Anju Murayama1,*
Affiliations:
1 School of Medicine, Tohoku University, Sendai City,
Miyagi, Japan
*Correspondence:
Anju Murayama
Tohoku University School of Medicine, 2-1 Seiryo machi, Aoba Ward,
Sendai, Miyagi 980-0872, Japan
Telephone: +81-22-717-8006
Email address:ange21tere@gmail.com
Twitter summary
Using the 2014-2022 Open Payments Database, this study found 50.5% to
68.0% of endocrinologists in the US received general payments from the
healthcare industry each year.
Abstract
Objective: This study aimed to evaluate industry payments to
endocrinologists and their institutions between 2014 and 2022.
Research Design and Methods: This serial cross-sectional study examined
general and research payments (direct to individuals or associated
research payments to institutions) made to endocrinologists registered
in the National Plan and Provider Enumeration System in the United
States, using the Open Payments Database between 2014 and 2022. Payment
data were analyzed descriptively. Trends were evaluated by generalized
estimating equations.
Results: Among 8002 active endocrinologists, 50.5% to 68.0% annually
received general payments excluding those for ownership interests and
royalties (GPEOR) between 2014 and 2022. The annual median GPEOR per
physician declined from $984 in 2014 to $438 in 2022. Only top 10% of
endocrinologists annually received 90.0% to 94.4% of all GPEOR.
Despite 68.5% of all payments being for research, only 1.6% to 3.0%
of endocrinologists directly received these annually, while 6.0% to
9.3% did through their institutions. Per-physician GPEOR decreased
between 2014 and 2019, with a relative annual change of -4.4% (95%
confidence interval [CI]: -5.7% to -3.3%). The number of
endocrinologists receiving research payments decreased by 3.5% (95%
CI: -4.8% to -2.2%) between 2014 and 2019. Both GPEOR and research
payments were significantly lower in 2020-2022 compared to 2014-2019 in
the number of endocrinologists receiving payments and/or payment
amounts.
Conclusions: Majority of endocrinologists accepted general payments from
the healthcare industry, while less than 10% of endocrinologists
received research payments (personally or to their institution) in the
United States.
Highlights
• This study examined industry payments to endocrinologists and their
institutions using the Open Payments Database from 2014 to 2022.
• Findings showed that 50.5%-68.0% of endocrinologists accepted
non-research payments each year between 2014 and 2022, while less than
10% of endocrinologists received research payments annually.
• Median per-physician annual payments varied, with $438-$984 in
general, $1710-$4956 in direct research, and $40,300-$73,161 in
associated research.
• There was a decreasing trend in per-physician general payments between
2014 and 2019, with a relative annual change of -4.4% (95% confidence
interval: -5.7% to -3.3%, p<0.001).
Introduction
Financial collaborations between physicians and the healthcare industry
can improve patient care through developing and implementing novel
medications and medical devices and fostering research to combat
diseases (1). However, these relationships might also negatively impact
patient care, as evidenced by various medical scandals involving
clinical trials and guideline recommendations (2,3). Increasing public
demand for greater transparency in physician-industry relationships led
the United States (US) to enact the 2010 Physician Payment Sunshine Act
(4), mandating that pharmaceutical and medical device companies report
all financial transfers made to physicians and teaching hospitals since
2013. The reported data is publicly disclosed under a federal
transparency database, the Open Payments Database.
Endocrinology attracts substantial attention from pharmaceutical and
medical device manufacturers due to the large and growing population of
persons with obesity and diabetes (5,6), the development of novel
medications for diabetes and endocrinological diseases, and expansion of
indications for certain of these medications over the last decade (7).
Conflicts of interest are common among the Endocrine Society guideline
authors (8). Irwig et al. reported that 74.3% of the Society’s
clinical-practice guideline authors received about $5.5 and $30.9
million in general and research payments, respectively, from
pharmaceutical companies. Liu et al. reported that in 2014 the editors
of Diabetes Care, an official journal of the American Diabetes
Association, received the highest median personal payments from
healthcare industries ($19,618) of 52 US medical journals (9). While
editors must declare any financial conflicts of interest, to the
American Diabetes Association and their academic institutions, that
information may not be readily available to the public. Studies have
identified positive associations between payment amounts from
pharmaceutical companies marketing diabetes medications and increases in
physicians’ prescriptions in the US and other developed countries
(10-12).
Prior studies have not investigated the overall picture of financial
relationships between the healthcare industry and endocrinologists since
the establishment of the Open Payments Database in the US. This study
aimed to shed light on the magnitude, prevalence, and trends in
physician-industry financial relationships in endocrinology in the US.
Research Design and Methods