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).