- Email: [email protected]
Analysis of Open Payments Receipts Among Surgical Faculty at a Large Academic Institution
j o u r n a l o f s u r g i c a l r e s e a r c h d e c e m b e r 2 0 1 9 ( 2 4 4 ) 5 9 9 e6 0 3
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Association for Academic Surgery
Analysis of Open Payments Receipts Among Surgical Faculty at a Large Academic Institution Jessica M. Fazendin, MD,a Britney L. Corey, MD,b Martin J. Heslin, MD,b and Herbert Chen, MD, FACSb,* a b
Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
article info
abstract
Article history:
Background: Section 6002 of the Affordable Care Act, commonly referred to as “The
Received 27 February 2019
Sunshine Act,” is legislation designed to provide transparency to the relationship be-
Received in revised form
tween physicians and industry. Since 2013, medical product and pharmaceutical man-
1 August 2019
ufacturers were required to report any payments made to physicians to the Centers for
Accepted 19 August 2019
Medicare and Medicaid Services (CMS). We predicted that most clinical faculty at our
Available online 16 September 2019
institution would be found on the Open Payments website. We elected to investigate payments in relationship to divisions within the department of surgery and the level of
Keywords:
professorship.
Open payments
Methods: All clinical faculty (n ¼ 86) within the department of surgery at our institution
Conflict of interest
were searched within the database: https://openpaymentsdata.cms.gov/. The total amount
Sunshine act
of payments, number of payments, and the nature of payments (food and beverage, travel
Surgery
and lodging, consulting, education, speaking, entertainment, gifts and honoraria) were recorded for 2017. Comparison by unpaired t-test (or ANOVA) where applicable, significance defined as P < 0.05. Results: Of the 86 faculty studied, 75% were found within the CMS Open Payments database in 2017. The mean amount of payment was $4024 (range $13-152,215). Median amount of payment was $434.90 (range $12.75-152,214.70). Faculty receiving outside compensation varied significantly by division and academic rank (P < 0.05). Plastic surgery had the highest percentage of people receiving any form of payment ($143-$1912) and GI surgery had the largest payments associated with device management ($0-$152,215). The variation seen by rank was driven by a small number of faculty with receipt of large payments at the associate professor level. The median amount of payment was $428.53 (range $13.97-2306.05) for assistant professors, $5328.03 (range $28.30152,214.70) for Associate Professors, and $753.82 (range $12.75-17,708.65) for full professors. Conclusions: Reporting of open payments to CMS provides transparency between physicians and industry. The significant relationship of division and rank with open payments
Society Paper: Association for Academic Surgery and Society of University Surgeons 14th Academic Surgical Congress, Houston TX, February 5-7th. * Corresponding author. Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue, South Suite 502, Birmingham, AL, 35233. Tel.: þ1 205 934 3333; fax: þ1 205 934 0135. E-mail address: [email protected] (H. Chen). 0022-4804/$ e see front matter ª 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jss.2019.08.012
600
j o u r n a l o f s u r g i c a l r e s e a r c h d e c e m b e r 2 0 1 9 ( 2 4 4 ) 5 9 9 e6 0 3
database is driven by relatively few faculty. The majority (94%) received either no payments or less than $10,000. ª 2019 Elsevier Inc. All rights reserved.
Introduction Most medical training in the United States and Canada now incorporates a formal ethics course into its curriculum. The principles of autonomy, justice, nonmaleficence, and beneficence are fundamental to this syllabus.1 Both physicians and many laypersons are familiar with the Hippocratic Oath and its emphasis on the implicit goodwill toward the sick. “So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all (people) for all time”.2 Pharmaceutical, biomedical, technologic, and surgical advances have changed the landscape of modern medicine in the last century. These innovations have both been a result of and have led to the continued growth of biomedical industry. While both individual physicians and companies are able to benefit from this relationship, it is vital to ensure that the public be made aware of any conflicts of interests that could potentially affect their medical care. Since 2010, the federal government has mandated that every medical device and pharmaceutical company report any payment made to a physician or academic institution. Section 6002 of the Affordable Care Act, commonly referred to as “The Sunshine Act” is legislation designed to provide transparency to the relationship between physicians and industry. This law has resulted in a publicly accessible online database that can be searched online.3-6 Since the first reported data were released in 2014, open payments to orthopedic, neurosurgical, and surgical oral maxillofacial subspecialties have been well-described.7,8 In 2018, Garstka et al. analyzed payments made to physicians, comparing surgeons and nonsurgeons, as well as geographic distribution throughout the United States.9 To better understand the relationship between industry and the various divisions within a large academic surgical department, we searched for all surgical faculty at our institution within the publicly available open payments database website. We hypothesized that division of surgery and rank of professorship would shows significant differences in both the monetary value and the nature of payments.
recorded. The nature of payments included 1) food and beverages, 2) travel and lodging, 3) consulting, 4) education, 5) speaking engagements, and 6) gifts and honoraria. Data about the faculty practice, specialty, gender, rank, and other demographics were obtained from the University of Alabama at Birmingham faculty data reports. These data are also available in public accessible sites. Statistical analysis using unpaired t-test (or ANOVA) was used. Statistical significance was defined as P < 0.05.
Results Sixty-four (75%) of the 86 surgical faculty were found within the OPD for the 2017 calendar year. There were 897 individual payments made to physicians, totaling $346,110.47. The mean total amount of payment for an individual surgeon was $4024.54 with a large range ($13-152,215). The basic demographics in regard to specialties are shown in Table 1. Divisions within the department of surgery showed statistical differences not only in terms of percentage of individuals receiving payments, but also the total amount of payments. Only 46% of surgeons within the division of surgical oncology accepted any form of payment, whereas all of the plastic surgeons received some form of payment. Again the division of surgical oncology accepted the lowest median payments in terms on monetary value: $23.55 ($14.26-440). Gastrointestinal surgery accepted the highest median valued payments: $76,130.44 ($13.97-152,214.70). A complete list of median amount of payments based on division can be seen in Table 2. On the whole, 80% of the faculty received well under $1000 in total payments. This distribution can be seen in Figure 1. Rank of the faculty was also examined and statistically significant differences were seen between these levels. At the Associate professor rank, the highest mean receipt of payment was seen: $13,847.78 7839.37. Assistant and full
Table 1 e Mean total amounts of payments for physicians based on division within the department of surgery. Division
N
Methods Owing to the publicly available data, Institutional Review Board approval was not needed for this study. The Open Payments database (OPD), https://openpaymentsdata.cms. gov/, was first accessed on July 31, 2018, for the purposes of this study. All of the clinical faculty in the Department of Surgery at the University of Alabama at Birmingham who were in clinical practice (n ¼ 86) at our institution were searched within the publicly available database for the 2017 calendar year. The total amount of payments, the number of individual payments, and the nature of payments were all
Mean SEM($)
% With payment (s)
Acute care
14
116.82 45.24
50
Cardiothoracic
14
931.31 312.76
79
Gastrointestinal
15
17,476.54 11,946.82
93
8
109.90 92.12
75
Pediatrics
9
832.22 237.08
100
13
48.01 33.33
46
Transplant
8
3220.92 2784.61
75
Vascular
5
4024.54 2161.77
75
Plastics Surgical oncology
P ¼ 0.014.
601
fazendin et al open payments at a large academic institution
Table 2 e Median total amounts of payments for physicians found within the CMS Open Payments database based on division within the department of surgery.
Table 3 e Mean total payments related to rank of professorship. Level
N
Mean SEM($)
Division
Assistant professor
34
421.84 108.96
Acute care
N 7
Median payment amount
Range
159.98
69.51-562.87 56.57-2851.79
Cardiothoracic
11
342.19
Gastrointestinal
14
76,130.44
Pediatrics
6
20.57
Plastics
9
324.49
Surgical oncology
6
23.55
14.26-440
Transplant
6
58.03
23.63-22,618.81
Vascular
5
9275.04
13.97-152,214.70 12.75-753.82 143.27-1912.83
841.43-17,708.65
professors received almost equal mean total amount of payments, averaging under $500. The average and median amount of payment for all ranks of professorship is shown in Tables 3 and 4. Figure 2 and Table 5 show the nature of payments reported for 2017. Of the 897 open payments, 585 (65.2%) were food and beverage and 209 (23.3%) were for travel and lodging.
Discussion Tringale et al. have shown that surgeons receive more compensation, both in total amount payments and higher valued payments, from industry than general practitioners.10 But while surgical subspecialties such as orthopedics, neurosurgery and oral and maxillofacial surgery have been wellreported,7,8 open payments made to a large academic surgical department faculty are not as well-described. There may be several reasons for this. Surgical departments often encompass a variety of subspecialty divisions, with each of them having its own relationship to industry. For example, in our study, the three highest valued payments on average belonged to gastrointestinal surgery, vascular surgery, and transplant surgery. Each of these specialties have unique
Associate professor
23
Full professor
29
13,847.78 7839.37 457.55 163.82
needs in terms of medical devices such as robotics and implantable mesh, endovascular stents and pharmaceutical agents such as antirejection medication to name a few.11 While our institutional data show statistically significant differences, this is mostly due to a small number of individuals within the department. Only 20% of the faculty studied received payments totaling greater than $1000 for 2017. Food and beverage was by far the most common form of payment received. However, these were usually of low monetary value. Payments such as for travel and lodging, educational opportunities, speaking engagements, and continuing medical education (CME) tend to have higher costs. In this study, a small cohort of gastrointestinal surgeons at the associate professor level accounted for most of these payments. There could be several reasons that differences were seen in regard to level of professorship. As stated previously, teaching educational courses and CME all tend to be associated with higher amounts of payments. Young physicians at the assistant professor level may be focused on the task of building busy clinical practices. Full professors may be at a point in their career where their institutional administrative duties and already established clinical practices have taken precedent. Associate professors may be at the stage in their career where they have the freedom to take on new teaching and speaking engagements. There are several limitations to this study. This is a singleinstitution descriptive study. Therefore, it is too small to fully account for the reasons for these differences in payment receipts. A larger sample size across several institutions, and potential survey data, would be needed to make a more comprehensive conclusion. Of note, our study did not compare data taken from the OPD https://openpaymentsdata. cms.gov/ with actually reported conflicts of interest per the individual surgeons. In recent years, both academic medical centers and the general public have placed emphasis on the transparency of physician compensation.12 In regard to the gender pay gap, Morris et al. investigated differences in compensation between men and women in the department of surgery at our institution. A new structured compensation plan was
Table 4 e Median total payments related to rank of professorship for faculty found within the CMS Open Payments database. Level
Fig. 1 e Faculty distribution of payments.
Median ($)
Range ($)
Assistant professor
428.53
Associate professor
5328.03
28.3-152,214.70
753.82
12.75-17,708.65
Full professor
13.97-2306.05
602
j o u r n a l o f s u r g i c a l r e s e a r c h d e c e m b e r 2 0 1 9 ( 2 4 4 ) 5 9 9 e6 0 3
Conclusion Reporting of open payments provides transparency between physicians and industry. Our institutional data show a significant relationship between division of surgery and rank of professorship in terms of open payments. This difference is likely driven by a few faculty members at the associate professor level. Because there is sparse literature comparing general surgery open payments data, larger multi-institutional studies should be performed to further compare divisions within general surgery and academic rank. It is our hope that in these future studies, we can also analyze gender differences and compare receipt of open payments with reported conflicts of interest.
Acknowledgment
Fig. 2 e Nature of payments.
developed and significantly raised female surgeon’s compensation commensurate with their academic rank and level of productivity.13 Previous literature has also shown that accurate reporting of physicians’ conflicts of interest is important to the general public. In 2009, Ross et al. distributed surveys to Mount Sinai physicians in 35 departments at 11 hospitals. They found that most physicians believed that on a whole, it was appropriate to receive compensation from industry for collaboration.14 Patient perceptions to physicians receiving payments from industry have been described in the neurosurgical literature. DiPaola showed that in surveys of more than 500 individuals, 90% of patients of patients agreed that surgeon’s funding for tuition and travel for educational meetings and speaking engagements was ethical. In a separate study, DiPaola et al. showed that 80% of 610 survey responders believed that it was ethical or even beneficial for neurosurgeons to be consultants for device companies. However, in both of these studies, surveyed patients felt that disclosure of this information was important.15,16 Similarly, in a Canadian study, Camp et al. interviewed a small cohort of patients who supported their surgeons’ relationships with industry if it would provide potential benefit to current or future patients.17
Table 5 e Types of payments, nature of payments, and mean value of payment. Nature of payment
No. of payments received
Food and beverage
585
Travel and lodging
Mean value ($) 23.89
218
327.53
Consulting
7
712.42
Education
58
1907.09
Speaker
16
2718.75
CME
23
3980.32
Entertainment
1
Gifts
1
6500.0
23.66
Honoraria
2
1780.0
Author contributions: J.F. collected the data and wrote the manuscript and prepared tables and figures with the assistance of B.C., M.H., and H.C. H.C. carried out statistical analysis. H.C. and M.H. provided overall guidance in the interpretation of findings. No funding was provided for the study.
Disclosure All authors declare no conflict of interest.
references
1. Lehmann LS, Kasoff WS, Koch P, Federman DD. A survey of medical ethics education at U.S. and Canadian medical schools. Acad Med. 2004;79:682e689. 2. Hippocratic Oath. Available at National Library of medicine https://www.nlm.nih.gov/hmd/greek/greek_oath.html. Accessed February 10, 2019. 3. H.R. 3590 e patient protection and affordable care act. 111th United States congress (2009-2010). Available at https://www. congress.gov/111/plaws/publ148/PLAW-111publ148.pdf. Accessed July 31, 2018. 4. How Open Payments Works. Centers for Medicaid and Medicare Services. Available at https://www.cms.gov/ OpenPayments/About/How-Open-Payments-Works.html. Accessed July 31, 2018. 5. Ziai K, Pigazzi A, Smith BR. Association of compensation from the surgical and medical device industry to physicians and self-declared conflict of interest. JAMA Surg. 2018;153:997e1002. 6. International Committee of Medical Journal. Recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals: author responsibilitiesd conflicts of interest. Available at http://www. icmje.org/recommendations. Accessed February 10, 2019. 7. Ji YD, Peacock ZS. Shining sunlight on industry payments in oral and maxillofacial surgery: the sunshine act. J Oral Maxillofac Surg. 2018;77:685e689. 8. Weiner JA, Cook RW, Hashmi S, et al. Factors associated with financial relationships between spine surgeons and industry: an analysis of the open payments database. Spine. 2017;42:1412e1418.
fazendin et al open payments at a large academic institution
9. Garstka ME, Monlezun D, DuCoin C, Killackey M, Kandil E. The sunshine act and surgeons: a nation-wide analysis of industry payments to physicians. J Surg Res. 2019;233:41e49. 10. Tringale KR, Marshall D, Mackey TK, Connor M, Murphy JD, Hattangadi-Gluth JA. Types and distribution of payments from industry to physicians in 2015. JAMA. 2017;317:177. 11. Ahmed R, Chow EK, Massie AB, et al. Where the sun shines: industry’s payments to transplant surgeons. Am J Transplant. 2016;16:292e300. 12. Zhuge Y, Kaufman J, Simeone D, Chen H, Velazquez OC. Is there still a glass ceiling for women in academic surgery? Ann Surg. 2011;253:637e643. 13. Morris M, Chen H, Heslin MJ, Krontiras H. A structured compensation plan improves but does not erase the sex pay gap in surgery. Ann Surg. 2018;268:442e448.
603
14. Ross JS, Keyhani S, Korenstein D. Appropriateness of collaborations between industry and the medical profession: physicians’ perceptions. Am J Med. 2009;122:955e960. 15. DiPaola CP, Dea N, Dvorak MF, Lee RS, Hartig D, Fisher CG. Surgeon-industry conflict of interest: survey of opinions regarding industry-sponsored educational events and surgeon teaching: clinical article. J Neurosurg Spine. 2014;20:313e321. 16. DiPaola CP, Dea N, Noonan VK, Bailey CS, Dvorak MF, Fisher CG. Surgeon-industry conflict of interest: survey of North Americans’ opinions regarding surgeons consulting with industry. Spine J. 2014;14:584e591. 17. Camp MW, Gross AE, McKneally MF. Patient views on financial relationships between surgeons and surgical device manufacturers. Can J Surg. 2015;58:323e329.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Association for Academic Surgery
Analysis of Open Payments Receipts Among Surgical Faculty at a Large Academic Institution Jessica M. Fazendin, MD,a Britney L. Corey, MD,b Martin J. Heslin, MD,b and Herbert Chen, MD, FACSb,* a b
Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
article info
abstract
Article history:
Background: Section 6002 of the Affordable Care Act, commonly referred to as “The
Received 27 February 2019
Sunshine Act,” is legislation designed to provide transparency to the relationship be-
Received in revised form
tween physicians and industry. Since 2013, medical product and pharmaceutical man-
1 August 2019
ufacturers were required to report any payments made to physicians to the Centers for
Accepted 19 August 2019
Medicare and Medicaid Services (CMS). We predicted that most clinical faculty at our
Available online 16 September 2019
institution would be found on the Open Payments website. We elected to investigate payments in relationship to divisions within the department of surgery and the level of
Keywords:
professorship.
