing changes and changes and trends in the trends in the

quality of health quality of health carecare

Factors influencing Factors influencing changes and changes and trends in the trends in the

quality of health quality of health carecare

The role and value The role and value of professional of professional

medical medical associations associations

to doctors, and the to doctors, and the influence of those influence of those

associations on associations on public policypublic policy

The role and value The role and value of professional of professional

medical medical associations associations

to doctors, and the to doctors, and the influence of those influence of those

associations on associations on public policypublic policy

1. Attitudes Towards the Practice of Medicine2. Impact of Third-Party Payers3. Assessment of Doctor-Patient Relationship4. Attitudes Towards Physician Activism & Third-Party Advocates

11

2008 Key Findings

There are more data available

Lots of data on each slide to maintain accuracy as much as possible

Europe is more homogeneous than Asia and North America and so we have broken out data points for Asia and US, Canada

Attitudes Toward the Practice of Medicine

13

6%

24%

68%

55%

25%

9%

39%

51%

23%

56% 14% 30%GLOBAL

North America

Europe

Asia

Positive Depends Negative

Concerns About Negative Direction of Medicine in Europe, North America and Parts of Asia

Q1: To begin, please tell me your views about the direction of events in the practice of medicine. In your opinion, is the practice of medicine going in a positive direction or a negative direction?

Views about the Direction of Events in the Practice of MedicineViews about the Direction of Events in the Practice of MedicineViews about the Direction of Events in the Practice of MedicineViews about the Direction of Events in the Practice of Medicine

17% 71% 12%

4% 52% 44%US

Canada

17%

42%

29%

31%

26%

40%

52%

32%

37%

40%

31%

15%

38%45%

20%

25%

16%

65%Germany

France

UK

Belgium

Portugal

Netherlands

77%

50%

6%

19%

17%

30%

79%

79%

78%

5%

5%

10%

14%

16%

12%India

China

Australia

Korea

Japan

14

Medical AdvancementsSet Practice in a Positive Direction

Across regions, advancements to the practice of medicine – such as medical techniques, technologies and treatments – are most often mentioned without prompt as reasons why the practice of medicine is going in a positive direction

Non-medical factors (like tort, government, insurance reforms) are often cited by Asian doctors, as are developments leading to better patient care – more time, better communication and more providers

Q2a: In what ways is the practice of medicine going in a positive direction? [Among those who see practice of medicine going in a positive or mixed direction]

Unprompted Reasons Practice of Medicine Going a Unprompted Reasons Practice of Medicine Going a PositivePositive Direction DirectionUnprompted Reasons Practice of Medicine Going a Unprompted Reasons Practice of Medicine Going a PositivePositive Direction Direction

Multiple Responses AcceptedGLOBALGLOBAL

North North AmericaAmerica EuropeEurope AsiaAsia

Improvements in Non-Medical FactorsImprovements in Non-Medical Factors 31% 6% 6% 37%

Improved Medical Techniques/ApproachesImproved Medical Techniques/Approaches 23% 30% 24% 23%

Improved Doctor-Patient RelationshipImproved Doctor-Patient Relationship 21% 8% 14% 23%

Improved Medical TechnologyImproved Medical Technology 17% 45% 19% 16%

Improved Treatments/MedicationsImproved Treatments/Medications 16% 7% 15% 16%

General Physician ExperienceGeneral Physician Experience 14% 8% 6% 15%

Better or More Information for PatientsBetter or More Information for Patients 9% 6% 5% 10%

Increased Prominence at Academic ResearchIncreased Prominence at Academic Research 6% 18% 15% 4%

Greater Emphasis on Primary Care/PreventionGreater Emphasis on Primary Care/Prevention 4% 18% 9% 2%

Better or More Information for DoctorsBetter or More Information for Doctors 2% 10% 5% 1%

Alternative Approaches to Patient CareAlternative Approaches to Patient Care 1% 8% 4% 0%

15

Umprompted Reasons for Negative DirectionDeclining Patient Relationship, Third-Party Interference, and Administrative Requirements

Q2b: In what ways is the practice of medicine going in a negative direction? [Among those who see practice of medicine going in negative or mixed direction]

