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The Association of Subspecialty and Sex with Industry Payments to Internal Medicine Physicians Who Recently Completed Training

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A Correction to this article was published on 21 February 2024

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Abstract

Background

Financial relationships with drug and medical device companies may impact quality of care and academic research. However, little is known when and how these financial relationships develop among newly independent physicians who recently completed from residency or fellowship programs in internal medicine (IM).

Objective

To compare patterns of industry payments among IM graduates.

Design

Retrospective, observational cohort study.

Subjects

IM graduates from residency or fellowship programs between January 2015 and December 2019.

Main Measures

We analyzed Open Payments reports made between July 2015 and June 2021 to recent graduates of U.S. Accreditation Council for Graduate Medical Education (ACGME)-accredited residency and fellowship programs in IM. The primary outcome was general payments accepted by these physicians, stratified by procedural (i.e., critical care medicine/pulmonary medicine, cardiac/cardiovascular disease, and gastroenterology) and non-procedural (i.e., infectious disease, general internal medicine, and other specialties) subspecialties. The secondary outcomes included general payments stratified by sex and age at residency or fellowship training completion.

Key Results

There were 41,669 IM physicians with a median age of 33.0 years. In the first 3 years after completion, the proportion of physicians accepting any general payments was 72.6%, 91.9%, and 86.8% in Critical Care Medicine/Pulmonary Medicine, Cardiac/Cardiovascular Disease, and Gastroenterology, compared to 56.1%, 52.6%, and 52.3% in Infectious Disease, General Internal Medicine, and Other Specialties (p<0.0001). After adjusting for confounding variables, the procedural group showed an increased hazard ratio (HR) for accepting any general payments and at least $5000 of general payments compared to the non-procedural group. The HRs of accepting any general payments in the procedural subspecialty were 2.26 (95% CI, 2.11–2.42) and 2.83 (95% CI, 2.70–2.97) in female and male physicians, respectively (p-value < 0.0001).

Conclusion

Industry financial relationships among newly independent physicians in IM exist immediately after completion of training and are influenced by subspecialty, sex, and age.

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References

  1. Schwartz LM, Woloshin S. Medical Marketing in the United States, 1997-2016. JAMA. 2019;321(1):80-96. https://doi.org/10.1001/jama.2018.19320

    Article  PubMed  Google Scholar 

  2. Hartung DM, Johnston K, Cohen DM, Nguyen T, Deodhar A, Bourdette DN. Industry Payments to Physician Specialists Who Prescribe Repository Corticotropin. JAMA Netw Open. 2018;1(2):e180482. https://doi.org/10.1001/jamanetworkopen.2018.0482

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mitchell AP, Winn AN, Lund JL, Dusetzina SB. Evaluating the Strength of the Association Between Industry Payments and Prescribing Practices in Oncology. Oncologist. May 2019;24(5):632-639. https://doi.org/10.1634/theoncologist.2018-0423

  4. DeJong C, Aguilar T, Tseng CW, Lin GA, Boscardin WJ, Dudley RA. Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries. JAMA Intern Med. 2016;176(8):1114-1122. https://doi.org/10.1001/jamainternmed.2016.2765

    Article  PubMed  Google Scholar 

  5. Cuomo RE, Cai M, Shah N, Mackey TK. Physicians payment in the United States between 2014 and 2018: An analysis of the CMS Open Payments database. PLoS One. 2021;16(6):e0252656. https://doi.org/10.1371/journal.pone.0252656

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Mitchell AP, Basch EM, Dusetzina SB. Financial Relationships With Industry Among National Comprehensive Cancer Network Guideline Authors. JAMA Oncol. 2016;2(12):1628-1631. https://doi.org/10.1001/jamaoncol.2016.2710

    Article  Google Scholar 

  7. Janssen SJ, Langerhuizen DWG, Kerkhoffs G, Ring D. Payments by Industry to Residency Program Directors in the United States: A Cross-Sectional Study. Acad Med. 2022;97(2):278-285. https://doi.org/10.1097/ACM.0000000000004166

    Article  PubMed  Google Scholar 

  8. Weng JK, Valle LF, Nam GE, Chu FI, Steinberg ML, Raldow AC. Evaluation of Sex Distribution of Industry Payments Among Radiation Oncologists. JAMA Netw Open. 2019;2(1):e187377. https://doi.org/10.1001/jamanetworkopen.2018.7377

    Article  PubMed  PubMed Central  Google Scholar 

  9. Haque W, Espinoza M, Hsiehchen D. Industry Payments Are Prevalent and Contagious in Subspecialty Medical Education. J Gen Intern Med. 2021;36(10):3257-3260. https://doi.org/10.1007/s11606-021-06612-z

