Doctors who are male or graduates of top-ranked medical schools tend to receive more money from drug and medical device companies than their peers, a UCLA study found.
Researchers from the UCLA Fielding School of Public Health linked physician profiles to financial disclosures to determine what types of doctors received industry payments. They published their findings in September in the medical journal BMJ Open.
Pharmaceutical and medical device companies provide payments to doctors and teaching hospitals. These payments can be relatively small offerings such as lunch during meetings, but they may also be larger payments such as speaking and consulting fees, research grants or royalties from treatments doctors helped develop.
Kosuke Inoue, a graduate student in public health and co-author of the paper, said he thinks the financial relationship between physicians and industry in the United States can be concerning if it leads to doctors inappropriately prescribing drugs to their patients.
For example, the pharmaceutical industry marketing their products to physicians might have contributed to the opioid overdose crisis, Inoue said.
In 2017, nearly 50,000 people in the U.S. died from an opioid overdose, and an estimated 1.7 million people had substance use disorders related to prescription opioids, according to the National Institute on Drug Abuse.
There is ample evidence showing that financial ties between industry and physicians impact the prescription patterns of drugs, which might lead to higher healthcare spending in the U.S., said Yusuke Tsugawa, an assistant professor of medicine and co-author of the paper.
Tsugawa said the researchers wanted to investigate how industry payments were distributed among physicians. The researchers found that payments were concentrated among a small number of physicians.
Roughly 90% of the total amount of industry payments went to 5% of physicians paid, he added.
Drug companies might want to create ties with physicians who have a lot of patients to whom they might be able to prescribe medications, Tsugawa said.
“The industry is not paying equal amounts to all physicians,” he said. “They are highly targeting a small number who might be influential.”
On average, male physicians are paid roughly 2 1/2 times more than female physicians are by industry, according to the study.
Medical companies might target male doctors because they perceive them to be more vocally influential in their recommendations of drug prescriptions or medical devices, Tsugawa said. He added he thinks it is possible male doctors might be more willing to interact with industries than female doctors.
Companies could also target graduates of top-20 ranked U.S. medical schools, Tsugawa said. When those physicians speak at conferences, they can influence how other doctors nationwide practice medicine, he added.
Inoue said physicians with more years of experience could also influence other doctors within the same hospital. For example, if a senior physician says one drug has benefits over another, then junior physicians might learn to prescribe that drug to their patients. The researchers found that more experienced physicians were paid more by industry.
Tsugawa said concerns about physicians’ financial conflicts of interest led to the Physician Payments Sunshine Act, a part of the Affordable Care Act which requires medical product manufacturers to publicly report all payments they make to physicians and teaching hospitals.
However, an unintended consequence of this financial transparency could be patients mistrusting their doctors because of industry ties, he said.
“Most physicians are not receiving money,” Tsugawa said. “The relationships are more subtle, like getting food or reimbursement for traveling to conferences.”
Inoue said the researchers did not look at patient outcomes or investigate whether the industry payments were inappropriate.
“If (payments) affect inappropriate or biased prescriptions, then it would be problematic,” Inoue said. “Whether this is appropriate or inappropriate is the next research question.”