Unprompted Reasons Practice of Medicine Going in a Unprompted Reasons Practice of Medicine Going in a NegativeNegative Direction DirectionUnprompted Reasons Practice of Medicine Going in a Unprompted Reasons Practice of Medicine Going in a NegativeNegative Direction Direction



Doctor Patient Relationship Deteriorating 28% 26% 25% 31%

General Aspects of ProfessionGeneral Aspects of Profession 25% 20% 25% 28%

Business Aspects of MedicineBusiness Aspects of Medicine 25% 42% 28% 19%

Government Mismanagement of Healthcare Systems 22% 13% 8% 32%

Non-Medical Entities Interfering in Medical Decisions 21% 39% 36% 8%

Administrative and Legal Aspects of Medicine 19% 39% 35% 4%

Lack of Access to Medical CareLack of Access to Medical Care 12% 16% 10% 13%

Shortage of Medical ProfessionalsShortage of Medical Professionals 10% 10% 11% 9%

Patient IssuesPatient Issues 2% 11% 1% 1%

16

6.94

6.32

7.25

7.06GLOBAL

North America

Europe

Asia

Most Physicians Are Satisfied with Their Own Experience

1 = Very Unsatisfied 10 = Very Satisfied

Q3: Thinking about your own experience practicing medicine today, please tell me how satisfied you are by using a scale of 1-to-10 where a 1 means a very unsatisfying experience and a 10 means a very satisfying experience.

Satisfaction with Own Experience Practicing Medicine TodaySatisfaction with Own Experience Practicing Medicine TodaySatisfaction with Own Experience Practicing Medicine TodaySatisfaction with Own Experience Practicing Medicine Today

7.20

7.23

8.29

5.60

5.09

India

China

Australia

Korea

Japan

6.61

6.46

6.99

5.93

6.84

6.26

Germany

France

UK

Belgium

Portugal

Netherlands

7.25

6.88US

Canada

17

Job Satisfaction is Affected by Many Factors

No single issue emerges above others affecting doctors’ job satisfaction. Indeed, all are rated as significant in the top third of 10-point scale.

Across regions, agreement doctors have a relatively more significant problem having enough time with patients and relatively less significant problem with receiving adequate compensation.

Q5: Here are some problems that physicians often mention. For each one, please tell me how significant the problem is to your job satisfaction. Please use the same 10 point scale, where a 1 means completely insignificant and a 10 means extremely significant problem affecting job satisfaction.

Significance of Problems to Job SatisfactionSignificance of Problems to Job SatisfactionSignificance of Problems to Job SatisfactionSignificance of Problems to Job Satisfaction

Mean score on 1-10 scale:1=‘Completely Insignificant’; 10=‘Completely Significant’ GLOBALGLOBAL


Protecting my medical practice from threat of lawsuits or Protecting my medical practice from threat of lawsuits or civil actionscivil actions

8.30 7.78 7.28 8.58

Being recognized with the trust and respect traditionally Being recognized with the trust and respect traditionally given to physiciansgiven to physicians

8.29 7.44 7.65 8.51

Having enough time with each patient to provide care in the way I would choose

8.15 7.57 8.05 8.21

Receiving financial compensation at the level I expectedReceiving financial compensation at the level I expected 7.89 7.30 7.70 7.97

Making medical decisions without interference from Making medical decisions without interference from government guidelines or payer organizationsgovernment guidelines or payer organizations

7.86 7.53 7.87 7.88

18

Administrative & Financial IssuesCommonly Cited as Unsatisfying

Q6: Which experience in the practice of medicine today is the most unsatisfying to you?

GLOBALGLOBALNorth North

AmericaAmerica EuropeEurope AsiaAsia

Rationing care/Cost Rationing care/Cost containmentcontainment

17% 3% 5% 20%

CompensationCompensation 14% 7% 12% 15%

Declining Declining Respect/TrustRespect/Trust

13% 4% 5% 16%

Payer issuesPayer issues 13% 28% 20% 11%

Administrative tasksAdministrative tasks 11% 15% 33% 6%

Declining patient Declining patient relationshiprelationship

11% 11% 8% 11%

LitigationLitigation 10% 8% 6% 11%

Business/AdminBusiness/Admin 4% 3% 3% 5%

Shortage of qualified Shortage of qualified medical staffmedical staff

3% 1% 2% 3%

Most Most UnsatisfyingUnsatisfying Experiences Experiencesin Practice of Medicinein Practice of Medicine

