Medical specialists that get the most industry money

The Physician Payments Sunshine Act, passed under the Affordable Care Act, has garnered its share of controversy, but the physician-reported data about payments received from companies in the form of gifts, meals or consulting fees is part of a new era of transparency affecting several stakeholders in various ways.

One of the most recent analyses of the data, published in Mayo Clinic Proceedings, looks at how industry payments have been distributed by physician specialty, a perspective that hasn't been widely studied thus far.

Indeed, researchers' review of 2.4 million physician payments totaling $475 million made during the last five months of 2013 revealed distinct patterns. The team found that while primary care physicians--including internists and family physicians--were the target of half of the total payments, the value of the payments was lower compared to those of other specialties. The highest-value payments, on average, went to doctors performing orthopedic surgery and neurosurgery. Meanwhile, specialties involving high levels of intervention, including cardiology, gastroenterology and dermatology had the highest proportion of physicians receiving payments.

"During the last few decades, physicians have become much more engaged in the development of novel drugs and devices, which is critical to bringing innovation to patients," Hattangadi-Gluth, M.D., chief of the central nervous system tumor service at UC San Diego Health, said in a study announcement. "Certain specialties, like surgery, may require more research and involvement in device development, resulting in higher royalty and license payments. Our study not only identified how industry payments are distributed by specialty, it also helped put those payments in context."

However, just putting the data into context doesn't fully answer the questions of how payments--and physicians' reporting of them--influences decision-making, costs and utilization, the researchers noted.

Unintended consequences of physician reporting could include industry shifting of funds toward direct-to-consumer advertising and payers, the authors noted, or giving physicians a feeling of 'moral license' after having disclosed industry relationships.

The authors concluded that "the implications of these payments are complex, and the prevalence and magnitude of payments seen in these data increase the need for further research into the effect of these payments, both beneficial and problematic."

To learn more:
- see the study
- read the announcement