    Article  PubMed  PubMed Central  Google Scholar 

  10. Glass HE. Open Payments and the US Clinical Landscape. Ther Innov Regul Sci. 2020;54(2):390-395. https://doi.org/10.1007/s43441-019-00067-5

    Article  PubMed  Google Scholar 

  11. Agrawal S, Brennan N, Budetti P. The Sunshine Act--effects on physicians. N Engl J Med. 2013;368(22):2054-7. https://doi.org/10.1056/NEJMp1303523

    Article  CAS  PubMed  Google Scholar 

  12. Centers for Medicare & Medicaid Services. Open Payments Data Overview. Available at: https://www.cms.gov/OpenPayments/Data. Accessed September 21, 2022.

  13. Centers for Medicare & Medicaid Services. Open Payments dataset explorer. Available at: https://openpaymentsdata.cms.gov/. Accessed September 21, 2022.

  14. Fleischman W, Ross JS. Industry support of physician education in the USA. J Epidemiol Community Health. 2017;71(3):213-216. https://doi.org/10.1136/jech-2015-206592

    Article  PubMed  Google Scholar 

  15. Han M, Hogan SO, Holmboe E, Jing Y, Yamazaki K, Trock BJ. Trends in Industry Payments to Physicians in the First 6 Years After Graduate Medical Training. JAMA Netw Open. 2022;5(10):e2237574. https://doi.org/10.1001/jamanetworkopen.2022.37574

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bergman A, Grennan M, Swanson A. Medical Device Firm Payments To Physicians Exceed What Drug Companies Pay Physicians, Target Surgical Specialists: Study examines payments medical device firms pay to physicians. Health Affairs. 2021;40(4):603-612.

    Article  PubMed  Google Scholar 

  17. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. Oct 20 2007;370(9596):1453-7. https://doi.org/10.1016/S0140-6736(07)61602-X

  18. Tringale KR, Marshall D, Mackey TK, Connor M, Murphy JD, Hattangadi-Gluth JA. Types and Distribution of Payments From Industry to Physicians in 2015. JAMA. 2017;317(17):1774-1784. https://doi.org/10.1001/jama.2017.3091

    Article  PubMed  PubMed Central  Google Scholar 

  19. Agrawal A. Interventional Pulmonology: Diagnostic and Therapeutic Advances in Bronchoscopy. Am J Ther. 2021;28(2):e204-e216. https://doi.org/10.1097/MJT.0000000000001344

    Article  PubMed  Google Scholar 

  20. Sullivan T. National Institutes of Health Final Rule on Conflict of Interest Summary. Available at: https://www.policymed.com/2011/08/national-institutes-of-health-final-rule-on-conflict-of-interest-summary.html Accessed September 21, 2022.

  21. Lo B, Field M. Institute of Medicine (US). Committee on Conflict of Interest in Medical Research E: Conflict of interest in medical research, education, and practice. Washington, DC: National Academies Press; 2009.

    Google Scholar 

  22. Almaguer AM, Wills BW, Robin JX, et al. Open Payments Reporting of Industry Compensation for Orthopedic Residents. J Surg Educ. 2020;77(6):1632-1637. https://doi.org/10.1016/j.jsurg.2020.05.010

    Article  PubMed  Google Scholar 

  23. McCormick BB, Tomlinson G, Brill-Edwards P, Detsky AS. Effect of restricting contact between pharmaceutical company representatives and internal medicine residents on posttraining attitudes and behavior. JAMA. 2001;286(16):1994-9. https://doi.org/10.1001/jama.286.16.1994

    Article  CAS  PubMed  Google Scholar 

  24. Hopper JA, Speece MW, Musial JL. Effects of an educational intervention on residents’ knowledge and attitudes toward interactions with pharmaceutical representatives. J Gen Intern Med. 1997;12(10):639-42. https://doi.org/10.1046/j.1525-1497.1997.07126.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Robin JX, Murali S, Paul KD, et al. Disparities Among Industry’s Highly Compensated Orthopaedic Surgeons. JB JS Open Access. 2021;6(4) https://doi.org/10.2106/JBJS.OA.21.00015

  26. Buerba RA, Arshi A, Greenberg DC, SooHoo NF. The Role of Gender, Academic Affiliation, and Subspecialty in Relation to Industry Payments to Orthopaedic Surgeons. J Natl Med Assoc. 2020;112(1):82-90. https://doi.org/10.1016/j.jnma.2019.09.004