Most Most UnsatisfyingUnsatisfying Experiences Experiencesin Practice of Medicinein Practice of Medicine



Treating patient’s Treating patient’s illness or healing illness or healing patientspatients

34% 17% 35% 36%

Witnessing the Witnessing the recovery of patientsrecovery of patients

25% 6% 11% 29%

Helping peopleHelping people 14% 17% 25% 12%

Diagnosing patient Diagnosing patient conditionsconditions

10% 4% 10% 11%

Spending time with Spending time with patientspatients

7% 38% 10% 4%

Prestigious Prestigious occupationoccupation

5% 1% 5% 5%

Increase of private Increase of private insurance patientsinsurance patients

1% 0% 0% 2%

CompensationCompensation 1% 2% 1% 1%

Most Most SatisfyingSatisfying Experiences Experiencesin Practice of Medicinein Practice of Medicine

Most Most SatisfyingSatisfying Experiences Experiencesin Practice of Medicinein Practice of Medicine

Impact ofThird-Party Payers

20

Treatment Guidelines a Factor Compromising Patient Care

(% Always/Frequently, Rarely/Never)

37%

23%

24%

52%

49%

48%

25%

11%

27%

25%3%

1%

0%

3% 25% 48%GLOBAL

North America

Europe

Asia

Always Frequently Rarely Never

Q11: How often do insurance company, or government treatment guidelines prevent you from providing patient care according to your professional judgment: always, frequently, rarely or never?

Frequency Treatment Guidelines Prevent Providing CareFrequency Treatment Guidelines Prevent Providing Careto Professional Judgmentto Professional Judgment

Frequency Treatment Guidelines Prevent Providing CareFrequency Treatment Guidelines Prevent Providing Careto Professional Judgmentto Professional Judgment

15% 54%

7%

31%

42% 51%US

Canada

36%

67%

53%

45%

45%

16%

50%

23%

31%

35%

2%

1%1%

21%

17%

15%

32%

23%

24%

50%

15%

Germany

France

UK

Belgium

Portugal

Netherlands

15% 69%

34%

12%

63%

60%

53%

17%

3%

2%

4%

3%

2%

18%

7%28%

15%

52%

1%

18%China

India

Australia

Korea

Japan

21

16%

22%

37%

12%

16%

15%

36%

44%

51%

32%

7%

27%

10%

5%11%

1%

1%

8% 34% 15%GLOBAL

North America

Europe

Asia

Very positive Somewhat positive No effect Somewhat negative Very negative

Majority Believe Treatment Guidelines Have Adverse Effect on Patient Health

Q12: In your opinion, have insurance company or government treatment guidelines had a very positive, somewhat positive, somewhat negative, or very negative effect or no effect on patient health?

Effect of Treatment Guidelines on Patient HealthEffect of Treatment Guidelines on Patient HealthEffect of Treatment Guidelines on Patient HealthEffect of Treatment Guidelines on Patient Health

(% Positive, No effect, Negative)

20% 26% 54%

17% 9% 74%US

Canada

42%

33%

8%

12%

17%

17%

13%

41%

50%

89%

75%

81%

3%

10%9%India

China

Australia

Korea

Japan

43%

34%

26%

25%

20%

9%

11%

17%

60%

47%

40%

38%

50%

50%

10%

6%

10%

13%

8%

1%

2%1% 22%

10%

17%

18% 12%Germany

France

UK

Belgium

Portugal

Netherlands

Assessment ofDoctor-Patient Relationship

23

Patient Visits Account for Most Time

Q8. Here are some tasks that physicians often complete during the day. For each one, please estimate the percentage of time in your typical working day that you spend on the task.

