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Health services research
Original research
Association between physician characteristics and payments from industry in 2015–2017: observational study
  1. Kosuke Inoue1,
  2. Daniel M Blumenthal2,3,4,
  3. David Elashoff5,6,7,
  4. Yusuke Tsugawa7,8
  1. 1 Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
  2. 2 Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3 Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Devoted Health, Waltham, Massachusetts, USA
  5. 5 Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California, USA
  6. 6 Department of Medicine Statistics Core, UCLA David Geffen School of Medicine, Los Angeles, California, USA
  7. 7 General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
  8. 8 Department of Health Policy Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
  1. Correspondence to Dr Kosuke Inoue; koinoue{at}ucla.edu

Abstract

Objective To investigate the association between physician characteristics and the value of industry payments.

Design Observational study.

Setting and participants Using 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 measures Our 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.

Results Of 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.

Conclusions Industry 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.

  • open payments
  • physician compare
  • physician characteristics
  • medicare beneficiaries

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-031010

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    Footnotes

    • Contributors All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: KI, YT. Acquisition, analysis or interpretation of data: KI, YT. Drafting of the manuscript: KI, DMB, DE, YT. Critical revision of the manuscript for important intellectual content: KI, DMB, DE, YT. Statistical analysis: KI, DE, YT.

    • Funding KI was supported by the Burroughs Wellcome Fund Interschool Training Program in Chronic Diseases (BWF-CHIP), a Fellowship in Epidemiology at UCLA and Heiwa Nakajima Foundation.

    • Disclaimer Study sponsors were not involved in study design, data interpretation, writing or the decision to submit the article for publication.

    • Competing interests All authors have completed the ICMJE uniform disclosure format (available on request from the corresponding author) and declare: DMB has received consulting fees unrelated to this work from Precision Health Economics, Amgen, Novartis and HLM Venture Partners and is the Associate Chief Medical Officer of Devoted Health, which is a health insurance company.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the institutional review board (Human Research Protection Program) at University of California, Los Angeles (IRB#18-001960).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository.