In the JournalsPerspective

Female radiation oncologists receive smaller share of industry funding than male counterparts

Female radiation oncologists appeared to benefit less from industry relationships than their male counterparts, receiving an inequitable proportion of industry funding and lower median payments across categories, according to study results published in JAMA Network Open.

“The introduction of the CMS Open Payments program as part of the Physician Payments Sunshine Act has permitted the increased scrutiny of physicians’ industry relationships,” Julius K. Weng, BS, of the department of radiation oncology at David Geffen School of Medicine at University of California, Los Angeles, and colleagues wrote. “More than 50% of radiation oncologists received industry payments in 2014, but the sex distribution of these payments has not been characterized.”

In the retrospective, cross-sectional study, Weng and colleagues acquired data on the 3,052 (68.1%) of 4,483 practicing U.S. radiation oncologists in 2016 (74% men; n = 3,319) with industry payment data in the CMS Open Payments database. The CMS program required industry reporting of any individual payments greater than $10.22 or total payments exceeding $102.19 in a calendar year.

The researchers established total monetary value, number of payments and median payment amounts for each sex in payment categories that seemed indicative of a substantial industry-physician relationship, such as research, consulting, services other than consulting, honoraria, grants linked to industry ownership, and royalty or license. Researchers assessed other payment types — such as charitable donations, education, food and beverage, travel and lodging, and entertainment/gifts — in an exploratory analysis.

Industry payment amounts in 2016 and the correlation of median payment with the types of payment by sex served as the study’s primary outcomes.

Results showed that 61.4% (n = 1,164) of female oncologists received at least one industry payment vs. 70.4% (n = 2,237) of male radiation oncologists.

Consulting represented the most common payment type (n = 369) and had the highest overall monetary value ($2,745,252). Industry grants represented the least common payment (n = 29) but second largest in terms of monetary value ($2,467,906).

Research payments had the lowest overall value ($208,005; n = 29).

In each category, female radiation oncologists received a smaller proportion of total funding than the proportion of women documented in each category. Female radiation oncologists received smaller median payments in consulting (–$1,000; 95% CI, –1,966.67 to 100.63) and honoraria (–$500; 95% CI, –1,071.43 to 0). They also received less in research payments (–$135.02; 95% CI, –476.93 to 6.88), although this difference was not statistically significant.

Female radiation oncologists did not receive any of the $1,347,509 in royalty or license payments provided to 72 physicians.

The researchers acknowledged some limitations to the study, including its reliance on the CMS Open Payments database and uncertainty regarding the total number of radiation oncologists in the U.S. in 2016.

“The Physician Payments Sunshine Act, although originally intended to provide insight into problematic conflicts of interest, has shed light on sex inequality in industry relationships,” the researchers wrote. “However, the identification and surveillance of sex inequality may only be a step toward parity. The path toward mitigating inequity likely must be multifaceted, and numerous strategies for addressing these barriers have recently emerged. It is incumbent on all of us — regardless of sex — to advocate for and word toward equality.” – by Jennifer Byrne

Disclosures: The researchers report no relevant financial disclosures.

Female radiation oncologists appeared to benefit less from industry relationships than their male counterparts, receiving an inequitable proportion of industry funding and lower median payments across categories, according to study results published in JAMA Network Open.

“The introduction of the CMS Open Payments program as part of the Physician Payments Sunshine Act has permitted the increased scrutiny of physicians’ industry relationships,” Julius K. Weng, BS, of the department of radiation oncology at David Geffen School of Medicine at University of California, Los Angeles, and colleagues wrote. “More than 50% of radiation oncologists received industry payments in 2014, but the sex distribution of these payments has not been characterized.”

In the retrospective, cross-sectional study, Weng and colleagues acquired data on the 3,052 (68.1%) of 4,483 practicing U.S. radiation oncologists in 2016 (74% men; n = 3,319) with industry payment data in the CMS Open Payments database. The CMS program required industry reporting of any individual payments greater than $10.22 or total payments exceeding $102.19 in a calendar year.

