Figure 1. General payments excluding ownership and royalties to top 10%
(1A) and the other 90% (1B) of endocrinologists by categories.
Legend: Non-CME related speaking fees included “compensation for
services other than consulting, including serving as faculty or as a
speaker at a venue other than a continuing education program.” CME
speaking payments included “compensation for serving as faculty or as a
speaker for an accredited or certified continuing education program”
(applicable to program years 2013-2020), “compensation for serving as
faculty or as a speaker for an unaccredited and non-certified continuing
education program” (applicable to program years 2013-2020), and
“compensation for serving as faculty or as a speaker for medical
education program” (applicable beginning with program year 2021 and
subsequent program years). General payments for ownership interests and
royalties/licenses were excluded from the figure.
Supplemental Materaial 1. Terminology of the Open Payments Database used in this study.
| Variables | Content, definition, and example |
| Payment types | |
| Associated research payment | Associated research payment is a research payment whose recipient is recorded as either an individual physician/nurse practitioner or a teaching hospital/institution for research where an endocrinologist serves as a principal investigator. |
| Direct research payment | Direct research payment is a research payment whose recipient is record as an individual endocrinologist. |
| General payments | General payment is a payment for non-research, non-ownership purposes. |
| Types of general payments | |
| Acquisition | Acquisition payment is a buyout payment made to covered recipients who have ownership interest in a company that has been acquired. This payment category was introduced into the Open Payments Database in 2021. |
| Charitable contribution | Charitable contribution is a payment or transfer of value made to an organization with tax-exempt status under the Internal Revenue Code of 1986. |
| Consulting fee | Consulting fee is a payment that a company makes to a physician or nurse practitioner for advice and expertise about a medical product or treatment. Consulting fees are typically arranged with a written agreement between a company and physician based on the company’s particular business needs. |
| Non-CME related speaking fee | Non-CME related speaking fees includes “compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program.” This payment is a payment that a company makes to physicians or nurse practitioners for speaking, training, and education engagements that are not for continuing education. |
| CME related speaking fee (CME speaking payment) | CME related speaking fee includes “compensation for serving as faculty or as a speaker for an accredited or certified continuing education program” (applicable to program years 2013-2020), “compensation for serving as faculty or as a speaker for an unaccredited and non-certified continuing education program” (applicable to program years 2013-2020), and “compensation for serving as faculty or as a speaker for medical education program” (applicable beginning with program year 2021 and subsequent program years). This payment is typically a compensation for serving as faculty or as a speaker for medical education program. |
| Current or prospective ownership or investment interest | This payment includes ownership or investment interest currently or potentially held by physicians and teaching hospitals. |
| Debt forgiveness | This payment type includes forgiving the debt of a covered physicians, physician owner, or the immediate family of the physicians, such as money for drugs, medical devices, and medical supplies. For example, in this study, there was a debt forgiveness payment for to one endocrinologist for write-off of open accounts receivable. |
| Education fee | Education fee is a financial transfer for educational activities, classes, events, or materials including textbooks. |
| Entertainment | Entertainment fee includes a cost for attendance at recreational, cultural, sporting or other events. |
| Food and beverage | Food and beverage fee is a cost for lunch or dinner meal offered at industry-sponsored educational or marketing events. |
| Gift | Gift is any item that does not fit into another payment category such as clocks or stationery. |
| Grant | Grant is a payment to support a specific purpose or activity not related to research. |
| Honoraria | Honoraria is a payment for a brief, one-time activity, similar to a consulting fee, but are generally provided for services without a set price. |
| Long-term medical supply or device loan | This payment includes the loan of supplies or a device for 91 days or longer. |
| Royalty or license | Royalty or license is a payment based on sales of medications or medical devices that use a physician’s intellectual property. |
| Travel and lodging | Travel and lodging fee is any compensation for costs associated with travel, such as hotel fees, airfare, mileage, and taxi fare. |
The definition of payment categories was based on the nature of payments published on the Open Payments Database webpage (
https://www.cms.gov/OpenPayments/Natures-of-Payment). Definition and content of each variable is detailly described in the Open Payments Methodology Overview & Data Dictionary (https://www.cms.gov/OpenPayments/Downloads/OpenPaymentsDataDictionary.pdf).
