PracticalDermatology

The majority of physicians practicing in the United States have received some form of compensation from private industry during their careers. These payments may include consulting fees, compensation for speaking engagements, and stock options. Certain payments take indirect forms, such as physician education materials, office supplies, and other items. Private companies provide funding and equipment to test new drugs and devices, especially in academic medicine. The marketing of medications, equipment, and other services to physicians has been reported to cost as much as $30 billion per year.¹

Given the potential for conflicts of interest, the Physician Payments Sunshine Act was passed in 2010 to “shine a light” on the financial relationships between industry and physicians. From 2014 onward, industry partners were required to report general payments, research payments or funding support, and investments or ownership interests for each individual physician via the Centers for Medicare and Medicaid Services (CMS) Open Payments Program.^2-3 Physicians can create an account to access their profile to confirm or contest payments. This online database is freely available to the public at openpaymentsdata.cms.gov.

In 2016, an analysis of the Open Payments Program found that the median payment to dermatologists was $298, although a subset of 8,333 listed dermatologists received a combined amount of more than $34 million.⁴ The top one percent of dermatologists received over $100,000 while the vast majority (77 percent) received less than $1,000.⁵ However, there have reportedly been several inconsistencies between the compensation reported by private companies and those confirmed by dermatologists.⁶ Moreover, a study of public attitudes reported that the Open Payments Program has neither increased public knowledge of industry payments to physicians nor increased awareness about potential conflicts of interest.⁷

What is less clear is how the Open Payments Program has affected dermatologists. As a result, we conducted an Institutional Review Board-approved survey of academic dermatologists in the state of Michigan to ask them about what they knew about the initiative. Our pilot study of 17 dermatologists found that a simple majority were aware of the website (59 percent), but that most had never accessed it (65 percent) or reviewed the transactions for accuracy (76 percent). Moreover, all dermatologists indicated that they had never been asked by a patient about their financial relationship with industry partners.

These findings suggest that the Open Payments Program has limited success in initiating a dialogue between dermatologists and patients regarding financial ties and conflicts of interest with private industry partners.

1. Schwartz LM, Woloshin S. Medical marketing in the United States, 1997-2016. JAMA 2019;321(1):80-96. doi: 10.1001/jama.2018.19320.

2. Gorlach I, Pham-Kanter G. Brightening up: the effect of the Physician Payment Sunshine Act on the existing regulation of pharmaceutical marketing. J Law Med Ethics 2013;41(1):315-22. doi: 10.1111/jlme.12022.

3. Agrawal S, Brennan N, Budetti P. The Sunshine Act -- effects on physicians. N Engl J Med 2013;368:22.

4. Feng H, Wu P, Leger M. Exploring the industry-dermatologist financial relationship: insight from the Open Payment Data. JAMA Dermatol 2016;152(12):1307-13. doi: 10.1001/jamadermatol.2016.3037.

5. Schlager E, Flatten H, St Claire C, Maxim E, Dunnick C, Dellavalle RP. Industry payments to dermatologists: updates from the 2016 open payment data. Dermatol Online J 2018;24(4):13030/qt8r74w3c4.

6. Feng H, Shih AF, Feng PW, Stein JA, Adamson AS. Concordance between dermatologist self-reported and industry-sponsored interactions at a national dermatology conference. Cutis 2020;105(4):203-8;E1.

7. Kanter GP, Carpenter D, Lehmann L, Mello MM. Effect of the public disclosure of industry payments information on patients: results from a population-based natural experiment. BMJ Open 2019;9(2):e024020.