In 2015, 48% of all 933,295 US physicians together reportedly received $2.4 billion in industry payments, a new analysis of Open Payments data has found. Most recipients were men (70.2%), and the payments were most likely to be general (consulting fees and food and beverage payments) and given to physicians in surgical specialties rather than those in primary care. The findings were published online May 2 in JAMA in an issue themed around conflict of interest. Previous studies on the Open Payments data have looked at payments by specialty. This study sorts out the payments by physicians' sex and specialty and whether they were general payments; ownership interests; or royalty, license, or research payments. Kathryn R. Tringale, BS, from the University of California, San Diego, School of Medicine in La Jolla, and colleagues found that general payments ($1.8 billion) made up the bulk of the $2.4 billion, followed by $544 million in cumulative ownership interests and $75 million for research payments specified in a written contract. Under Open Payments, part of the Affordable Care Act, biomedical manufacturers and group purchasing organizations must report all payments and ownership interests given to physicians. The authors note the reason Open Payments was enacted in 2013 remains relevant. "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," they write. Researchers found that men were more likely to receive general payments than women in every specialty category. Men also reportedly received more royalty or license payments than did women, and women held fewer patents than their male counterparts. "Furthermore, women who obtain patents are less likely to have them commercialized or licensed than men," the authors write. Industry payments varied by specialty and by per-physician amounts. More surgeons (61%) than primary care physicians (47.7%) reported receiving general payments (absolute difference, 13.3 percentage points; 95% confidence intervaI, 13.1 - 13.6 percentage points; odds ratio, 1.72; P < .001). The mean per-physician payment value was $6879 for surgeons compared with $2227 for primary care physicians. "Surgical and interventional specialties have strong industry ties, dependence on devices and equipment, and perhaps a greater influence over industry-related expenditures," the authors explain. "Industry presence in the operating room allows representatives to form relationships with proceduralists, providing device training and income-enhancing opportunity." The authors add, "Companies may preferentially market to profitable specialties such as cardiologists because these physicians influence the prescribing practices of nonspecialists. However, industry also appears to target and influence primary care physicians who accepted frequent low-value payments." The authors note that the frequent-but-lower primary care payments may reflect lunches paid for by pharmaceutical companies. The nature of payments also varied for specialties. Surgeons received 54.5% of their value from royalty or license payments, while the rest of the specialties received the most from service fees, such as faculty lectures. Service fee percentages were as follows: 41.3% for primary care physicians, 39.8% for specialists, and 37.5% for interventionalists. The researchers also looked at proportions of physicians who personally received more than $10,000 — the threshold the US Department of Health and Human Services says represents a significant conflict of interest. Neurosurgeons had the highest percentage of those with personal totals passing $10,000, at 12.6%, followed by cardiologists (12.1%) and neurologists (11.8%). Source
