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Characteristics of Advanced Practice Nurses Receiving Top Industry Payments and Their Practice Settings: a Cross-sectional Study

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Abstract

Background

The pharmaceutical industry promotes prescribing through the cultivation of key opinion leaders. Advanced practice nurses (APNs) are a growing and influential group of prescribers across generalist and specialty practice. Public reporting of industry payments to APNs allows for exploration of their influence within practice settings.

Objective

To understand the characteristics of APNs with top industry payments including their positions of influence and other payment recipients at the same address.

Design and Setting

Cross-sectional study of US national Open Payments reports of industry payments made between January 1, 2021, and December 31, 2021.

Participants

APNs who received > $50,000 USD in industry payments for speaking, consulting, and honoraria (“personal fees”).

Measures

Description of top APN recipients’ practice setting type, clinical specialty, presence of other payment recipients, value of payments attributed to the same address, and top manufacturers and therapeutic categories associated with payments to top APN recipients. Structured content analysis of public-facing websites for evidence of APNs’ clinical, research, and teaching leadership.

Results

A total of 99 APNs received > $50,000 USD in aggregate personal fees and a median $74,080 USD (IQR $57,303–101,702) in aggregate payments. They shared a practice setting with a median of 1 (IQR 0–5) physician and 0 (IQR 0–3) other APN payment recipients and were often the only (39%, 42/109) or the dominant (45%, 30/67) payment recipient in their practice setting. In total, 36% held clinical leadership positions, 25% led scientific research, and 18% had university appointments. Forty-two percent (37/88) owned a clinical practice, including cosmetic clinics (51%, 19/37) and mental/behavioral health clinics (24%, 9/37).

Conclusions

Top APN payment recipients attracted high-value payments in practice settings and specialities associated with high-cost drug development; however, there may be little oversight of APNs’ industry relationships. Policy development related to industry relationships must be inclusive of and responsive to the activities of interprofessional providers.

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Data Availability

All data pertaining to payment records are publicly available for download from the Center for Medicare and Medicaid Services Open Payments website at: https://openpaymentsdata.cms.gov and NPPES https://download.cms.gov/nppes/NPI_Files.html

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Funding

This work was supported by the Greenwall Foundation Making a Difference Grant.

Author information

Authors and Affiliations

  1. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

    Quinn Grundy PhD RN & Dana Hart MA

  2. Office of the Deputy Vice-Chancellor (Education), University of Sydney, Sydney, NSW, Australia

    Fabian Held PhD

  3. Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, CO, USA

    Christine M. Baugh PhD, MPH, Eric Campbell PhD & Lisa Bero PhD

  4. Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Christine M. Baugh PhD, MPH & Eric Campbell PhD

  5. School of Nursing, MGH Institute of Health Professions, Boston, MA, USA

    Elissa Ladd PhD FNP-BC, FAAN

Authors
  1. Quinn Grundy PhD RN
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  2. Fabian Held PhD
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  6. Eric Campbell PhD
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  7. Lisa Bero PhD
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Corresponding author

Correspondence to Quinn Grundy PhD RN.

Ethics declarations

Ethics Approval

The University of Toronto Research Ethics Board approved the study (#42961); however, the data reported in this paper was publicly available and did not involve the recruitment or participation of human subjects.

Conflict of Interest

QG, FH, DH, CB, EL, and LB declare no conflicts of interest. EGC has served as a paid expert witness for the Arizona Attorney General’s Office on a legal case related to conflicts of interest in medicine.

Disclaimer

The Greenwall Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Grundy, Q., Held, F., Hart, D. et al. Characteristics of Advanced Practice Nurses Receiving Top Industry Payments and Their Practice Settings: a Cross-sectional Study. J GEN INTERN MED 39, 1142–1148 (2024). https://doi.org/10.1007/s11606-023-08508-6

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  • DOI: https://doi.org/10.1007/s11606-023-08508-6

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