% of Time Spent in Typical Day% of Time Spent in Typical Day% of Time Spent in Typical Day% of Time Spent in Typical Day



Visiting with patients 46.1 54.1 36.4 48.3

Completing paperwork, administrative requirementsCompleting paperwork, administrative requirements 11.5 19.2 18.7 9.4

Taking private time as neededTaking private time as needed 9.8 4.2 5.8 11.0

Reviewing medical articles, journals and other Reviewing medical articles, journals and other publicationspublications

7.6 4.7 7.2 7.8

Consulting with other healthcare professionalsConsulting with other healthcare professionals 6.3 5.5 8.0 5.9

Reading and responding to correspondenceReading and responding to correspondence 5.7 5.6 10.8 4.4

Talking with hospitals or other healthcare facilitiesTalking with hospitals or other healthcare facilities 4.8 3.1 6.2 4.5

Discussing treatment choices with pharmacies or drug Discussing treatment choices with pharmacies or drug formulariesformularies

4.5 2.2 3.4 4.8

Speaking with pharmaceutical representativesSpeaking with pharmaceutical representatives 3.8 1.5 3.6 4.0

24

19%

16%

36%

30%

30%

41%

51%

53%

23%

32% 38% 30%GLOBAL

North America

Europe

Asia

Increased Remained the same Decreased

Majority in North America and Europe areSpending Less Time with Patients

Q9: Since you began practicing medicine, has the average time you spend with each patient increased, decreased or remained the same?

Change in Average Time Spent with Each PatientChange in Average Time Spent with Each PatientChange in Average Time Spent with Each PatientChange in Average Time Spent with Each Patient

(% Increased, Same, Decreased)

18% 50% 32%

19% 26% 55%US

Canada

42%

32%

13%

12%

38%

37%

65%

20%

31%

38%

23%

34%

49%

39% 27%India

China

Australia

Korea

Japan

17%

24%34%

21%

18%

46%

30%

43%

40%

38%

46%29%

36%

42%

10%

38%

18% 73%GermanyFrance

UK

BelgiumPortugal

Netherlands

25

Primary Culprits for Less Patient TimeAdmin Requirements, Shortage of Medical Professionals and Lack of Remuneration

Q9: Why has the time you spend with patients increased/decreased? [Among those who say time spent with patients has either increased or decreased]

Unprompted Reasons Time Spent with Patients Increased/DecreasedUnprompted Reasons Time Spent with Patients Increased/DecreasedUnprompted Reasons Time Spent with Patients Increased/DecreasedUnprompted Reasons Time Spent with Patients Increased/Decreased



Demands from PatientsDemands from Patients 45% 12% 39% 47%

Increase in Information Options to be Increase in Information Options to be ProcessedProcessed

43% 17% 26% 46%

More Complicated Medical IssuesMore Complicated Medical Issues 22% 29% 20% 22%

Deliberate Changes in PracticeDeliberate Changes in Practice 5% 42% 25% 1%

Preventative CarePreventative Care 5% 2% 5% 5%

Fear of LitigationFear of Litigation 3% 1% 0% 4%

Shortage of Medical ProfessionalsShortage of Medical Professionals 55% 2% 28% 80%

Lack of RemunerationLack of Remuneration 12% 59% 16% 2%

Administrative Bureaucratic RequirementsAdministrative Bureaucratic Requirements 27% 21% 51% 14%

Change in Work HabitsChange in Work Habits 8% 20% 12% 4%

Re

as

on

s T

ime

In

cre

as

ed

Re

as

on

s T

ime

D

ec

rea

se

d

26

90%

85%

95%

93%GLOBAL

North America

Europe

Asia

More Patient Time & Less MD Time ConstraintsMake Better Outcomes

Q15: In your opinion, would spending more time with each patient contribute to better health outcomes for those patients?

Spending More Time with Patients Contributes to Better Health Outcomes? (% Yes)Spending More Time with Patients Contributes to Better Health Outcomes? (% Yes)Spending More Time with Patients Contributes to Better Health Outcomes? (% Yes)Spending More Time with Patients Contributes to Better Health Outcomes? (% Yes)

80%

92%US

Canada

99%

75%

88%

97%

86%

India

China

Australia

Korea

Japan

99%

91%

72%

78%GLOBAL

North America

Europe

Asia

Physician Time Constraints Have Negative Outcomes for Patient Health? (% Yes)Physician Time Constraints Have Negative Outcomes for Patient Health? (% Yes)Physician Time Constraints Have Negative Outcomes for Patient Health? (% Yes)Physician Time Constraints Have Negative Outcomes for Patient Health? (% Yes)

77%

84%

50%

96%

89%

India

China

Australia

Korea

Japan

Q16: When physicians face constraints on the amount of time spent with each patient, does it have negative outcomes for the healthof patients?

