Background: Industry-physician collaboration is critical for anticancer therapeutic development, but financial relationships introduce conflicts of interest. We examined the specialty variation and context of physician payments and ownership interest among oncologists. Methods: We performed a population-based multivariable analysis of 2014 Open Payments reports of industry payments to US physicians matched to physician and practice data, including sex, specialty, practice location, and sole proprietor status. Payment data were aggregated per physician and compared by specialty (medical, radiation, surgical, and nononcology), and practice location linked with spending level (low, average, and high). Primary outcomes included likelihood, mean annual amount, and number of general payments. Secondary outcomes included likelihood of holding ownership interests and receipt of royalty/license payments. Estimates for each outcome were determined using multivariable models, including logistic regression for likelihood and linear regression with gamma distribution and log-link for value, adjusted for physician specialty, sex, sole proprietor status, and practice spending. All statistical tests were two-sided. Results: In 2014, there were 883 438 physicians, including 22 712 oncologists, licensed to practice in the United States. Among oncology specialties, 52.4% to 63.0% of physicians received a general payment in 2014, totaling $76 million, $4 million, and $5 million to medical, radiation, and surgical oncology, respectively. The median annual per-physician payment to medical oncologists was $632 (IQR ¼ 136-2500), compared with $124 (IQR ¼ 39-323) in radiation oncology and $250 (IQR ¼ 84-1369) in surgical oncology. After controlling for physician and practice characteristics, oncologists were 1.09 to 1.75 times as likely to receive a general payment compared with nononcologists (overall P < .001). There was a 67.6% difference (95% confidence interval [CI] ¼ 63.6 to 71.5, P < .001) in the mean annual value of payments between medical oncology and nononcology specialties (vs À92.7%, 95%CI ¼ À100.2 to À85.0, P < .001] for radiation oncology). Medical and radiation oncologists were more likely to hold ownership interest (adjusted OR ¼ 3.72, 95% CI ¼ 3.22 to 4.27, and 2.27, 95% CI ¼ 1.65 to 3.03, respectively, P < .001 both comparisons). Conclusions: In 2014, industry-oncologist financial relationships were common, and their impact on oncology practice should be further explored.
The Centers for Medicare and Medicaid Services' Open Payments program implements Section 6002 of the Affordable Care Act requiring medical product manufacturers to report payments made to physicians or teaching hospitals, as well as ownership or investment interests held by physicians in the manufacturer. To determine the characteristics and distribution of these industry payments by specialty, we analyzed physician payments made between August 1, 2013 and December 31, 2013 that were publicly disclosed by Open Payments. We compared payments between specialty type (grouped as medical, surgical, and other specialties) and across specialties within each type, using Pearson's chi square test and the Kruskal-Wallis test. The number of physicians receiving payments was compared to the total number of active physicians in each specialty in 2012. We also analyzed physician ownership interests. There were 2.7 million identified payments to recipient physicians totaling $527 million. Allopathic and osteopathic physicians received 2.43 million payments totaling $475 million. General payments represented 90% ($430 million) of payments by total value (per-physician median:$100, IQR:$31-$273, mean:$1,407, SD:$23,766) with the remaining 10% ($45 million) as research payments (median:$2,365, IQR:$592-$8,550; mean:$12,880, SD:$66,743). Physicians most likely to receive general payments were cardiovascular specialists (78%) and neurosurgeons (77%); those least likely were pathologists (9%). Reports of ownership interest in reporting entities included $310 million in dollar amount invested and $447 million in value of interest held by 2,093 physicians. In conclusion, the distribution and characteristics of industry payments to physicians varied widely by specialty during the first half-year of Open Payments reporting.
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