Association between physician characteristics and payments from industry in 2015–2017: observational study

Abstract

ObjectiveTo investigate the association between physician characteristics and the value of industry payments.DesignObservational study.Setting and participantsUsing the 2015–2017 Open Payments reports of industry payments linked to the Physician Compare database, we examined the association between physician characteristics (physician sex, years in practice, medical school attended and specialty) and the industry payment value, adjusting for other physician characteristic and institution fixed effects (effectively comparing physicians practicing at the same institution).Main outcome measuresOur primary outcome was the value of total industry payments to physicians including (1) general payments (all forms of payments other than those classified for research purpose, eg, consulting fees, food, beverage), (2) research payments (payments for research endeavours under a written contract or protocol) and (3) ownership interests (eg, stock or stock options, bonds). We also investigated each category of payment separately.ResultsOf 544 264 physicians treating Medicare beneficiaries, a total of $5.8 billion in industry payments were made to 365 801 physicians during 2015–2017. The top 5% of physicians, by cumulative payments, accounted for 91% of industry payments. Within the same institution, male physicians, physicians with 21–30 years in practice and physicians who attended top 50 US medical schools (based on the research ranking) received higher industry payments. Across specialties, orthopaedic surgeons, neurosurgeons and endocrinologists received the highest payments. When we investigated individual types of payment, we found that orthopaedic surgeons received the highest general payments; haematologists/oncologists were the most likely to receive research payments and surgeons were the most likely to receive ownership interests compared with other types of physicians.ConclusionsIndustry payments to physicians were highly concentrated among a small number of physicians. Male sex, longer length of time in clinical practice, graduated from a top-ranked US medical school and practicing certain specialties, were independently associated with higher industry payments.

Voluntary disclosures of payments from pharmaceutical companies to healthcare professionals in Germany: a descriptive study of disclosures in 2015 and 2016

“…The distribution of disclosed annual payment amounts was skewed to lower amounts of payments with half of all disclosing HCPs disclosing annual payment sums up to €536, while one percent of HCPs disclosed payment sums of €17 049 to €200 194. This is comparable to the distribution of non-voluntary disclosed payments in the US 5 : a large proportion of the total payments is concentrated among few physicians, whereas many physicians receive comparable smaller amount of payments. We observed that on average, female HCPs disclosed lower amounts of payments than male HCPs and HCPs with lower academic degrees disclosed lower amounts of payments than HCPs with higher academic degrees.…”

“…This is comparable to studies from the US that have shown that male physicians, 4 5 31 physicians who have been practising longer, and those who graduated from a top-ranked US medical school receive higher industry payments. 5 These factors, however, might interact at various levels: for example, women are less likely to attain senior-level positions, and therefore, are more likely to have lower academic degrees. 32 33 Findings in context It is often argued by pharmaceutical companies that adherence to self-regulation codices like the EFPIA provides a sufficient basis for transparency of payments to HCPs.…”

Association between industry payments for opioid products and physicians’ prescription of opioids: observational study with propensity-score matching

“…11 13 15 However, these studies did not employ robust causal design with insufficient adjustment for physician-level confounders. Given the potential association of such physician characteristics with both industry payments and prescription behaviour, 17–19 32 their lack of data could potentially lead to biased estimates. For example, a recent study reported the association between lower ranked medical school graduated and higher opioid prescriptions 32 ; lack of this information might induce positive confounding (ie, bias away from the null) if medical school graduated is also associated with the receipt of industry payments in the same direction.…”

“…20 Second, we linked the Open Payments data with the NPPES Database using physicians’ full name and the zip code for the primary practice location, an approach used in previous studies. 17 19 21 Then, we linked the merged database of the Open Payments and NPPES Databases with the Physician Compare database 22 and the Medicare Provider Utilization and Payment Database 23 using physicians’ National Provider Identifier (NPI).…”

“…Existing studies on this topic were observational studies that adjusted for a limited set of potential confounders (therefore, there are concerns about residual confounding) 11– 14 or ecological studies using data aggregated at the regional level 15 (thus, susceptible to ‘ecological fallacy’ 16 ). In addition, while the difference in financial relationships with industry by physician characteristics has been shown in general, 17– 19 it is still unclear whether some types of physicians are more susceptible to opioid-related industry payments than others. Finally, although it is important to understand how much industry payments are necessary to influence physicians’ prescription practice, the dose–response relationship between industry payments for opioids and physician prescription of opioid has not been well characterised.…”