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In 2015, American Doctors Received $2.4 Billion in Payments From the Biomedical Industry

A new analysis shows the prevalence of payments from companies that make drugs, implants, pacemakers, and other medical devices.

Almost half of America’s licensed doctors received some kind of payment from drug and medical-device companies in 2015, totaling $2.4 billion worth in gifts and grants, according to a new analysis.

Research shows that even small gifts can alter doctors’ treatment decisions to favor a company’s products. In one recent study, doctors who received relatively modest free meals from a pharmaceutical representativewere more likely to prescribe the representative’s drug. In another, newer study, doctors who worked in university medical centers that prohibited pharmaceutical representatives from bringing in free food and drug samples were less likely to prescribe the advertised drugs than doctors who worked in medical centers with no such bans.

The new analysis, published today in the Journal of the American Medical Association, looked at numbers from 2015 in Open Payments, a database maintained by the Centers for Medicare and Medicaid Services. Biomedical companies are required as part of the Affordable Care Act to report to Open Payments all the gifts and grants they give to licensed doctors. That includes everything from free bagels to speaking fees, to research grants and royalty payments for doctor-invented drugs and devices.

The study found that about 450,000 doctors received industry payments in 2015—a bit less than half of all physicians licensed to practice in the United States. The median payment received was worth $201. The most common “payments” were for free food and drinks, though the most valuable payments included stocks and partnership shares in companies: Only 3,302 licensed doctors in all of America had ownership interests in biomedical companies in 2015, but, together, their holdings were worth $544 million. Royalty and licensing payments also made up a large share of the industry money paid to doctors in 2015 — $484 million — as did speaking and other service fees, which amounted to $472 million.

The researchers — a team of doctors and health-policy researchers from the University of California–San Diego — broke down their data by specialty and gender. They found that cardiologists were the most likely to have received industry payments. Three out of four cardiologists did so, with median overall earnings worth $862. Neurosurgeons were the most likely to have earned $10,000 or more from industry payments, a threshold that the Department of Health and Human Services considers to be a significant conflict of interest. One out of every eight neurosurgeons met that threshold. (An orthopedic physician received the highest individual payment—$38 million.)

Within the specialties, men were more likely to receive payments and had higher average payments than women. Men both received more “general” payments, which includes meals and speaking fees, and were more likely to have ownership interests in companies and to receive royalties or licensing fees for products they had invented. Why the gender gap? In general, women are less likely to hold patents than men, and those who do are less likely to earn money from them. In addition, a previous study suggests female doctors are more likely to provide patient-centered care, the new study’s authors note.

As the debate about industry payments rages on, this Open Payments analysis points to other places reformers may want to investigate: certain specialties within the profession, for example, and payments like speaking and service fees.