98%

99%US

Canada

27

Patient Relationships Changing Worldwide

Patient Information Levels Increased – and Their Expectations

How Have Patient Relationships Changed for Physicians?How Have Patient Relationships Changed for Physicians?How Have Patient Relationships Changed for Physicians?How Have Patient Relationships Changed for Physicians?

Q17: Please tell me if you strongly agree, somewhat agree, somewhat disagree or strongly disagree with the following statements about how patient relationships have changed for physicians.


Patients rely on sources other than the physician’s counsel to understand their condition

1 1 6

Patients are more informed now about health problems 4 2 2

Patients have specific expectations for treatments including preferred medications, tests or therapies

2 3 5

Patients are more informed now about specific medications and treatments

3 4 4

Patients expect to spend more time with physicians than before

9 6 1

Patients are increasingly concerned about their ability to pay for care

5 8 3

Patients are concerned that they are not offered the best choices for quality care

7 5 7

Patients are increasingly skeptical of physicians’ authority 6 7 8

The quality of the average patient visit has deteriorated 8 9 9

Str

on

ger

Ag

reem

ent

Attitudes Toward Physician Activism & Advocates

29

Medical Societies Viewed As Effective With Some Moderation

63%

51%

50%

18%

36%

30%

8%

12%

9%

8%12%

4%

7%

10% 51% 31%GLOBAL

North America

Europe

Asia

Very effective Somewhat effective Somewhat ineffective Very ineffective

Q22: Generally speaking, are medical societies, professional organizations and physicians’ unions very effective, somewhat effective, somewhat ineffective or very ineffective in advancing the interests of physicians?

Effectiveness of Medical Societies/Professional Orgs/Physician UnionsEffectiveness of Medical Societies/Professional Orgs/Physician UnionsEffectiveness of Medical Societies/Professional Orgs/Physician UnionsEffectiveness of Medical Societies/Professional Orgs/Physician Unions

11% 73%

7% 60%

14%

19%

2%

14%US

Canada

9%

12%

6%

38%

61%

55%

42%

22%

18%

36%

11%

5%

9%

7%3%

23%

68%

72% 4%1%India

China

Australia

Korea

Japan

53%

61%

68%51%

42%28%

26%41%

10%15%

12%

3%7%2%

4%

3%

4%2%

5% 50%

46%

40%

25%

6%Germany

FranceUK

Belgium

PortugalNetherlands

30

58%

46%

26%

30%

6%

38%

44%

63%

52%

32%

96%

90%

89%

68%

72%

66%

46%

82%

38%

27%

33%

32%

44%

16%

22%

11%

58%

37%

41%

28%

50%

45%

35%

67%

70%

90%GLOBAL

North America

Europe

Asia

GLOBAL

North America

Europe

Asia

GLOBAL

North America

Europe

Asia

Strongly agree Somewhat agree

Broad Agreement:Change in Medical System will Require MD Leadership

Q20: Turning to another topic, for each of the following statements, please tell me if you strongly agree, somewhat agree, somewhat disagree or strongly disagree?

Agreement with Statements – Top 3Agreement with Statements – Top 3Agreement with Statements – Top 3Agreement with Statements – Top 3

Improving healthcare systems will require public leadership from physicians

Improving healthcare systems will require public leadership from physicians

Reducing government involvement in healthcare would be better for everyone

Reducing government involvement in healthcare would be better for everyone

Physicians have lost control of medical care decisions to other people

Physicians have lost control of medical care decisions to other people

Regional Differences: More Sense of Lost Control in North America and Europe; Less in AsiaRegional Differences: More Sense of Lost Control in North America and Europe; Less in AsiaRegional Differences: More Sense of Lost Control in North America and Europe; Less in AsiaRegional Differences: More Sense of Lost Control in North America and Europe; Less in Asia

20%62% 35%

33%46%

34%

52%50%

51%71%

IndiaChina

AustraliaKoreaJapan

12%34% 30%

23%43%

16%

43%46%

38%58%

IndiaChina

AustraliaKoreaJapan

21% 49%4%

10%28%

6%

23%53%

22%37%

IndiaChina

AustraliaKoreaJapan

31

Medical Societies Most Aligned with Physician Interests

Alignment of Organizations with the Interests of PhysiciansAlignment of Organizations with the Interests of PhysiciansAlignment of Organizations with the Interests of PhysiciansAlignment of Organizations with the Interests of Physicians

Q19: Please tell me how supportive of physicians the following organizations are by telling me if you feel they are very closely aligned, somewhat closely aligned, not very closely aligned, or not-at-all aligned, with the interests of physicians?


