General payments
General payments, including those payments for ownership interests and
royalties, accounted for 31.5% of all industry payments, totaling
$649.6 million over nearly nine years.
Total amounts of GPEOR were
$617.2 million over the study period. A total of 6882 endocrinologists
(86.0% of all NPPES-registered endocrinologists) received one or more
GPEOR during that period.
Table 1 shows yearly breakdown of GPEOR between 2014 and 2022. The
annual number of endocrinologists accepting GPEOR peaked at 5437
(68.0%) in 2016 and has gradually declined since then, reaching 4043
(50.5%) in 2021. Among
endocrinologists who received GPEOR each year, annual median
per-physician GPEOR decreased from $984 (interquartile range [IQR]:
$213–$5,444) in 2014 to $438 (IQR: $96–$1,896) in 2022. Annual
mean GPEOR ranged from $8,423 (standard deviation [SD]: $28,493)
to $17,853 (SD: $57,001). The
Gini index for per-physician annual GPEOR was 0.915-0.941, indicating
only a few endocrinologists received substantial GPEOR.
Only top 1%, 5%, and 10% of
all endocrinologists received 29.1%-38.3%, 71.6%-85.8%, and
90.0%-94.4% of all GPEOR each year.
Of payment categories of GPEOR,
non-CME related speaking payments were the largest ($413.0 million:
67.2%) in aggregate monetary value over the nine-year period
(Supplemental Material 3).
Payments for food and beverages
were the most common, comprising 80.9% (2.0 million) of nine-year total
number of GPEOR (Supplemental material 3). A total of 84.5% of all
endocrinologists received one or more food and beverage payments. Of the
nine-year total GPEOR paid to the top 10% of endocrinologists,
non-CME-related speaking payments accounted for the largest share in
monetary value ($386.9 million 71.8%), followed by consulting fees
($60.9 million: 11.3%) and travel and lodging expenses ($58.1
million: 10.8%) (Figure 1A). On the other hand, food and beverage
($27.2 million: 35.5%) and non-CME related speaking payments ($26.1
million: 34.1%) accounted for the largest percentage of the total GPEOR
paid to the other 90% endocrinologists over the 9-year period (Figure
1B).