Industry Payments to US Physicians by Specialty and Product Type
JAMA. March 28, 2024. doi:10.1001/jama.2024.1989
Ahmed Sayed, MBBS1; Joseph S. Ross, MD, MHS2; John Mandrola, MD3; et alLisa Soleymani Lehmann, MD, PhD4; Andrew J. Foy, MD5
Despite evidence that financial conflicts of interest may influence physician prescribing and may damage patients’ trust in medical professionals,1-3 such relationships remain pervasive.4 The Physician Payments Sunshine Act led to the creation of the Open Payments database in August 2013, a repository of industry payments to health care professionals.5 We examined the distribution of payments within and across specialties and the medical products associated with the largest total payments.
Methods
We used data from the Open Payments platform from 2013 to 2022.5 We included
payments (cash and noncash equivalents) for
- consulting services,
nonconsulting services (such as fees for serving as a speaker or faculty at a venue),
- food and beverages,
- travels and lodging,
- entertainment,
- education,
- gifts,
- grants,
- charitable contributions, and
- honoraria made to physicians (allopathic and osteopathic).
Open Payments data were linked to the National Plan and Provider Enumeration System (NPPES).6 Specialties for each physician are coded according to the Health Care Provider Taxonomy in the NPPES. We characterized between-specialty variation in industry payments to physicians by determining the total amount of payments from industry to physicians across 39 specialties (eMethods in Supplement 1), the amount received by the median physician (50th percentile of physicians), and the proportion of physicians receiving payments. We characterized within-specialty variation by comparing, within each specialty, the amount paid to the median physician and the mean amount paid to the top 0.1% of physicians. We also determined the 25 drugs and medical devices associated with the largest total payments. When a payment was made for several products, we assigned it to the primary product.
All analyses were performed using R, version 4.2.0 (R Project for Statistical Computing). The study was determined to be exempt by the Ain Shams University institutional review board because it used anonymized and deidentified data from a publicly available database.
Results
From 2013 to 2022, 85 087 744 payments with a total value of $12.13 billion were made by industry to 826 313 of 1 445 944 eligible physicians (% receiving payments, 57.1%; median payment, $48 per physician [IQR, $0-$1015]), and 79 774 940 (93.8%) of these payments were associated with 1 or more marketed medical products. Excluding the year 2013 (when data were only available for August onward), the total value of payments was highest in 2019 ($1.60 billion) and lowest in 2020 ($863.93 million). Additionally, the number of physicians receiving payments was highest in 2015 (468 164) and lowest in 2020 (359 509). The total value of payments changed from $1.34 billion (to 443 367 physicians) in 2014 to $1.28 billion (to 424 417 physicians) in 2022.
Orthopedic surgeons received the greatest sum of payments at $1.36 billion, followed by neurologists and psychiatrists at $1.32 billion, and then cardiologists at $1.29 billion (Table). Pediatric surgeons ($2.89 million) and trauma surgeons ($6.96 million) received the lowest sum of payments. Within each specialty, payment distributions were skewed, with payments to the median physician ranging from $0 to $2339, whereas the mean amount paid to the top 0.1% of physicians ranged from $194 933 for hospitalists to $4 826 944 for orthopedic surgeons.
The 3 drugs associated with the most payments were Xarelto ($176.34 million), Eliquis ($102.62 million), and Humira ($100.17 million) (Figure, A). The 3 medical devices associated with the most payments were the da Vinci Surgical System ($307.52 million), Mako SmartRobotics ($50.13 million), and CoreValve Evolut ($44.79 million) (Figure, 
.
Discussion
From 2013 to 2022, US physicians received $12.1 billion from industry. More than half of physicians received at least 1 payment. Payments varied widely between specialties and between physicians within the same specialty. A small number of physicians received the largest amounts, often exceeding $1 million, while the median physician received much less, typically less than a hundred dollars.
Study limitations included not recording payments made to other health care professionals (nurses, nurse practitioners, and physician assistants) because these payments only began to be recorded in 2021; the reliance on industry reporting; the absence of data on certain types of payments (like free drug samples), which may underestimate financial transactions; and the different durations of time over which products were marketed because the analysis focused on cumulative totals rather than annualized amounts.
Note: Does not include payments such as $1 Billion to non-physcians in NIH for development of vaccines
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