Assessment of Medical Industry Compensation to US Physicians by Gender

Sullivan, Brittany; Al-Khouja, Fares; Herre, Margaret; Manasa, Morgan; Kreger, Alexander; Escobar, Jessica; Dinicu, Andreea; Naaseh, Ariana; Dehkordi-Vakil, Farideh; Stamos, Michael J.; Pigazzi, Alessio; Jafari, Mehraneh D.

doi:10.1001/jamasurg.2022.4301

Cited by 12 publications

(15 citation statements)

References 23 publications

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“…Gender differences in industry payments to physicians are well established. 25 , 26 , 27 In this study, we also found that male physicians received higher numbers and value of industry payments compared with female physicians in 2021. However, this pattern was reversed for APCs.…”

Section: Discussionsupporting

confidence: 67%

Evaluation of Industry Payments to US Advanced Practice Clinicians in 2021

2022

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ImportanceAdvanced practice clinicians (APCs) are a growing part of the US health care system, and their financial relationships with pharmaceutical and medical device companies have not been well studied.ObjectivesTo examine the value, frequency, and types of payments made to APCs and the association of state scope-of-practice laws with these payments.Design, Setting, and ParticipantsThis cross-sectional study used 2021 Open Payments Program data to analyze payments from pharmaceutical or medical device companies to physicians or APCs between January 1 and December 31, 2021. Doctors of medicine and osteopathy were categorized as physicians, and nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists, certified nurse midwives, and anesthesiologist assistants as APCs.Main Outcomes and MeasuresThe total value and total number of payments were calculated in aggregate and per clinician for each type of APC, all APCs, and physicians. These calculations were repeated by submitting manufacturer, form of payment, nature of payment, and state scope-of-practice law for nurse practitioners, physician assistants, and physicians.ResultsA total of 412 000 physicians and 232 000 APCs collectively received $1.99 billion in payments from industry in 2021, of which APCs received $121 million (6.1%). The median total value of payments per clinician for physicians was $167 (IQR, $45-$712) and for APCs was $117 (IQR, $33-$357). The median total number of payments per clinician was equal for physicians and APCs (n = 4). The most common payments to APCs included food and beverage ($69 million [57.6%]), compensation for services other than consulting ($32 million [26.4%]), and consulting fees ($8 million [6.6%]). Advanced practice clinicians in states with the most restrictive scope-of-practice laws received 15.9% lower total value of payments than those in the least restrictive states (P = .002). Physician assistants received 7.6% (P = .005) higher value and 18.1% (P &lt; .001) greater number of payments than nurse practitioners.Conclusions and RelevanceIn this cross-sectional study, 232 000 APCs collectively received $121 million in industry payments in 2021. The frequency of industry interactions with APCs was similar to that for physicians, but the average value was lower. The greater value of payments to APCs who practice in states with the least restrictive scope-of-practice laws suggests that industry payments may be related to clinician autonomy.

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Section: Discussionsupporting

confidence: 67%

Evaluation of Industry Payments to US Advanced Practice Clinicians in 2021

2022

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“…In medicine, Jena et al showed in 2016 that academic male physicians out earned female physicians by a mean difference of $51 315 annually . Thus, the findings of gender inequity in medical industry compensation presented by Sullivan et al are not surprising. But the degree to which mean payments to top earners differed ($41 320 for women vs $1 226 377 for men) is still astonishing.…”

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confidence: 99%

“…Thus, the findings of gender inequity in medical industry compensation presented by Sullivan et al are not surprising. But the degree to which mean payments to top earners differed ($41 320 for women vs $1 226 377 for men) is still astonishing.…”

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confidence: 99%

“…There was no obvious identifiable explanation for this disparity. The authors found that men were paid more at every academic stage, including the assistant, associate, and full-time professor levels. Men were paid more even after adjusting for adjusting for h-index, a measure of research impact and accomplishment.…”

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confidence: 99%

“…Men were paid more even after adjusting for adjusting for h-index, a measure of research impact and accomplishment. Men were even paid more in the female-dominated specialties of obstetrics and gynecology and pediatrics . This is, quite simply, unfair.…”