Supplemental Material 2. General payments more than $100,000 made to endocrinologists between 2014 and 2022.
| Anonymized endocrinologist name | Company name making payments | Actual payment amounts, $ | Inflation-adjusted amount, $ | Payment categories listed in the Open Payments Database | Detailed payment content available from the Open Payments Database | Change in payment categories in this study | Payment year |
| Endocrinologist A | Dexcom, Inc. | 232,498 | 287,416 | Current or prospective ownership or investment interest | Annual stock grant to member of Dexcom Board of Director | No change | 2014 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,485,149 | 1,835,953 | Royalty or License | No information | No change | 2014 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,477,915 | 1,827,011 | Royalty or License | No information | No change | 2014 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,627,835 | 2,012,343 | Royalty or License | No information | No change | 2014 |
| Endocrinologist A | Dexcom, Inc. | 324,344 | 400,481 | Consulting Fee | Compensations to member of Dexcom Board of Director | Changed payment category to “current or prospective ownership or investment interest”a | 2015 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,407,050 | 1,737,345 | Royalty or License | No information | No change | 2015 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,695,981 | 2,094,100 | Royalty or License | No information | No change | 2015 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,826,075 | 2,254,733 | Royalty or License | No information | No change | 2015 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,734,921 | 2,142,181 | Royalty or License | No information | No change | 2015 |
| Endocrinologist A | Dexcom, Inc. | 327,319 | 399,119 | Consulting Fee | Compensations to member of Dexcom Board of Director | Changed payment category to “current or prospective ownership or investment interest”a | 2016 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,653,615 | 2,016,352 | Royalty or License | No information | No change | 2016 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,720,480 | 2,097,885 | Royalty or License | No information | No change | 2016 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,505,772 | 1,836,079 | Royalty or License | No information | No change | 2016 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,527,523 | 1,862,601 | Royalty or License | No information | No change | 2016 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,518,822 | 1,813,360 | Royalty or License | No information | No change | 2017 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,569,575 | 1,873,955 | Royalty or License | No information | No change | 2017 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,231,477 | 1,470,292 | Royalty or License | No information | No change | 2017 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,445,452 | 1,725,762 | Royalty or License | No information | No change | 2017 |
| Endocrinologist A | Dexcom, Inc. | 304,364 | 363,387 | Compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program | Resistered stock unit grant to member of Dexcom Board of Director | Changed payment category to “current or prospective ownership or investment interest”a | 2017 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 1,145,872 | 1,335,467 | Royalty or License | No information | No change | 2018 |
| Endocrinologist B | AstraZeneca Pharmaceuticals LP | 326,541 | 380,570 | Royalty or License | No information | No change | 2018 |
| Endocrinologist A | Dexcom, Inc. | 332,562 | 387,587 | Consulting Fee | Resistered stock unit grant to member of Dexcom Board of Director | Changed payment category to “current or prospective ownership or investment interest”a | 2018 |
| Endocrinologist D | Boehringer Ingelheim Pharmaceuticals, Inc. | 116,888 | 136,229 | Consulting Fee | No information | No change | 2018 |
| Endocrinologist A | Dexcom, Inc. | 331,025 | 378,930 | Compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program | Resistered stock unit grant to member of Dexcom Board of Director | Changed payment category to “current or prospective ownership or investment interest”a | 2019 |
| Endocrinologist C | Medtronic MiniMed, Inc. | 281,645 | 318,475 | Royalty or License | No information | No change | 2020 |
| Endocrinologist A | Dexcom, Inc. | 333,116 | 376,676 | Current or prospective ownership or investment interest | No information | No change | 2020 |
| Endocrinologist A | Dexcom, Inc. | 307,881 | 332,520 | Current or prospective ownership or investment interest | No information | No change | 2021 |
| Endocrinologist A | Dexcom, Inc. | 311,268 | 311,268 | Grant | No information | No change | 2022 |
a Five general payments of consulting fees and compensation were paid to endocrinologists as registered stock units in return for their membership on the board of directors of the company. Therefore, this study classified these payments as ownership payments in this study, as the compensations were made in the form stocks.
