An analysis of Open Payments reports found that 74.9 percent of cardiologists in the U.S. received industry-related payments in 2015, representing the highest proportion within physician specialties.

Overall, 48 percent of U.S. physicians received a total of $2.4 billion in industry payments, including approximately $1.8 billion for general payments, $544 million for ownership interests and $75 million for research payments.

Lead researcher Kathryn R. Tringale, of the University of California, San Diego School of Medicine, and colleagues published results online in JAMA on May 2.

“Although physicians may consider themselves committed to ethical practice and professionalism, many do not recognize the subconscious bias that industry relationships have on their decision making,” the researchers wrote. “Companies may preferentially market to profitable specialties such as cardiologists because these physicians influence the prescribing practices of nonspecialists. However, industry also appears to target and influence primary care physicians who accepted frequent low-value payments.”

The federal government created the Open Payments program as part as the Affordable Care Act, which was passed in 2010, according to the researchers. They noted that Open Payments requires pharmaceutical companies and group purchasing organizations to report all payments and ownership interests made to physicians starting in 2013. CMS manages the programs and makes the data available to the public.

This observational, retrospective, population-based study analyzed 933,295 physicians who were part of the 2015 CMS National Plan & Provider Enumeration System (NPPES) database and the 2015 Open Payments reports.

The researchers found that 51 percent of male physicians and 42.7 percent of female physicians received an industry payment or held ownership interests in 2015.

The median per-physician value of general payments was $201.27, while the median number of general payments was six per physician. Interventionalists such as cardiologists, gastroenterologists and anesthesiologists received the highest (9) median per-physician number of reported payments.

Although 88.7 percent of the general payments were for food and beverage, the researchers noted that the greatest proportions of value were from royalty or license payments (27.3 percent) and service fees (26.6 percent) such as faculty lectures. Only 0.4 percent of physicians held ownership interests, but ownership interests accounted for 22.8 percent of the total value of payments to physicians.

Within medical specialties, cardiologists ($862) and thoracic surgeons ($860) received the highest median per-physician value of general payments. Meanwhile, neurosurgeons (12.6 percent) and cardiologists (12.1 percent) had the highest proportion of physicians to receive a personal total value of more than $10,000.

“Surgical and interventional specialties have strong industry ties, dependence on devices and equipment, and perhaps a greater influence over industry-related expenditures,” the researchers wrote. “Industry presence in the operating room allows representatives to form relationships with proceduralists, providing device training and income-enhancing opportunity.”

After the researchers adjusted for geographic spending region and sole proprietorship, men within each specialty had a higher odds of receiving general payments than did women. Men also received more royalty or license payments than did women. The mean per-physician payment values were $5,252 among men and $2,141 among women. 

Further, 47.7 percent of primary care physicians and 61 percent of surgeons received general payments, which was a statistically significant difference. The mean per-physician payment values were $6,879 for surgeons and $2,227 for primary care physicians.

The researchers mentioned a few limitations of the study, including that the databases could have had inaccuracies and physicians could have been unaware of their reported payments. The NPPES database also did not have information on age, career duration or race/ethnicity, which could be potentially confounding variables. In addition, they did not analyze the direct association of payment receipt and drug or device use.

“A recent study found that physicians who received industry-sponsored meals were more likely to prescribe brand-name medications, with mixed findings across sexes,” the researchers wrote. “Some medical centers have restricted access of industry representatives to physicians. Further studies are needed to understand the effects of industry payments on specialty- and sex-specific prescribing or operating practices.”