The Role of Physician Professional Networks in Physicians’ Receipt of Pharmaceutical and Medical Device Industries’ Payments

Abstract

BACKGROUND: Financial relationships between physicians and the pharmaceutical and medical device industries are common, but the factors associated with physicians receiving payments are unknown. OBJECTIVE: The objective of this study is to evaluate the influence of physicians' professional networks' characteristics on the receipt of payments among physicians. DESIGN: Network analysis of cross-sectional data PARTICIPANTS: US physicians who shared Medicare patients with other physicians in 2015 (N=357,813). EXPOSURE (INTERVENTION):Proportion of a physician's professional network that received industry payments and other network characteristics including number of physician connections, how central the physician is within the network, and the tightness of the referral network in which a physician is located. MAIN OUTCOME MEASURES: Relative risk of receiving industry payments. We used modified Poisson regression to control for confounding by gender, time since graduation, practice size, and practice setting (teaching hospital vs. not). We included dummy variables for specialty and hospital referral region level. KEY RESULTS: The proportion of a physician's peers in their professional network that received payments was strongly associated with receipt of pharmaceutical or device industry payments by the physician (top vs bottom quartile aRR=1.28, 95%CI=1.25-1.31). Physician's centrality within a network had a small positive effect on receiving payment (top vs bottom quartile aRR=1.02, 95%CI=1.01-1.04). Network density also had a small negative association with receipt of payment (top vs bottom quartile aRR=0.97, 95%CI=0.96-0.98). CONCLUSIONS: Network characteristics, particularly the receipt of payments among physicians one shares patients with, are associated with whether a physician receives payments. This finding has implications for institutional regulation of industry payments to physicians and demonstrates how institutional policy may impact not only the physicians within the institution but also physicians outside of the institution.

Quantifying Industry Spending on Promotional Events Using Open Payments Data

“…However, the true extent of the scope of all sponsored events targeted at prescribing clinicians is likely an underestimate given that our parameters for defining an event were conservative and because certain manufacturers and products are exempt from reporting requirements. Previous Open Payments analyses have largely taken an individual and grouped prescriber-centric approach, finding that receipt of payments is associated with increased prescribing quantity and cost and that the likelihood of receiving a payment increases when those within a physician’s professional referral network also receive payments . An event-centric approach allows for a better understanding of the nature and impacts of prescriber-industry interactions in the social contexts in which they occur.…”

“…Previous Open Payments analyses have largely taken an individual and grouped prescriber-centric approach, finding that receipt of payments is associated with increased prescribing quantity and cost 19 and that the likelihood of receiving a payment increases when those within a physician’s professional referral network also receive payments. 20 , 21 , 22 An event-centric approach allows for a better understanding of the nature and impacts of prescriber-industry interactions in the social contexts in which they occur.…”

Capitalizing on transparency: Commercial surveillance and pharmaceutical marketing after the Physician Sunshine Act

“…At the same time, several researchers have maintained that payment disclosure alone cannot solve larger underlying problems of the ‘institutional corruption’ of medicine (Light et al, 2013), namely, ‘that the pharmaceutical industry has a disproportionate influence on medical opinion, which weakens medicine's ability to promote individual and public health in ways that are independent of the industry’ (Sismondo, 2013: 636). Furthermore, it has been noted that many of the larger payments that companies make to physicians are primarily intended not to affect their prescriptions, but rather to purchase their influence on other physicians (Sismondo, 2013), meaning that studies tend to underestimate the effects of these payments (Winn et al, 2021).…”

Industry Payments to Rheumatologists Ought to Be Going Down, Not Up

“…Industry payments to a physician increase not only that physician’s prescribing but also their peers’ prescribing, and key opinion leaders are well positioned to influence a large number of other physicians in this manner (8). Second, physicians also follow their peers in terms of which companies they accept money from (9). Targeting key opinion leaders for industry payments may therefore lead to a larger number of other physicians accepting similar payments, and the potential to be swayed by them, in the future.…”