Study Spots Sex Gap in Industry Payments to Physicians

Patrice Wendling

December 19, 2017

SAN DIEGO, CA — New research suggests male physicians across all specialties received more payments from industry and held more ownership interests in all but a few specialties than their female counterparts[1].

"A lot of this has to do not just with industry targeting certain physicians or certain specialties, but I think it really speaks to the behavior of the physicians themselves and the motivation for their interactions," coauthor Dr Kathryn Tringale (University of California, San Diego) told theheart.org | Medscape Cardiology.

It's possible, she suggests, that women may be approached to take part in these partnerships but choose not to for a variety of reasons. "Maybe they're just not interested or don't have enough time, or maybe they're more focused on their patient care or they think it's actually a conflict of interest.

"But I do think it's more complicated," she added. "Because if these payments are reflective of industry interacting with both men and women, but men are negotiating more or women aren't even being offered as much money, then that's a disparity."

The new analysis, published online December 18, 2017 in JAMA Internal Medicine, teases out gender-specific differences observed in a recent study by the investigators that linked the 2015 Centers for Medicare & Medicaid Services National Plan & Providers Enumeration System (NPPES) database with the 2015 Open Payments reports[2]. It showed that 48% of US physicians received $2.4 billion in industry-related payments, of which only $75 million were for research.

In the present analysis involving 25 medical specialties, the median difference between men and women in general payments, such as speaker and consulting fees, food and beverages, was $1470. The largest mean difference was in orthopedic surgery at $12,976.

The biggest payments were in neurosurgery, where the per-physician value reached $15,821 for men vs $3970 for women neurosurgeons.

In cardiology, total payments were $6200 for men and $2308 for women. The per-physician value of ownership interests was $2283 for male cardiologists but just $26 for female cardiologists, according to Tringale.

Overall, men held 93% of the value from ownership interests and received a higher per-physician value across most specialties, with the biggest difference seen in radiology at $5568.

Coauthor Dr Jona Hattangadi-Gluth (University of California, San Diego) pointed out in an interview that a lot of biotech leadership is male and that industry professionals she's spoken with aren't all that surprised that these leaders would reach out to male physicians they worked with in the OR 20 years earlier, before they become a chief executive.

"A lot of this might be related to devices or this OR experience that Jona was referring to," agreed Tringale. "Having these partnerships in the OR may be a popular place for these interactions to occur because neurosurgery and orthopedic surgery are pretty substantially different from a lot of these other fields."

With regard to the smaller payments, Hattangadi-Gluth said looking at the sheer number shows most of them were for food and beverages. "So it could be that perhaps female cardiologists or radiologists may not attend as many of these national conferences where they're exposed to these payments."

Bright spots where women physicians held more ownership interests than men were obstetrics and gynecology, psychiatry, and urology, with the biggest difference seen in OB/GYN at $1061.

Because years in practice is not included in Open Payments or NPPES, the two researchers also conducted a subset analysis among 63,466 California physicians. After they controlled for this potential confounder as well as physician sex, specialty group, practice spending region, sole proprietorship, and the interaction between physician sex and specialty, men were still more likely than women to hold ownership interests and to receive general payments, both in higher numbers and at greater value, than women.

In the end, what's important is to maintain transparency about these industry relationships, which research has shown can change practice and prescribing patterns, Tringale said.

"We don't want to squander innovation and not be interacting with industry," she said. "It's really important for physicians to be involved in the design and development of devices so that it's appropriate and tailored to the specialty."

She continued, "The most important thing is just awareness, in that physicians should not just report their interests in a conference with their peers but that their patients are aware of what's going on, because ultimately it's up to the patient to decide if they want to be involved."

Hattangadi-Gluth reports research funding from Varian Medical Systems; Tringale reports no relevant financial relationships.

Follow Patrice Wendling on Twitter: @pwendl. For more from theheart.org | Medscape Cardiology, follow us on Twitter and Facebook.

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