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confidence: 99%

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Disparities in Physician Compensation—A Call to Action

2022

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Historically, a gender wage gap has existed across every field in the US. The US Bureau of Labor Statistics estimated in 2020 that full-time working women had median salaries that were 82% of those of men. 1 This disparity persisted across all age groups and ethnicities. In medicine, Jena et al 2 showed in 2016 that academic male physicians out earned female physicians by a mean difference of $51 315 annually. 2 Thus, the findings of gender inequity in medical industry compensation presented by Sullivan et al 3 are not surprising. But the degree to which mean payments to top earners differed ($41 320 for women vs $1 226 377 for men) 3 is still astonishing.There was no obvious identifiable explanation for this disparity. The authors 3 found that men were paid more at every academic stage, including the assistant, associate, and fulltime professor levels. Men were paid more even after adjusting for adjusting for h-index, a measure of research impact and accomplishment. Men were even paid more in the femaledominated specialties of obstetrics and gynecology and pediatrics. 3 This is, quite simply, unfair.These disparities not only represent financial inequity, but also lost opportunities. Surveys have shown that women in surgical residency have similar leadership aspirations as men and similar goals of becoming experts in their field. 4 But the field of medicine, both clinical and in industry, as a whole has done a poor job at promoting and sponsoring women into leadership roles. As a profession, we must do better. Greater efforts should be made at increasing the visibility of women at academic societies, including leadership roles, committee appointments, and moderators and discussants at the podium. 5 Medical companies need to reevaluate their practices, too, in terms of how they diversify their leadership-all but 1 company in the study had male CEOs, and board members were predominantly male. There also needs to be greater transparency in how companies recruit and compensate medical consultants.This study by Sullivan et al 3 represents a call to action and an opportunity. Women are increasing in numbers in every specialty. Their opinions and perspectives must be valued and reflected in the development of medical devices and drugs. Increasing recruitment of women into leadership positions in both industry and medicine will certainly help, as will increased transparency in consulting practices, consultant opportunities, and structure of compensation fees. Above all, we must remember that physicians and surgeons as a group hold considerable influence, as the end users of medical devices, products, and drugs that the industry develops. As the number of women entering medicine and surgery continues to rise, this growth should be leveraged. Holding leaders in surgery and industry accountable will hopefully lead to meaningful results. We look forward to the change.

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Gender Disparities in Medical Industry Payments

2023

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To the Editor Sullivan and colleagues 1 showed that male physicians received far larger medical industry compensations than female physicians possibly due to the so-called glass ceiling effect. We have 3 comments.First, we are interested in how the COVID-19 pandemic affected the male-female disparity of industry compensations. Sullivan and colleagues 1 analyzed data from the Open Payments Database only through 2019, but it is already possible to obtain data through 2021 as we did. 2 Notably, during the pandemic, academic performance has been more devastating among women than men, and to analyze whether similar disproportionate impacts exist in the medical industry compensations is of interest after 2020.Second, it would be meaningful to reveal the breakdown of the industry compensations in this study. While a malefemale disparity of the compensation was increasingly exacerbated as the position got higher and as the year progressed, the factors that affected such a difference were not well investigated. A detailed breakdown of industry compensations may shed some light on this matter. For example, it has been pointed out that consulting, traveling, and lodging may be received more by those with higher positions. 3 Furthermore, speaking engagements have been noted to be related to promotion and have been shown to be lower among female physicians. 4 Third, it is unfortunate that there was a lack of discussion regarding a negative impact of financial relationships with pharmaceutical companies on practice and research. Not only Sullivan and colleagues 1 but also the accompanying Invited Commentary discussed that a disproportionately low acceptance of the compensations among women should be justified. However, industry compensations are the primary source of financial conflict of interest in medical society, and the fact that female physicians received fewer compensations should not always be considered negative. Namely, it is possible that

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Assessment of Medical Industry Compensation to US Physicians by Gender

Cited by 12 publications

References 23 publications

Evaluation of Industry Payments to US Advanced Practice Clinicians in 2021

Evaluation of Industry Payments to US Advanced Practice Clinicians in 2021

Disparities in Physician Compensation—A Call to Action

Gender Disparities in Medical Industry Payments

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