Physicians with more severe or a higher number of unsolicited complaints from patients were more likely to have accepted non-research industry payments, and the trend is even stronger for those taking higher payments, an analysis published Tuesday found.
The research reviewed nearly 72,000 doctors practicing at a care site participating in the Patient Advocacy Reporting System (PARS) over a five-year period. It sought alignment between a physician’s highest PARS index score—which comprises complaints submitted through the system and is a predictor of future medical malpractice claims, worse patient outcomes and well-being concerns—and records on the Open Payments Program database of any general payments accepted by that practitioner.
That approach is a first for healthcare researchers, as is the significant positive association it unveiled, the study’s authors wrote. Though it does not explicitly demonstrate a direct causal relationship (i.e., that accepting payments leads to patient complaints), the connection raises potential ethics concerns that healthcare organizations should further investigate, researchers said.
“These findings emphasize the need for multifaceted strategies to address lapses in professionalism, safeguard the integrity of clinical decision-making and strengthen patient trust,” the researchers wrote in JAMA Network Open.
The study included physicians practicing across a range of specialties, and more than three in five practiced in an academic setting. Just over two-thirds of the sample had received at least one general payment, while about 11% had received more than $5,000 in a single year. Forty-three percent of the doctors had received unsolicited patient complaints through the reporting system.
The researchers found that the positive association persisted after adjustment for factors such as physician gender and practice setting—though male physicians were more likely to receive higher general payments per year than female physicians, as were those in nonacademic settings. The former is in line with prior research on such gender disparities, while the latter could be tied to stricter conflict of interest policies at academic medical centers.
Further analyses showed higher proportions of physicians with worse PARS index scores had accepted more general payments, and mean and median highest observed PARS index scores rose with increasing ranges of accepted payments.
“Future research should focus on evaluating the effectiveness of targeted interventions, such as peer-guided feedback to physicians who are outliers and [conflict of interest] review and management, to mitigate these challenges and promote a culture of accountability and transparency in healthcare,” the researchers wrote.
In an accompanying invited commentary, Aaron Mitchell, M.D., a health services researcher in Memorial Sloan Kettering Cancer Center’s Department of Epidemiology and Biostatistics, agreed with the authors that the trend “is highly concerning.”
He described a range of potential explanations of varying concern. One “quite plausible” reason could be that industry payments and worse PARS Index scores stem from “an underlying physician phenotype,” such as a doctor who takes a more transactional view of their role. This cause would be well addressed by the institutional interventions suggested by researchers, he wrote.
Patients could also be aware that their physician accepts general payments and take on a more critical view of their care, though that’s less likely due to how few patients are aware of Open Payments, Mitchell continued. The link could also be confounded by other factors like patient volume or subspecialty.
However, the “most obvious, and most concerning,” explanation of a direct causal relationship appears probable and is in need of additional investigation—especially in light of prior studies that have shown industry payments to drive lower-value, higher-risk prescribing.
“The need to fully understand this association is urgent, and more research is needed,” Mitchell wrote. “Industry payments to physicians would be a modifiable risk factor through policy action, and additional evidence that these payments might worsen care quality would be an important step in that direction.”