When the University of Michigan imposed restrictions on relationships between its clinicians and industry representatives several years ago, the changes were not immediately embraced by everyone.
"There was a fair amount of, I'd say, resistance from lots of different camps," said Deborah Biggs, director of compliance, regulatory and business affairs at the medical school.
Despite predictions of increased costs or other "dire consequences," the change turned out to be easier than expected, she said.
Officials at other universities that have implemented similar policies expressed much the same view.
"It's gone very well, believe it or not," said Dr. Harry Greenberg, a senior associate dean at Stanford University School of Medicine. The university's policy took effect last fall.
Dr. Greenberg said that officials publicized the new policy widely and maintained a telephone hot line and Web-based resources to field questions.
At first, there were many, he said, and a committee dealt with more complicated issues that were raised.
In general, compliance has been good, he said. While officials have had to notify some physicians that they were in apparent violation of the guidelines, "we have not had recalcitrant people for whom disciplinary actions have been required," he said.
Dr. Kathleen Yaremchuk, vice president of clinical practice performance at Henry Ford Hospital, said some industry representatives expressed doubts that the health system could successfully implement its policy, which took effect early this year.
So far, officials have informed a few physicians that their practices conflicted with the new policy, she said. And they have imposed a one-month suspension on "five to 10" industry representatives for violating the policy, as well as one lifetime ban, she said.
Dr. Patrick Brennan, chief medical officer for the University of Pennsylvania Health System, said efforts to implement the system's new policy have generally gone well.
Free meals for physician offices "have essentially vanished," he said, noting that some industry representatives have complained that they are not getting invited to present their products because they are no longer providing meals.
The biggest issue for groups implementing such restrictions is "the cultural backlash within their own organizations," Ms. Biggs said, noting some doctors have had relationships with industry throughout their careers.
"They may call you and debate the issue," she said, "but in the end, we've had pretty good compliance."