Open payments
Methods: All clinical faculty (n ¼ 86) within the department of surgery at our institution
Conflict of interest
were searched within the database: https://openpaymentsdata.cms.gov/. The total amount
Sunshine act
of payments, number of payments, and the nature of payments (food and beverage, travel
Surgery
and lodging, consulting, education, speaking, entertainment, gifts and honoraria) were recorded for 2017. Comparison by unpaired t-test (or ANOVA) where applicable, significance defined as P < 0.05. Results: Of the 86 faculty studied, 75% were found within the CMS Open Payments database in 2017. The mean amount of payment was $4024 (range $13-152,215). Median amount of payment was $434.90 (range $12.75-152,214.70). Faculty receiving outside compensation varied significantly by division and academic rank (P < 0.05). Plastic surgery had the highest percentage of people receiving any form of payment ($143-$1912) and GI surgery had the largest payments associated with device management ($0-$152,215). The variation seen by rank was driven by a small number of faculty with receipt of large payments at the associate professor level. The median amount of payment was $428.53 (range $13.97-2306.05) for assistant professors, $5328.03 (range $28.30152,214.70) for Associate Professors, and $753.82 (range $12.75-17,708.65) for full professors. Conclusions: Reporting of open payments to CMS provides transparency between physicians and industry. The significant relationship of division and rank with open payments
Society Paper: Association for Academic Surgery and Society of University Surgeons 14th Academic Surgical Congress, Houston TX, February 5-7th. * Corresponding author. Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue, South Suite 502, Birmingham, AL, 35233. Tel.: þ1 205 934 3333; fax: þ1 205 934 0135. E-mail address: [email protected] (H. Chen). 0022-4804/$ e see front matter ª 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jss.2019.08.012
600
j o u r n a l o f s u r g i c a l r e s e a r c h d e c e m b e r 2 0 1 9 ( 2 4 4 ) 5 9 9 e6 0 3
database is driven by relatively few faculty. The majority (94%) received either no payments or less than $10,000. ª 2019 Elsevier Inc. All rights reserved.
Introduction Most medical training in the United States and Canada now incorporates a formal ethics course into its curriculum. The principles of autonomy, justice, nonmaleficence, and beneficence are fundamental to this syllabus.1 Both physicians and many laypersons are familiar with the Hippocratic Oath and its emphasis on the implicit goodwill toward the sick. “So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all (people) for all time”.2 Pharmaceutical, biomedical, technologic, and surgical advances have changed the landscape of modern medicine in the last century. These innovations have both been a result of and have led to the continued growth of biomedical industry. While both individual physicians and companies are able to benefit from this relationship, it is vital to ensure that the public be made aware of any conflicts of interests that could potentially affect their medical care. Since 2010, the federal government has mandated that every medical device and pharmaceutical company report any payment made to a physician or academic institution. Section 6002 of the Affordable Care Act, commonly referred to as “The Sunshine Act” is legislation designed to provide transparency to the relationship between physicians and industry. This law has resulted in a publicly accessible online database that can be searched online.3-6 Since the first reported data were released in 2014, open payments to orthopedic, neurosurgical, and surgical oral maxillofacial subspecialties have been well-described.7,8 In 2018, Garstka et al. analyzed payments made to physicians, comparing surgeons and nonsurgeons, as well as geographic distribution throughout the United States.9 To better understand the relationship between industry and the various divisions within a large academic surgical department, we searched for all surgical faculty at our institution within the publicly available open payments database website. We hypothesized that division of surgery and rank of professorship would shows significant differences in both the monetary value and the nature of payments.
recorded. The nature of payments included 1) food and beverages, 2) travel and lodging, 3) consulting, 4) education, 5) speaking engagements, and 6) gifts and honoraria. Data about the faculty practice, specialty, gender, rank, and other demographics were obtained from the University of Alabama at Birmingham faculty data reports. These data are also available in public accessible sites. Statistical analysis using unpaired t-test (or ANOVA) was used. Statistical significance was defined as P < 0.05.
