On October 31, 2022, the Journal of the American Medical Association (JAMA) published a research letter, “Comparison of Industry Payments to Physicians and Advanced Practice Clinicians.” The letter used 2021 Open Payments data to characterize and compare payments to physicians and advanced practice clinicians (APCs), a group for whom industry payment data were not previously collected.
Advanced practice clinicians were defined by the study as nurse practitioners, physician assistants, certified registered nurse anesthetists, anesthesiologist assistants, certified nurse midwives and clinical nurse specialists.
According to the findings, 35.8% of advanced practice clinicians working in the United States in 2021 accepted payments from industry, compared to 35% of physicians. However, payments to physicians totaled $1.75 billion, compared to the payments made to advanced practice clinicians, which totaled $119 million. However, when looking at the median payment amounts and median number of payments, the numbers were much more equal: the median total payment for doctors was $167 and the median total payment for advanced practice clinicians was $117. The median number of interactions was four for both doctors and advanced practice clinicians.
When looking specifically at the money earned by advanced practice clinicians, nurse practitioners earned the most (about $79 million) followed by physician assistants (about $39 million). Industry spent about $69 million on food and beverage for advanced practice clinicians, $32 million on services other than consulting, and $8 million on consulting fees.
Audrey Zhang, MD, senior assistant resident in the Department of Medicine at the Duke University School of Medicine, one of the study’s authors, said that the findings raise concerns about the way industry may be influencing care of patients. “Receiving payments and developing relationships with an industry sponsor can encourage use of that sponsor’s products,” Zhang said. “The concern is when that practice affects the quality of patient care, especially if it incentivizes lower-value care.”
Parth Modi, MD, MS, of the University of Chicago, believes that “even small amounts can influence behavior” and that “the number of interactions per year is more relevant, potentially.” Modi also noted that while physician payments totaled significantly more, they were more likely to have ownership and stock payments as part of their earnings, “We see physicians who are inventors or have created a device or have intellectual property or an ownership stake in these businesses,” he said. “The data are skewed by these large-ticket items to physicians.”
Funding for the research, which was conducted by Zhang and Timothy S. Anderson, MD, MAS, came from the National Institute of Aging.