Medical societies and physician associations 1 1 1

Pharmacists and their professional organizations 2 4 4

Pharmaceutical companies 6 2 3

Nursing organizations 3 5 5

Medical device companies 4 3 6

Hospital administrators 7 7 2

Patient advocacy groups 5 6 9

Government payment agencies 9 9 7

Insurance and managed care companies 10 8 8

The mass media 8 10 10

32

22%

25%

29%

46%

49%

42%

46%

28%GLOBAL

North America

Europe

Asia

Very likely Somewhat likely

Majorities Believe Physicians Should Speak Out– And Would Join Together

73%

70%

67%

75%

98%

90%

86%

88%GLOBAL

North America

Europe

Asia

Q23: Generally speaking, do you believe that physicians should speak out publicly about problems facing the practice of medicine?

Should Physicians Speak Out Publicly About Problems? (% Yes)Should Physicians Speak Out Publicly About Problems? (% Yes)Should Physicians Speak Out Publicly About Problems? (% Yes)Should Physicians Speak Out Publicly About Problems? (% Yes)

97%

93%

61%

99%

72%

India

China

Australia

Korea

Japan

Q24: Some physicians have suggested forming an advocacy organization to educate the public about the importance of the role of physicians to public health and to also influence government policies affecting the practice of medicine. How likely would you be to join such an organization?

Likelihood to Join an Organization of Physicians to Educate the PublicLikelihood to Join an Organization of Physicians to Educate the PublicLikelihood to Join an Organization of Physicians to Educate the PublicLikelihood to Join an Organization of Physicians to Educate the Public

16% 46%

22% 50%US

Canada

27%

30%

44%

32%

40%

42%

9%

56%

44%

39%

India

China

Australia

Korea

Japan

33

Physicians Emphasize More Public Role and Partnerships to Reform Healthcare Policies

Relative Uniformity of Ranking

Across Regions

Support for Ideas to Support PhysiciansSupport for Ideas to Support PhysiciansSupport for Ideas to Support PhysiciansSupport for Ideas to Support Physicians

Q25: Now I will describe several ideas that have been suggested to support physicians. As I read each one, please tell me if you would strongly support, somewhat support, somewhat oppose or strongly oppose the idea.

Number indicates rank - based on mean score – from 1 = most support; 6 = least support


Participate in training programs to help physicians become better advocates for reform of healthcare policies

1 2 1

Cooperate with third-parties to publicize the important role of physicians in society

3 1 2

Work with private companies to train physicians and staff on the use of new technologies

2 3 5

Cooperate with private companies to establish training programs to improve the availability of competent medical staff

4 4 4

Form a coalition between healthcare professionals and private companies to defend physicians right to make independent medical decisions

5 5 3

Participate in programs in which private industry provides electronic medical record systems to individual physician offices at no cost

6 6 6

34

Summary

Direction of Medicine

North American and European doctors are generally negative about the direction of medicine

Attribute to interference and burdens from non-medical third-parties (payers).

Asian doctors tend to be more positive about the practice of medicine – buoyed by the experiences of Chinese and Indian doctors (but at the expense of highly dissatisfied Korean and Japanese doctors).

Doctor-Patient Relationship

There is widespread agreement that constraints on time spent with patients negatively affects health outcomes. And, they agree patients use alternative information sources, are more informed about conditions and treatments and make demands about their medical care. Also universal is doctors’ belief that more time spent with patients could help improve the quality of care.

Medical Leadership

Consensus also emerges as doctors agree that healthcare system changes will require their public leadership – and that healthcare systems focus more on reducing cost than providing good care.

June 15, 2008 Chicago, ILLINOIS, USA Bob Miglani Senior Director, External Medical Affairs – International Pfizer’s Medical Partnerships Initiative (MPI)

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