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Figure.  General Payments as a Percentage of Annual Base Salary in 2017 Among the 417 Academic Oncologists With Payments
General Payments as a Percentage of Annual Base Salary in 2017 Among the 417 Academic Oncologists With Payments

General payments refer to payments that are not associated with a research study (as defined by CMS Open Payments database).2 Three faculty members received general payments in excess of 100% of their salaries, specifically payments that were 124%, 124%, and 243% of their base salaries.

Table.  Descriptive Statistics on 2017 Salary and General Payments for 417 Oncology Faculty Members Who Received General Payments, by Position Titlea
Descriptive Statistics on 2017 Salary and General Payments for 417 Oncology Faculty Members Who Received General Payments, by Position Titlea
1.
Carlat  DJ, Fagrelius  T, Ramachandran  R, Ross  JS, Bergh  S.  The updated AMSA scorecard of conflict-of-interest policies: a survey of U.S. medical schools.  BMC Med Educ. 2016;16(1):202. doi:10.1186/s12909-016-0725-yPubMedGoogle ScholarCrossref
2.
OpenPaymentsData.CMS.gov. Search Open Payments. Published 2019. Accessed February 19, 2020. https://openpaymentsdata.cms.gov/
3.
Ornstein  C, Webber  T. Medical schools plug holes in conflict-of-interest policies. Published May 19, 2011. Accessed February 19, 2020. https://www.propublica.org/article/medical-schools-plug-holes-in-conflict-of-interest-policies
4.
Jena  AB, Olenski  AR, Blumenthal  DM.  Sex differences in physician salary in US public medical schools.  JAMA Intern Med. 2016;176(9):1294-1304. doi:10.1001/jamainternmed.2016.3284PubMedGoogle ScholarCrossref
5.
Waldman  A. Medical professors are supposed to share their outside income with the University of California. but many don't. Published December 6, 2019. Accessed February 19, 2020. https://www.propublica.org/article/medical-professors-are-supposed-to-share-their-outside-income-with-the-university-of-california-but-many-dont
6.
US Centers for Medicare and Medicaid Services. Open Payment: creating public transparency into industry-physician financial relationships. Published 2019. Accessed February 20 2020. https://www.cms.gov/OpenPayments/Downloads/forum-op-expansion-support-act-aug2019.pdf
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    Research Letter
    March 23, 2020

    Comparison of Industry Payments in 2017 With Annual Salary in a Cohort of Academic Oncologists

    Author Affiliations
    • 1Knight Cancer Institute, Division of Hematology Oncology, Oregon Health & Science University, Portland
    • 2Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
    • 3Now with Center for Indigenous Health Research and Policy, Oklahoma State University, Tulsa
    • 4Department of Analytics, Northwest Permanente, Portland, Oregon
    JAMA Intern Med. Published online March 23, 2020. doi:10.1001/jamainternmed.2020.0090

    Direct payments from industry to academic physicians are common in the US and differ from payments to medical centers for clinical research.1,2 Although most US medical schools have conflict of interest policies for faculty members,3 the restrictions vary.1 We compared industry payments with annual salary in a cohort of academic oncologists at US public medical schools.

    Methods

    From a 2016 study,4 we obtained a list of 24 US medical schools that provide public employee salary data and recorded all faculty member names from the oncology departments’ websites. We obtained 2017 annual salaries and job titles for faculty members with medical degrees from state-specific public salary databases. The eFigure in the Supplement shows the development of the analytical cohort of 630 faculty oncologists at 14 medical schools from 9 states; 5 schools were in California. We excluded faculty members not found in a 2017 salary database and those with salaries less than $100 000, because such salaries may represent incomplete reporting of pay or the pay of part-time or retired faculty members. We also excluded the faculty of medical schools with fewer than 10 oncology faculty members listed.

    All study data were publicly available. The study was not considered human subjects research and did not require institutional review board approval, per Oregon Health and Science University policies. Similarly, informed consent was not required.

    From the US Centers for Medicare & Medicaid Services (CMS) Open Payments database,2 we obtained 2017 general payments. The CMS defines general payments as “payments or other transfers of value made that are not in connection with a research agreement or research protocol.”6 General payments include consulting fees, honoraria, serving as faculty or a speaker at an event other than a continuing medical education program, gifts, entertainment, food and beverage, and travel and lodging. For faculty members with general payments, we compared general payments with annual salaries. From university websites, we obtained conflict of interest policies for faculty physicians. We collected and analyzed the data in August 2019, using Excel 2016 (Microsoft).

    Results

    Of the 630 oncologists from 14 medical schools in the analytical cohort, 417 (66.2%) had general payments from industry in 2017. The Table shows the mean, median, and interquartile ranges of base salaries and general payments by academic rank for faculty with general payments. Chairs and directors within departments and professors had the highest mean general payments (mean, $436 069; median, $433 819 [interquartile range, $351 199-$553 932]).

