S. Chrabaszcz1, R. Rajeev1, B. Klooster1, T. Gamblin1, F. Johnston1, K. Turaga1 1Medical College Of Wisconsin,Division Of Surgical Oncology,Milwaukee, WI, USA
Introduction: Evolving healthcare demands have necessitated changing relationships between surgeons and industry. Honoraria, speakers’ fees, consulting/advisory fees, gifts and other non-ownership payments can significantly introduce a conflict of interest in healthcare. We hypothesized that there exists significant variation between the surgical subspecialties in the non-research payments from industry likely due to significant difference in adoption of modern technology between them.
Methods: The Physician Payments Sunshine Act requires the health care industry to report payments made to physicians to the Centers for Medicare and Medicaid Services (CMS). This information is recorded in the Open Payments database (OPD) beginning with payments made on August 1, 2013. The OPD was reviewed to identify non-research payments made to physicians in surgical subspecialties between August 1, 2013 and December 31, 2013. Data on payments made to individual physicians and the number of surgeons receiving payments were compared across different surgical subspecialties. Focus group methodology was used to ascertain hierarchical ordering of adoption of technology amongst surgical subspecialties.
Results: In 2013, there were 131,819 general transactions from industry to 22,167 surgeons. Subspecialty classifications included General (and Trauma) Surgery (64.7%), Colorectal Surgery (4.3%), Critical Care Surgery (1.5%), Surgical Oncology (2%), Trauma only (1.3%), Vascular Surgery (11.2%), Thoracic (13%) and Transplant Surgery (1.1%). Median payment per transaction was $27 (IQR $14.4-$104.8) while the mean payment per transaction was $274 (± $7181.5). The mean number of payments per surgeon was 5.9. The specialty with the highest mean payment per transaction and mean payment per surgeon was critical care surgery ($2013 and $6872 respectively). Mean payment per surgeon was higher for subspecialists as compared to general surgeons ($2114 Colorectal Surgery, $6872 Critical Care Surgery, $1095 General Surgery, $1814 Pediatric Surgery, $1725 Surgical Oncology, $2383 Thoracic Surgery, $2566 Transplant Surgery, $545 Trauma Surgery, and $1800 Vascular Surgery). The maximum payment to one individual in a unique transaction was in critical care surgery ($2.3 million). Hierarchical ordering of specialties in magnitude of technological adoption was not possible using our current methods.
Conclusion: Critical care specialists and other surgical subspecialties are more likely to receive higher non-research payments from industry as compared to general surgeons. While we believe that this phenomenon is an effect of rapid adoption of evolving technology in ICUs and the operating rooms, we were unable to substantiate our hypothesis using current methods.