The researchers established total monetary value, number of payments and median payment amounts for each sex in payment categories that seemed indicative of a substantial industry-physician relationship, such as research, consulting, services other than consulting, honoraria, grants linked to industry ownership, and royalty or license. Researchers assessed other payment types — such as charitable donations, education, food and beverage, travel and lodging, and entertainment/gifts — in an exploratory analysis.

Industry payment amounts in 2016 and the correlation of median payment with the types of payment by sex served as the study’s primary outcomes.

Results showed that 61.4% (n = 1,164) of female oncologists received at least one industry payment vs. 70.4% (n = 2,237) of male radiation oncologists.

Consulting represented the most common payment type (n = 369) and had the highest overall monetary value ($2,745,252). Industry grants represented the least common payment (n = 29) but second largest in terms of monetary value ($2,467,906).

Research payments had the lowest overall value ($208,005; n = 29).

In each category, female radiation oncologists received a smaller proportion of total funding than the proportion of women documented in each category. Female radiation oncologists received smaller median payments in consulting (–$1,000; 95% CI, –1,966.67 to 100.63) and honoraria (–$500; 95% CI, –1,071.43 to 0). They also received less in research payments (–$135.02; 95% CI, –476.93 to 6.88), although this difference was not statistically significant.

Female radiation oncologists did not receive any of the $1,347,509 in royalty or license payments provided to 72 physicians.

The researchers acknowledged some limitations to the study, including its reliance on the CMS Open Payments database and uncertainty regarding the total number of radiation oncologists in the U.S. in 2016.

“The Physician Payments Sunshine Act, although originally intended to provide insight into problematic conflicts of interest, has shed light on sex inequality in industry relationships,” the researchers wrote. “However, the identification and surveillance of sex inequality may only be a step toward parity. The path toward mitigating inequity likely must be multifaceted, and numerous strategies for addressing these barriers have recently emerged. It is incumbent on all of us — regardless of sex — to advocate for and word toward equality.” – by Jennifer Byrne

Disclosures: The researchers report no relevant financial disclosures.

    Perspective

    Miriam A. Knoll, MD

    From the physician standpoint, industry payments can serve as a marker of professional standing and a tool for advancement. It’s important for us to study the flow of industry resources because they have a potential to significantly influence one’s career. 
    This study reports that 23.4% of industry disbursements to radiation oncologists in 2016 were received by women, which is in line with their representation among all radiation oncologists, at 25.9%. However, only 4.9% of the total dollar amount was paid to these women, demonstrating that male radiation oncologists are paid significantly more per distribution.
    Do the unconscious biases fueling this disparity originate within industry culture or medical culture? 
    It is likely both. On the one hand, industry payments are distributed by an outside establishment, ie industry, which has its own culture and gender-based values that impact how it decides to distribute payments. 
    On the other hand, these monies are likely distributed to those physicians who are already valued within our own culture of medicine and can serve to reinforce or even contribute to one’s professional advancement.
    It is unwise for us to ignore or accept this status quo, for a few reasons:
    1. If we want the best and the brightest leading health care, we need to make all sources of professional advancement open to all eligible oncologists, independent of gender, race or other biases. We truly need ‘all hands on deck’ to solve the problems of cancer care.
    2. We should investigate the reasons why women appear to accept lower payments than men. Is it because women don’t negotiate well? Are female physicians not aware of the maximum opportunities their male peers have access to? We should not assume women don’t want to be involved with industry, because they clearly do — in this study, women comprised 26% of all radiation oncologists and similarly received 23% of industry payments.
    3. We should hold industry accountable to this data, so that oncologists can collaborate with industry more effectively. We should encourage industry to help fix our leadership disparity by proactively and deliberately awarding payments and grants to underrepresented individuals, to help fuel their professional advancement.
    Let’s use the data to fuel action and create more opportunity for all oncologists.

    Miriam A. Knoll, MD

    John Theurer Cancer Center

    Hackensack University Medical Center

    Disclosure: Knoll reports no relevant financial disclosures.