Study setting, participants, and payment collection
This serial cross-sectional study examined the magnitude and trends in
industry payments to endocrinologists since the inception of the Open
Payments Database. Starting August 1, 2013, the Sunshine Act mandated
all pharmaceutical manufacturers, medical device manufacturers, and
group purchasing organizations to disclose financial transfers to
physicians in the Open Payments Database, which include three major
types: general, research, and ownership payments. General payments
included acquisitions (since 2021), charitable contributions, speaker
fees, consulting fees, debt forgiveness (since 2021), education,
entertainment, food and beverages, gifts, honoraria, long-term medical
supply or device loans (since 2021), royalties and licenses, and travel
and lodging. All categories of
general payments were considered in this study, as this study aimed to
evaluate overall size of the endocrinologists-industry financial
relationships.
As
the 2013 data are partial disclosure of payments between August and
December 2013, this study considered general and research payments
provided to endocrinologists between 2014 and 2022.
The analyses did not include data
from ownership and investment payment files that are separately
disclosed from the general payment files in the Open Payments, as these
datasets contain information of status of ownership interests or stocks
of healthcare companies hold by physicians each year. Therefore, these
datasets do not indicate the transfer of payments. Meanwhile, general
payment files contain information of transfer of payments made to
physicians by healthcare industry including payments for ownership
interests. Research payments include research costs such as medication
supply and equipment used in clinical trials. Detailed definitions of
each payment category and variables used for analysis in this study are
described in Supplemental Material 1 and available on the Open Payments
Database webpage (13).
This study defined
endocrinologists as physicians whose primary specialty was “Allopathic
& Osteopathic Physicians|Internal
Medicine|Endocrinology, Diabetes & Metabolism” (health care
provider taxonomy code: 207RE0101X) in the National Plan and Provider
Enumeration System (NPPES) and extracted National Provider Identifier
(NPI) numbers for all physicians classified as endocrinologists from the
NPPES database which was last updated on April 9, 2023. All general and
research payments data were downloaded from the Open Payments Database
between 2014 and 2022 (14) and extracted all general and research
payments they received between January 2014 and December 2022 matching
their NPI number. Payment datasets in 2014-2015 were archived as of July
2023, but were downloadable from the Open Payments Database webpage
(14).
Before data analysis, the
contents and nature of individual general payments over $100,000 were
checked by the corresponding author to exclude potential errors in these
large payments. Three consulting fees and two compensation fees were
recategorized as ownership payments, as these payments were made to an
endocrinologist as registered stock units for compensations
(Supplemental Material 2). The study excluded 2013 payments from this
study, as these payments only represented August-December. Most research
payments came indirectly via teaching hospitals and other third parties.
Including only direct research payments to individual physicians leads
to underestimating their magnitude (15,16); therefore, both associated
research payments and direct research payments were included in this
study (17-19). Associated research payments include any funding for
research where the physician is a primary investigator. Direct research
payments are those provided directly to the recipient.
Of
9164 active endocrinologists registered in the NPPES, 1162 were newly
activated after January 2014 and were excluded from the study sample.
Therefore, 8002 endocrinologists were included in this study.
The NPPES database only includes
information for active physicians and does not include physicians who
are currently deactivated due to death or retirement: thus,
endocrinologists who were deactivated as of April 9, 2023, were not
included in this study.