Supplemental Material 3. Industry payments by payment categories between 2014 and 2022.
| Payment categories | Monetary amounts, $ (%) | Payment contracts, no (%) | Number of physicians with payments, no (%) |
| General payments | 649,638,180 (31.5) c | 2,474,513 (88.4) c | 6882 (86.0) |
| Non-CME related speaking feesa | 412,987,384 (67.2) d | 212,242 (8.6) d | 2466 (30.8) |
| Consulting fees | 74,392,858 (12.1) d | 25,943 (1.0) d | 2253 (28.2) |
| Travel and lodging | 64,588,533 (10.5) | 186,509 (7.5) | 2615 (32.7) |
| Food and beverage | 52,035,242 (8.5) | 2,001,252 (80.9) | 6758 (84.5) |
| Royalty or license | 31,022,822 (not calculated)e | 48 (not calculated) e | 13 (0.2) |
| Honoraria | 6,027,916 (1.0) | 2,557 (0.1) | 559 (7.0) |
| CME related speaking feesb | 3,024,745 (0.5) | 1,917 (0.1) | 335 (4.2) |
| Current or prospective ownership or investment interest | 2,935,713 (not calculated)d,e | 13 (not calculated) d,e | 2 (0.02) |
| Education | 1,264,534 (0.2) | 41,465 (1.7) | 5040 (63.0) |
| Grant | 1,150,106 (0.2) | 142 (0.01) | 102 (1.3) |
| Gift | 163,406 (0.03) | 2,363 (0.1) | 965 (12.1) |
| Acquisitions | 20,265 (0.003) | 3 (0.0001) | 3 (0.04) |
| Long-term medical supply or device loan | 12,524 (0.002) | 6 (0.0002) | 6 (0.1) |
| Charitable contribution | 5,783 (0.001) | 5 (0.0002) | 5 (0.1) |
| Debt forgiveness | 5,568 (0.001) | 24 (0.001) | 24 (0.3) |
| Entertainment | 781 (0.0001) | 24 (0.001) | 15 (0.2) |
| Research payments | 1,414,033,684 (68.5) c | 324,673 (11.6) c | 1336 (16.7) |
| Associated research payments | 1,378,868,832 (97.5) | 313,068 (96.4) | 1220 (15.3) |
| Direct research payments | 35,164,852 (2.5) | 11,605 (3.6) | 611 (7.6) |
aNon-CME related speaking fees included “compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program.”
bCME speaking payments included “compensation for serving as faculty or as a speaker for an accredited or certified continuing education program” (applicable to program years 2013-2020), “compensation for serving as faculty or as a speaker for an unaccredited and non-certified continuing education program” (applicable to program years 2013-2020), and “compensation for serving as faculty or as a speaker for medical education program” (applicable beginning with program year 2021 and subsequent program years).
c The proportion of geneal payments and research payments to all industry payments to the endocrinologists.
d Five general payments of consulting fees and compensation were paid to endocrinologists as registered stock units in return for their membership on the board of directors of the company. Therefore, this study classified these payments as ownership payments in this study, as the compensations were made in the form stocks.
e General payments for ownership and royalties/licenses were not included in the calculation of percentage share of each payment relative to the total general payments.