Results Sixty-four (75%) of the 86 surgical faculty were found within the OPD for the 2017 calendar year. There were 897 individual payments made to physicians, totaling $346,110.47. The mean total amount of payment for an individual surgeon was $4024.54 with a large range ($13-152,215). The basic demographics in regard to specialties are shown in Table 1. Divisions within the department of surgery showed statistical differences not only in terms of percentage of individuals receiving payments, but also the total amount of payments. Only 46% of surgeons within the division of surgical oncology accepted any form of payment, whereas all of the plastic surgeons received some form of payment. Again the division of surgical oncology accepted the lowest median payments in terms on monetary value: $23.55 ($14.26-440). Gastrointestinal surgery accepted the highest median valued payments: $76,130.44 ($13.97-152,214.70). A complete list of median amount of payments based on division can be seen in Table 2. On the whole, 80% of the faculty received well under $1000 in total payments. This distribution can be seen in Figure 1. Rank of the faculty was also examined and statistically significant differences were seen between these levels. At the Associate professor rank, the highest mean receipt of payment was seen: $13,847.78 7839.37. Assistant and full
Table 1 e Mean total amounts of payments for physicians based on division within the department of surgery. Division
N
Methods Owing to the publicly available data, Institutional Review Board approval was not needed for this study. The Open Payments database (OPD), https://openpaymentsdata.cms. gov/, was first accessed on July 31, 2018, for the purposes of this study. All of the clinical faculty in the Department of Surgery at the University of Alabama at Birmingham who were in clinical practice (n ¼ 86) at our institution were searched within the publicly available database for the 2017 calendar year. The total amount of payments, the number of individual payments, and the nature of payments were all
Mean SEM($)
% With payment (s)
Acute care
14
116.82 45.24
50
Cardiothoracic
14
931.31 312.76
79
Gastrointestinal
15
17,476.54 11,946.82
93
8
109.90 92.12
75
Pediatrics
9
832.22 237.08
100
13
48.01 33.33
46
Transplant
8
3220.92 2784.61
75
Vascular
5
4024.54 2161.77
75
Plastics Surgical oncology
P ¼ 0.014.
601
fazendin et al open payments at a large academic institution
Table 2 e Median total amounts of payments for physicians found within the CMS Open Payments database based on division within the department of surgery.
Table 3 e Mean total payments related to rank of professorship. Level
N
Mean SEM($)
Division
Assistant professor
34
421.84 108.96
Acute care
N 7
Median payment amount
Range
159.98
69.51-562.87 56.57-2851.79
Cardiothoracic
11
342.19
Gastrointestinal
14
76,130.44
Pediatrics
6
20.57
Plastics
9
324.49
Surgical oncology
6
23.55
14.26-440
Transplant
6
58.03
23.63-22,618.81
Vascular
5
9275.04
13.97-152,214.70 12.75-753.82 143.27-1912.83
841.43-17,708.65
professors received almost equal mean total amount of payments, averaging under $500. The average and median amount of payment for all ranks of professorship is shown in Tables 3 and 4. Figure 2 and Table 5 show the nature of payments reported for 2017. Of the 897 open payments, 585 (65.2%) were food and beverage and 209 (23.3%) were for travel and lodging.
