Payments to physicians from medical vendors

 A useful rule of thumb when studying the design of markets is that when you see many related rules against something, that something may still be happening.  In yesterday's post I described the code of conduct that speakers at a medical conference are asked to subscribe to, mostly concerning payments received from medical vendors.  Below is a contemporary article about the incidence of such payments, to cardiologists (interventional cardiologists in particular), starting when they are still trainees.

Dhruva SS, Han M, Jing Y, Trock BJ, Hogan SO, Redberg RF. Industry Payments to Cardiology Fellows and Early-Career Cardiologists. JAMA Intern Med. 2024;184(9):1123–1125. doi:10.1001/jamainternmed.2024.3130 

Here's the introduction to the paper:

"Industry marketing payments to physicians may compromise the objectivity and integrity of clinical decision-making, playing a role in nonrecommended care, higher health care costs, and reduced patient trust. Payments to trainees merit scrutiny because these payments may be formative on future practice. The Association of American Medical Colleges (AAMC) recommends policies “that prohibit the acceptance of any gifts from industry by physicians…and trainees.”1 The Accreditation Council for Graduate Medical Education (ACGME) states “promotional activities by industry can seriously compromise the professional relationships that form the substance of medicine.”2 The National Academy of Medicine (NAM) also argues financial relationships do not benefit the educational mission in ways that offset the risks created.3 We quantified industry payments to cardiology fellows and the association of these payments with payments received after training."

And here is a summary of the results:

"During the year before fellowship graduation, 1993 fellows (80%) in procedural intensive subspecialties and 2057 of 3055 (67%) in nonprocedural intensive subspecialties received industry payments. Median (IQR) payment amount per physician in procedural intensive subspecialties was $1801 ($282-$4445; median [IQR] payments, 17 [4-38]). In nonprocedural intensive subspecialties, median (IQR) payment amount received per physician was $198 ($0-$893; median [IQR] payments, 3 [0-13]).

"A median (IQR) of 3 (2-5) years after fellowship, 2385 physicians (96%) in procedural intensive subspecialties and 2483 (81%) in nonprocedural intensive subspecialties received industry payments. Median (IQR) payment amount per physician per year was $1112 ($372-$2870) and $277 ($95-$838), respectively."