Supplemental Material 4. Annual average consumer price index values between 2014 and 2022 used in this study
| Payment year | Annual average consumer price index (CPI) | Relative annual average CPI value |
| 2022 | 292.655 | 1.00 (reference) |
| 2021 | 270.97 | 0.925902513198135 |
| 2020 | 258.811 | 0.884355298901437 |
| 2019 | 255.657 | 0.873578103910748 |
| 2018 | 251.107 | 0.858030787104270 |
| 2017 | 245.12 | 0.837573251781108 |
| 2016 | 240.007 | 0.820102168081871 |
| 2015 | 237.017 | 0.809885359894757 |
| 2014 | 236.736 | 0.808925184944730 |
Supplemental Material 5. Annual trends in number of physicians receiving payments and payments per physician since the inception of the Open Payments Database before and during the COVID-19 pandemic
| Variables | Relative annual mean percentage change (95% confidence interval), % |
| Number of endocrinologists receiving payments a | Payments per physician |
| Overall (N = 8002) a | $0.01–$500 (n = 1332) | $500–$1,000 (n = 543) | $1,000–$10,000 (n = 2528) | $10,000–$100,000 (n = 1534) | $100,000–$500,000 (n = 584) | $500,000– (n = 361) |
| General payments b | | | | | | | | |
| Pre-interruption trend since the inception of the Open Payments Database (2014-2019) | -0.03 (-0.3 to 0.3) | -4.4 (-5.7 to -3.3)*** | -4.3 (-6.9 to -1.5)** | -5.6 (-8.9 to -2.2)** | -6.3 (-7.8 to -4.7)*** | -10.1 (-12.1 to -8.0)*** | -9.6 (-11.7 to -7.5)*** | -1.9 (-3.5 to -0.2)* |
| Level change by the COVID-19 pandemic (2014-2019 vs 2020-2022) | -24.4 (-26.1 to -22.7)*** | -56.0 (-58.7 to -53.0)*** | -75.6 (-81.5 to -67.8)*** | -75.5 (-82.5 to -65.8)*** | -61.9 (-66.0 to -57.3)*** | -45.5 (-52.9 to -36.8)*** | -56.4 (-61.4 to -50.7)*** | -56.8 (-60.3 to -53.0)*** |
| Post-interruption trend since the COVID-19 pandemic (2020-2022) | 2.9 (1.8 – 3.9)*** | 8.0 (4.8 – 11.2)*** | 40.3 (24.8 – 57.6)*** | 41.3 (22.2 –63.4)*** | 28.9 (22.5 –35.7)*** | 20.0 (11.5 –29.2)*** | 15.3 (7.5 – 23.7)*** | 3.8 (0.1 – 7.6)* |
| Direct research payments | | | | | | | | |
| Pre interruption trend since the inception of the Open Payments Database (2014-2019) | -0.7 (-3.6 to 2.3) | 6.6 (-4.7 to 19.2) | – | – | – | – | – | – |
| Level change by the COVID-19 pandemic (2014-2019 vs 2020-2022) | -21.8 (-34.7 to -6.2)** | -25.9 (-59.8 to 36.7) | – | – | – | – | – | – |
| Post interruption trend since the COVID-19 pandemic (2020-2022) | 2.7 (-5.8 to 11.9) | -15.4 (-37.9 to 15.2) | – | – | – | – | – | – |
| Associated research payments | | | | | | | | |
| Pre interruption trend since the inception of the Open Payments Database (2014-2019) | -3.5 (-4.8 to -2.2)*** | -0.2 (-4.1 to 4.1) | – | – | – | – | – | – |
| Level change by the COVID-19 pandemic (2014-2019 vs 2020-2022) | -9.5 (-16.1 to -2.4)** | -13.7 (-35.0 to 14.6) | – | – | – | – | – | – |
| Post interruption trend since the COVID-19 pandemic (2020-2022) | -0.8 (-4.6 to 3.0) | -4.6 (-18.7 to 11.9) | – | – | – | – | – | – |
*p<0.05. **p<0.01. p<0.001.
a Endocrinologists who were activated before January 2014 were included in the trend analyses and this study excluded endocrinologists who were deactivated and newly activated after 2014 to remove new or retired endocrinologists in the trend analyses.
b This study excluded the payments for acquisitions, debt forgiveness, long-term medical supply or device loans, ownership interests, and royalties and licenses in the trend analysis of general payments, because this study observed substantial amounts of general payments for royalties and license in several years or these payment categories were newly-added in 2021.