MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Financial relationships between biomedical industry and physicians are common, and previous work has investigated the potential conflicts of interest that can arise from these interactions.
Data show that even small payments in the form of industry sponsored lunches can influence physician prescribing patterns. Given the concern for the potential influence of biomedical industry over practice patterns and potentially patient care, the Open Payments program was implemented under the Affordable Care Act to shed light on these interactions and make reports of these financial transactions publicly available. We recently published a paper in JAMA on industry payments to physicians that found that men received a higher value and greater number of payments than women physicians and were more likely to receive royalty or licensing payments when grouped by type of specialty (surgeons, primary care, specialists, interventionalists).
The purpose of the Research Letter discussed here was to further examine differences in the value of payments received by male and female physicians within each individual specialty. The main takeaway from this study is that male physicians, across almost every specialty, are receive more money from biomedical industry compared to female physicians. At first glance, this finding can be interpreted as merely another example of gender disparities in the workplace, which we have seen before with gender gaps in physician salaries and research funding. Indeed, this gender gap may be a product of industry bias leading to unequal opportunity for women to engage in these profitable relationships. Alternatively, these data may be more representative of gender differences in physician decision-making. Previous data has shown that industry engagement can lead to changes in practice patterns, so maybe female physicians acknowledge these conflicts of interest and actively choose not to engage with industry. Unfortunately, we cannot tease out these subtleties from our results, but our paper does reveal a remarkable gender difference among physician engagement with industry. With this being said, whether male or female, everyone needs a bit of help sometimes. The use of loans is a possibility for many people who need a little financial assistance. Regardless of whether men are getting paid a little more than women, they may all need help just as equally. The type of loans that would be worth looking into if this is your current situation is physician loans, which basically allows medical professionals to purchase a home with a low/little down payment while avoiding mortgage insurance. A little bit of help goes a long way, especially when it involves your future.
MedicalResearch.com: What are the main findings?
Response: The main takeaway from this study is that male physicians, across almost every specialty, are receive more money from biomedical industry compared to female physicians. At first glance, this finding can be interpreted as merely another example of gender disparities in the workplace, which we have seen before with gender gaps in physician salaries and research funding. Indeed, this gender gap may be a product of industry bias leading to unequal opportunity for women to engage in these profitable relationships.
Alternatively, these data may be more representative of gender differences in physician decision-making. Previous data has shown that industry engagement can lead to changes in practice patterns, so maybe female physicians acknowledge these conflicts of interest and actively choose not to engage with industry. Unfortunately, we cannot tease out these subtleties from our results, but our paper does reveal a remarkable gender difference among physician engagement with industry.
MedicalResearch.com: What should readers take away from your report?
Response: The biggest issue here is ensuring that male and female physicians are given equal opportunity to engage with industry. As evidenced by lower salaries among women physicians, women may not negotiate as often or for higher values during industry interactions. From the start, women have fewer assets to negotiate with due to barriers in obtaining equivalent faculty positions and salaries. Perhaps industry does not value women the same as men for the same role or task. Industry-based marketing may target men more than women, specifically by engaging with key opinion/thought leaders, predominantly specialists and male physicians, to establish credibility, promote products, and increase profits. Perhaps industries purposely target men more than women, presuming they may have greater influence on marketshare or sales of pharmaceuticals or devices.
Data shows that women hold fewer patents than their male counterparts, which may be explained by fewer initial connections to the marketplace or exclusion of their name from the patent itself after idea generation. Even women who obtain patents are less likely to have them commercialized or licensed. In order to start to close the gender gap shown here in profits from industry, we need to start by leveling the playing field from the beginning with assuring equal assets for women to invest, support for women innovate and receive proper credit for doing so, and opportunity for women to decide for themselves whether or not they even want to engage in these financial relationships.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Ultimately, the two most important aspects of this research are 1) ensuring that men and women are given equal opportunities (as just discussed), and 2) the impact that these relationships have on patient care and health outcomes. I should note that these data represent physician interactions with industry – we can speculate about what the impact of gender differences in industry payments might mean for patient care, but we cannot make conclusions about the downstream ramifications of these financial relationships. If we extrapolate from other studies that have shown that these financial relationships with industry can significantly influence physician prescribing practices, then we can speculate from our data that gender differences in industry payments may lead to gender differences industry influence over medical practice.
We know that biomedical industry seeks out physicians to influence utilization of their brand medication or device, which is why they have drug-sponsored lunches to begin with, so this could have downstream effects on public health and outcomes, but this conclusion is several steps beyond what we demonstrate in our study here. We know from previous studies that there are differences in patient outcomes based on provider gender, so we could hypothesize that a gender gap in industry payments could lead to differences in provider practice in a way that could impact patient outcomes, but we would have to wait several years to see downstream influences of payment receipt. Ultimately, as biomedical industry plays a larger role in sponsoring biomedical innovation, our study could indicate unequal opportunity for female physicians and perhaps unequal influence in the medical field. Further research into the impact of payments on prescribing patterns, physician decision-making, and patient outcomes is warranted.
MedicalResearch.com: Is there anything else you would like to add?
Response: We cannot classify biomedical industry payments as “good” or “bad,” which makes the interpretation of this data that much more interesting and complex. There is a great deal of good that can be done with physician collaboration with industry, and it is necessary to get physician guidance in developing appropriate and useful technology. But ultimately, we know that these relationships DO impact practice. The goal of this is NOT to dissuade collaboration, but bring these relationships to light so that physicians and most importantly, patients, are aware of potential conflicts of interests that physicians may have with industry.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Tringale KR, Hattangadi-Gluth JA. Types and Distributions of Biomedical Industry Payments to Men and Women Physicians by Specialty, 2015. JAMA Intern Med. Published online December 18, 2017. doi:10.1001/jamainternmed.2017.7445
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