Discussion Tringale et al. have shown that surgeons receive more compensation, both in total amount payments and higher valued payments, from industry than general practitioners.10 But while surgical subspecialties such as orthopedics, neurosurgery and oral and maxillofacial surgery have been wellreported,7,8 open payments made to a large academic surgical department faculty are not as well-described. There may be several reasons for this. Surgical departments often encompass a variety of subspecialty divisions, with each of them having its own relationship to industry. For example, in our study, the three highest valued payments on average belonged to gastrointestinal surgery, vascular surgery, and transplant surgery. Each of these specialties have unique
Associate professor
23
Full professor
29
13,847.78 7839.37 457.55 163.82
needs in terms of medical devices such as robotics and implantable mesh, endovascular stents and pharmaceutical agents such as antirejection medication to name a few.11 While our institutional data show statistically significant differences, this is mostly due to a small number of individuals within the department. Only 20% of the faculty studied received payments totaling greater than $1000 for 2017. Food and beverage was by far the most common form of payment received. However, these were usually of low monetary value. Payments such as for travel and lodging, educational opportunities, speaking engagements, and continuing medical education (CME) tend to have higher costs. In this study, a small cohort of gastrointestinal surgeons at the associate professor level accounted for most of these payments. There could be several reasons that differences were seen in regard to level of professorship. As stated previously, teaching educational courses and CME all tend to be associated with higher amounts of payments. Young physicians at the assistant professor level may be focused on the task of building busy clinical practices. Full professors may be at a point in their career where their institutional administrative duties and already established clinical practices have taken precedent. Associate professors may be at the stage in their career where they have the freedom to take on new teaching and speaking engagements. There are several limitations to this study. This is a singleinstitution descriptive study. Therefore, it is too small to fully account for the reasons for these differences in payment receipts. A larger sample size across several institutions, and potential survey data, would be needed to make a more comprehensive conclusion. Of note, our study did not compare data taken from the OPD https://openpaymentsdata. cms.gov/ with actually reported conflicts of interest per the individual surgeons. In recent years, both academic medical centers and the general public have placed emphasis on the transparency of physician compensation.12 In regard to the gender pay gap, Morris et al. investigated differences in compensation between men and women in the department of surgery at our institution. A new structured compensation plan was
Table 4 e Median total payments related to rank of professorship for faculty found within the CMS Open Payments database. Level
Fig. 1 e Faculty distribution of payments.
Median ($)
Range ($)
Assistant professor
428.53
Associate professor
5328.03
28.3-152,214.70
753.82
12.75-17,708.65
Full professor
13.97-2306.05
602
j o u r n a l o f s u r g i c a l r e s e a r c h d e c e m b e r 2 0 1 9 ( 2 4 4 ) 5 9 9 e6 0 3
Conclusion Reporting of open payments provides transparency between physicians and industry. Our institutional data show a significant relationship between division of surgery and rank of professorship in terms of open payments. This difference is likely driven by a few faculty members at the associate professor level. Because there is sparse literature comparing general surgery open payments data, larger multi-institutional studies should be performed to further compare divisions within general surgery and academic rank. It is our hope that in these future studies, we can also analyze gender differences and compare receipt of open payments with reported conflicts of interest.
Acknowledgment
Fig. 2 e Nature of payments.
developed and significantly raised female surgeon’s compensation commensurate with their academic rank and level of productivity.13 Previous literature has also shown that accurate reporting of physicians’ conflicts of interest is important to the general public. In 2009, Ross et al. distributed surveys to Mount Sinai physicians in 35 departments at 11 hospitals. They found that most physicians believed that on a whole, it was appropriate to receive compensation from industry for collaboration.14 Patient perceptions to physicians receiving payments from industry have been described in the neurosurgical literature. DiPaola showed that in surveys of more than 500 individuals, 90% of patients of patients agreed that surgeon’s funding for tuition and travel for educational meetings and speaking engagements was ethical. In a separate study, DiPaola et al. showed that 80% of 610 survey responders believed that it was ethical or even beneficial for neurosurgeons to be consultants for device companies. However, in both of these studies, surveyed patients felt that disclosure of this information was important.15,16 Similarly, in a Canadian study, Camp et al. interviewed a small cohort of patients who supported their surgeons’ relationships with industry if it would provide potential benefit to current or future patients.17
Table 5 e Types of payments, nature of payments, and mean value of payment. Nature of payment
No. of payments received
Food and beverage
585
Travel and lodging
Mean value ($) 23.89
218
327.53
Consulting
7
712.42
Education
58
1907.09
Speaker
16
2718.75
CME
23
3980.32
Entertainment
1
Gifts
1
6500.0
23.66
Honoraria
2
1780.0
Author contributions: J.F. collected the data and wrote the manuscript and prepared tables and figures with the assistance of B.C., M.H., and H.C. H.C. carried out statistical analysis. H.C. and M.H. provided overall guidance in the interpretation of findings. No funding was provided for the study.
Disclosure All authors declare no conflict of interest.
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