In 2015, nearly half of U.S. physicians were reported to have received a total of $2.4 billion in industry-related payments, primarily involving general payments (including consulting fees and food and beverage), with a higher likelihood and value of payments to physicians in surgical than in primary care specialties and to male than female physicians, according to a new study published in JAMA.
Concern regarding financial conflicts of interest and their effects on patient care, medical research, and education prompted the creation of the Open Payments program, a nationwide public-data repository reporting industry payments to physicians and teaching hospitals. Open Payments, implemented under the Patient Protection and Affordable Care Act, requires biomedical manufacturers and group-purchasing organizations to report all payments and ownership interests made to physicians starting in 2013.
Jona A. Hattangadi-Gluth, MD, of the University of California–San Diego in La Jolla, and colleagues conducted an observational, retrospective, population-based study that included 933,295 allopathic and osteopathic physicians linked to 2015 Open Payments reports of industry payments. The outcomes were compared across specialties (surgery, primary care, specialists, and interventionalists) and between male (66%) and female (34%) physicians.
The researchers found that, in 2015, 449,864 of 933,295 physicians (30% women), representing approximately 48% of all U.S. doctors, received $2.4 billion in industry payments, including approximately $1.8 billion for general payments; $544 million for ownership interests (including stock options and partnership shares); and $75 million for research payments. Compared with 48% of primary care physicians, 61% of surgeons received general payments. Surgeons had an average per-physician reported payment value of $6,879 compared with $2,227 for primary care physicians. Men within each specialty had higher odds of receiving general payments compared with women, and received more royalty or license payments than did women.
The authors conceded that their study had limitations, including that the Open Payments and National Plan & Provider Enumeration System databases may have inaccuracies, and that physicians may be unaware of their reported payments.
“Although physicians may consider themselves committed to ethical practice and professionalism, many do not recognize the subconscious bias that industry relationships have on their decision making,” the researchers write. “The Institute of Medicine has highlighted the tension that exists between ‘financial relationships with industry and the primary missions of medical research, education, and practice.’”
“Data have shown that financial conflicts of interest, from small gifts and meals to large sums for consulting, may affect physician decision making,” they add. “The current population-based analysis of industry-to-physician payments in 2015 shows the far-reaching extent (more than 10 million transactions totaling $2.4 billion) of these reported financial relationships.”