    When comparing general payments with base salary for the 417 faculty who received payments, 78 (18.7%) received payments of more than 10% of their annual salary, 45 (10.8%) received payments of more than 20%, 16 (3.8%) received payments of more than 50%, and 3 (0.7%) received payments of more than 100% (Figure). The general payments-to-salary ratio for the 3 physicians with the highest ratios were 124% ($185 316/$149 532), 124% ($132 696/$106 706), and 242% ($923 938/$380 768).

    Among the 14 medical schools, median general payment from industry-to-salary ratio was 0.8% for those physicians with payments. The 3 medical schools with the highest median general payment-to-salary ratios were University of California (UC) San Diego (16.0%), UC Davis (8.5%), and UC Irvine (4.6%).

    Of the 14 medical schools, 6 had conflict of interest policies establishing specific limits on the amount of industry payments faculty receive annually.5 The other 8 schools evaluated payment limits on a case-by-case basis. The 6 schools with fixed limits were the Ohio State University, with a limit of 20% of base salary, and all 5 California schools, with a limit of $40 000 or 40% of base salary, whichever is greater. At least one oncology faculty member from each of these 6 schools with fixed limits had general payments greater than stated limits.

    Discussion

    In a cohort of academic oncologists at US public medical schools, two-thirds (417 individuals) had general payments from industry in 2017. More than 10% of the oncologists with general payments received payments in excess of 20% of their annual salary. Our analysis complements a recent investigation by ProPublica into the UC medical school faculty with the highest industry payments, which found that many professors did not fully disclose payments and violated university limits on payments from industry.5 Our analysis was limited by the inclusion of only 14 medical schools and potential inaccuracies in the salary and CMS Open Payments data. These limitations notwithstanding, our findings established that many oncologists at US public medical schools receive substantial payments from industry, which are often sizeable in comparison with their annual salaries. Medical schools should enforce their own policies with regard to payment limits.

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    Article Information

    Accepted for Publication: January 10, 2020.

    Corresponding Author: Vinay Prasad, MD, MPH, Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (prasad@ohsu.edu).

    Published Online: March 23, 2020. doi:10.1001/jamainternmed.2020.0090

    Author Contributions: Dr Prasad had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Gill, Herrera-Perez, Prasad.

    Acquisition, analysis, or interpretation of data: Gill, Haslam, Crain, Herrera-Perez.

    Drafting of the manuscript: Gill, Haslam, Herrera-Perez.

    Critical revision of the manuscript for important intellectual content: Gill, Crain, Herrera-Perez, Prasad.

    Statistical analysis: Gill, Haslam, Crain.

    Supervision: Prasad.

    Conflict of Interest Disclosures: Dr Prasad reports receiving royalties from Johns Hopkins Press and Medscape; research funding from Arnold Ventures; honoraria from grand rounds/lectures from universities, medical centers, nonprofit groups, and professional societies; speaking fees from Evicore; and fees for consulting for UnitedHealthCare. Dr Prasad is the host of Plenary Session podcast, which is partially supported by contributions from the Patreon platform. No other disclosures were reported.

    References
    1.
    Carlat  DJ, Fagrelius  T, Ramachandran  R, Ross  JS, Bergh  S.  The updated AMSA scorecard of conflict-of-interest policies: a survey of U.S. medical schools.  BMC Med Educ. 2016;16(1):202. doi:10.1186/s12909-016-0725-yPubMedGoogle ScholarCrossref
    2.
    OpenPaymentsData.CMS.gov. Search Open Payments. Published 2019. Accessed February 19, 2020. https://openpaymentsdata.cms.gov/
    3.
    Ornstein  C, Webber  T. Medical schools plug holes in conflict-of-interest policies. Published May 19, 2011. Accessed February 19, 2020. https://www.propublica.org/article/medical-schools-plug-holes-in-conflict-of-interest-policies
    4.
    Jena  AB, Olenski  AR, Blumenthal  DM.  Sex differences in physician salary in US public medical schools.  JAMA Intern Med. 2016;176(9):1294-1304. doi:10.1001/jamainternmed.2016.3284PubMedGoogle ScholarCrossref
    5.
    Waldman  A. Medical professors are supposed to share their outside income with the University of California. but many don't. Published December 6, 2019. Accessed February 19, 2020. https://www.propublica.org/article/medical-professors-are-supposed-to-share-their-outside-income-with-the-university-of-california-but-many-dont
    6.
    US Centers for Medicare and Medicaid Services. Open Payment: creating public transparency into industry-physician financial relationships. Published 2019. Accessed February 20 2020. https://www.cms.gov/OpenPayments/Downloads/forum-op-expansion-support-act-aug2019.pdf
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