    Article  PubMed  Google Scholar 

  27. Inoue K, Blumenthal DM, Elashoff D, Tsugawa Y. Association between physician characteristics and payments from industry in 2015-2017: observational study. BMJ Open. 2019;9(9):e031010. https://doi.org/10.1136/bmjopen-2019-031010

    Article  PubMed  PubMed Central  Google Scholar 

  28. Weiss A, Parina R, Tapia VJ, et al. Assessing the domino effect: Female physician industry payments fall short, parallel gender inequalities in medicine. Am J Surg. 2018;216(4):723-729. https://doi.org/10.1016/j.amjsurg.2018.07.031

    Article  PubMed  Google Scholar 

  29. Stone AT, Carlson KM, Douglas PS, Morris KL, Walsh MN. Assessment of Subspecialty Choices of Men and Women in Internal Medicine From 1991 to 2016. JAMA Intern Med. 2020;180(1):140-141. https://doi.org/10.1001/jamainternmed.2019.3833

    Article  PubMed  Google Scholar 

  30. Zhuge Y, Kaufman J, Simeone DM, Chen H, Velazquez OC. Is there still a glass ceiling for women in academic surgery? Ann Surg. 2011;253(4):637-43. https://doi.org/10.1097/SLA.0b013e3182111120

    Article  PubMed  Google Scholar 

  31. Weiss A, Lee KC, Tapia V, et al. Equity in surgical leadership for women: more work to do. Am J Surg. 2014;208(3):494-8. https://doi.org/10.1016/j.amjsurg.2013.11.005

    Article  PubMed  Google Scholar 

  32. Wright K, Meyers DE, Chisamore TM, et al. Industry Relationships With Medical Oncologists: Who Are the High-Payment Physicians? JCO Oncol Pract. 2022;18(7):e1164-e1169. https://doi.org/10.1200/OP.21.00756

    Article  PubMed  Google Scholar 

  33. Ngaage LM, Harris C, Landford W, et al. Follow the money: Investigating gender disparity in industry payments among senior academics and leaders in plastic surgery. PLoS One. 2020;15(12):e0235058. https://doi.org/10.1371/journal.pone.0235058

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Fazendin JM, Corey BL, Heslin MJ, Chen H. Analysis of Open Payments Receipts Among Surgical Faculty at a Large Academic Institution. J Surg Res. 2019;244:599-603. https://doi.org/10.1016/j.jss.2019.08.012

    Article  PubMed  Google Scholar 

  35. Storino A, Vigna C, Polanco-Santana JC, et al. Disparities in industry funding among Colorectal Surgeons: a cross-sectional study. Surg Endosc. 2022;36(9):6592-6600. https://doi.org/10.1007/s00464-022-09062-8

    Article  PubMed  Google Scholar 

  36. Rachel EY. DOJ Announces the First Open Payments Program / Sunshine Act Enforcement Action. Available at: https://www.mintz.com/insights-center/viewpoints/2146/2020-11-03-doj-announces-first-open-payments-program-sunshine-act#:~:text=On%20October%2029%2C%202020%2C%20the,device%20manufacturer%20Medtronic%20USA%20Inc Accessed October 27, 2022.

  37. Sullivan T. Medicrea Agrees to $2 Million Settlement Over Kickbacks and Open Payment Violations. Available at: https://www.policymed.com/2021/06/medicrea-agrees-to-2-million-settlement-overkickbacks.html. Accessed 22 October 2022.

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Authors and Affiliations

  1. James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Yong Hyun Park MD, PhD, Andrew Gabrielson MD, Yuezhou Jing, Bruce J. Trock PhD & Misop Han MD, MS

  2. Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Yong Hyun Park MD, PhD

  3. Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA

    Paul O’Rourke MD, MPH

  4. Accreditation Council for Graduate Medical Education (ACGME), Chicago, IL, USA

    Sean O. Hogan PhD, Eric Holmboe MD & Kenji Yamazaki PhD

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  1. Yong Hyun Park MD, PhD
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Contributions

PO, SOH, EH, KY, BJT, and MH participated in the conception and design of the study and contributed to the writing of the protocol. YJ and BJT have full access to all the data in the study and led the statistical analysis and prepared results. All authors contributed to the interpretation of the results. YHP, AG, and MH led the writing of the initial drafts of the manuscript on which all authors commented, and all authors agreed with the decision to submit for publication.

Corresponding author

Correspondence to Yong Hyun Park MD, PhD.

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Park, Y.H., O’Rourke, P., Gabrielson, A. et al. The Association of Subspecialty and Sex with Industry Payments to Internal Medicine Physicians Who Recently Completed Training. J GEN INTERN MED 39, 45–51 (2024). https://doi.org/10.1007/s11606-023-08351-9

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