Question About Payment to Doctors


Hey Patrick (cc Dad)


My Dad and I just looked up my sleep doctor and the government site for tracking “payments” to doctors from pharmaceutical and equipment companies, and were shocked to see his numbers… $56,000+ in the year 2016 alone. Take a look at


What we don’t understand is what form these payments may have come in… Is there any explanation that looks good? If you click on the “payment information” button and hover over any of the bar graphs, you can get more detailed information. For example, you’ll see that $33,000 of that came from “Respiratory Technologies.” What do you think this was or could have been?






a Little Graft to Help Things Along


I paste below the column I was prompted to write for Front Porch (will be published in November) which maybe partially answers Michaels query.


A maybe more direct answer to his “is there any explanation that looks good?” would be “no.” Or not that I can see.


It all comes back to this issue of is it OK for any company providing medical services to use any trick they can to maximize their profits. Or is there something fundamentally different about healthcare.


Should providers (of medicines, devices, imaging, labs, hospitals and doctors providing medical services in general) be free to use any marketing gambit that a car manufacturer, hotel chain, restaurant, cell phone company etc might use? And then charge as much as the market will stand?


And the “market will stand” quite a lot. That is people will pay through the nose if they think they are going to die if they don’t. Consequently profits in healthcare are high, and a lot of corporate enterprises are getting in on the (lucrative) action.


These payments to doctors are just another manifestation.





So this is what I wrote:


My nephew, Michael, who has some sleep issues, has just been introduced to cynical world of manufacturers making payments to doctors and the potential conflict of interests this creates.


He sent me an email saying he had found you can look up what payments any doctor has received from pharmaceutical or medical device companies at the Center for Medicare and Medicaid Services (


He looked at what payments his sleep doctor had received and “was shocked” to see he had received $56,000 and change for 2016. And wanted to know “is there any explanation that looks good?”


“Welcome to the real world” was my response. This payment to doctors is not a new phenomenon. But what is relatively new is that it is possible to find out about what payments have been made and by whom – at least for the moment.


This is thanks to The Physicians Payment Sunshine Act passed in 2010, a part of the Affordable Care Act (another of those perks of the ACA but which no one ever seems to know about).



Pay For Performance




“So what’s wrong with these payment to doctors?” you might ask.


In the dog-eat-dog world of business, a little “schmoozing,” whether it be strait out dosh, trips to golf resorts/vineyards/nice restaurants/cruises/ski trips, or some kind of tchotchke is not so uncommon. In fact if it promotes the companies sales, everyone’s happy.


This brings up this debate about is medicine different to industry as a whole?


Whatever you think, there’s an awful lot of schmoozing goes on – to the tune of about $17 billion in the last 7 years, reports the website Stat News.


Fees are paid to experts for presentations, consultations and doing “research” on drugs and devices – a lot of it pretty bogus.


Most worrisome is the potential conflict of interests when some expert in the pay of one of these companies writes treatment guidelines for the rest of the profession to follow.

They talk about "eminence based medicine" instead of "evidence based" when you get some hot shot thought leader to persuade the audience their companies product is what you should use.



Drug Dinners


By far the most widespread type of “schmoozing” by drug companies however, is for we primary care medical “peons” and is “the Drug Dinner” – this is a dinners about , drugs I hasten to point out. It is usually at some fancy restaurant.


Ask any doctor if they can be bought with a steak and and a glass of wine and they will hotly deny it. But a study published in JAMA Internal Medicine concluded “receipt of industry-sponsored meals was associated with an increased rate of prescribing.” Prescribing expensive, name brand medicines - that the drug company produces.


And what’s really bad is how cheep we doctors are. Many of the meals provided had a mean value of less than $20.




The Other Deviousness



Self referrals (sending patients to some facility like an imaging or surgical center that the doctor has a financial interest in) is another area of conflict of interest.


One study of urologists sending patients for radiation treatment or example found non-owner urologist referrals decreased 5 per cent. But at the same time, those referred by doctors who had a financial steak increased by as much as 356 per cent.


There is no law requiring reporting of self-referrals. And the Sunshine Act is under threat – a bill to reverse it passed the House already but failed in the Senate. And there are grave concern that if the ACA is dismantled we will loose it.


So I say to nephew Michael, good job for being enough of a Medically Emancipated Patient to find out about these wicked payments your doctor is receiving and the potential conflict of interests this creates.


As always, it comes down to riding your politicians to do the right thing.


To preserve this one small step toward consumer empowerment.




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