Clinicians and industry payments

Open Payments' 2024 general-payment file — a manufacturer- and GPO-reported record of every transfer of value to a US physician, advanced-practice provider, dentist, or teaching hospital — joined to the clinician roster from dim_clinician, Part B utilization from fct_physician_utilization, and Part D prescribing from fct_prescriber_drug_spending. Every chart below reads a pre-aggregated source query; the 15.5M-record raw fact never leaves the warehouse. Payment payers are always rolled up on paying_manufacturer_or_gpo_id, never on raw name, so the same manufacturer under mixed-case filings collapses to one row.

How concentrated are the dollars?

Two thirds of every industry dollar reaches only the top 1% of paid clinicians, and 90% stops with the top 10%. The bottom half of the paid population combined receives a rounding-error share.

Looked at the other way — by absolute dollar bracket per clinician — about 83% of paid NPIs receive under $1,000 across all of 2024 combined, and 4,132 (0.4%) cross $100,000. Those 4,132 clinicians account for the bulk of the total.

The Food-and-Beverage paradox

Read either column at a time: Food and Beverage is by far the most common transfer type but each meal is small; Royalty or License is the smallest transaction count on the chart (about 15k records) yet tops the dollar ranking.

Who pays

The top 15 payers by 2024 dollars. Roll-up is on paying_manufacturer_or_gpo_id, so mixed-case duplicates of the same entity collapse to one row and any_value(name) chooses a single deterministic display label per id.

The list splits by business model: pharma manufacturers (AbbVie, Medtronic, Takeda, AstraZeneca) file hundreds of thousands of small meal / consulting records against a broad clinician base, while a few device and specialty firms (BioNTech, Edge Endo, DePuy Synthes) concentrate nine-figure totals on a handful of clinicians. BioNTech's number is almost entirely one royalty stream; Edge Endo's is a single $91.08M acquisition payment to one endodontist.

Who gets paid

Two rankings of the same specialty axis. First, top specialties by total dollars — dominated by high-volume Internal Medicine plus surgical fields with expensive implants. Endodontics ranks third almost entirely on the strength of Edge Endo LLC's $91.1M acquisition payment to a single clinician (see the per-clinician note below):

Second, the same table sorted by dollars per paid clinician (min 100 paid clinicians per specialty). The ranking flips: orthopaedic sub-specialties, endodontics, and other implant-centric fields average five figures per paid clinician, while primary-care specialties average low three figures each even though the summed total is large. Endodontics' top rank ($54K per clinician) is carried almost entirely by 11 Edge Endo LLC records to 9 clinicians — one $91.08M acquisition line plus a handful of small consulting and device-loan entries. Strip those 11 records out and the per-clinician average falls ~89% to ~$5.9K, dropping endodontics out of the top 15.

Payments and prescribing

The industry-payment fact and the Part D prescriber fact share NPI as a key — the intersection is 642,414 clinicians who both received industry payments in 2024 and appear in the prescriber-drug file. The two facts describe different behaviors reported by different parties, so the join surfaces an association between payment receipt and prescribing volume. It does not measure whether payments cause prescribing to change.

Grouping every prescriber by their total 2024 industry payments — a "No payments" bucket for the 497k prescribers with none, then deciles of the remaining 642k — median prescriber-billed drug cost rises steeply across the paid deciles: from ~$2.7K in decile 1 to ~$162K in decile 9 (~59×), with decile 10 slightly below decile 9 at ~$148K:

The association is real and large, but selection is heavy on both sides: manufacturers target clinicians who already prescribe a lot, and high-volume prescribers are more likely to be attend the meetings and dinners where payments are filed. Median (not mean) is the better summary here — decile 10's mean $ paid is inflated by a handful of royalty recipients receiving seven and eight figures.

Sliced by specialty rather than by decile, the paid share is high (≥ 70%) in nearly every high-volume prescribing specialty; primary care and psychiatry are the outliers with paid shares closer to half.

Do the drugs match?

The top 20 drug products by 2024 promotional spend, joined to Part D prescriber-billed spend on the same brand (upper-cased brand-name match against fct_prescriber_drug_spending). Rows with no Part D match are honest nulls, not zeros — Comirnaty and Pluvicto aren't Medicare Part D drugs, so their absence is the join working correctly, not missing data.

Ratio of promo $ to prescriber-billed $ varies by two orders of magnitude across products — Jardiance sees ~$1 of promo per $700 of prescribing, Sotyktu ~$1 per $4. Read this as a portfolio-strategy signal (mature drugs get less promotion per prescribing dollar than newly launched ones), not as an efficacy or influence signal.

Utilization: paid vs unpaid

For the 1.24M individual-clinician rows in fct_physician_utilization that also carry a payments-vs-no-payments label, the median clinician who received any 2024 industry payment bills roughly 1.8× the Medicare beneficiaries and 1.77× the Medicare dollars of the median clinician who received none. Average HCC risk score is essentially identical between the two cohorts — this isn't about paid clinicians treating sicker patients.

Same caveat as the prescribing section: manufacturers target high-volume clinicians, so the cohorts are not exchangeable. The utilization gap is what the two selected populations look like side by side, not the effect of receiving a payment.

Caveats

• One program year. fct_industry_payments currently holds program year 2024 only (payment_year = 2024, published mid-2025). Nothing on this page is a time series; a paid clinician here means a clinician who received at least one reportable transfer during calendar 2024.
• Coverage recipients are individuals + teaching hospitals. 51,278 records (~0.33%) carry no covered_recipient_npi and drop out of every NPI-based aggregation above: 37,388 name a teaching hospital rather than an individual clinician, and the remaining ~13.9K (7,729 non-physician practitioners + 6,161 physicians) are individual-clinician records filed without an NPI. All of these rows are still in the total dollar headline.
• Roster coverage is partial. 32.4% of paid NPIs don't appear in `dim_clinician` — the roster covers only currently Medicare-enrolled clinicians while Sunshine reports on every US physician / dentist / APP a manufacturer paid, including retirees, out-of-network dentists, and clinicians who never billed Medicare. Charts that only need Open Payments fields (nature, payer, specialty, product) are unaffected; the utilization and prescribing joins silently drop those NPIs.
• Prescribing snapshot has no year. fct_prescriber_drug_spending is a single vintage of Part D prescriber-drug totals with no year column; the association charts compare 2024 industry payments to a snapshot of prescribing that covers calendar 2024 claims. Rows below 11 claims are suppressed by CMS and drop out of the join denominator.
• Association ≠ causation. Every payment-vs-prescribing or payment-vs-utilization comparison on this page is observational. Manufacturers target high-volume clinicians (payment goes toward where the demand is), so the cohorts on either side of any split are not exchangeable. Nothing here estimates the effect of receiving a payment on how much a clinician prescribes or bills.
• covered_recipient_specialty uses NUCC pipe-delimited paths. The "specialty" tables above show them verbatim rather than normalizing to a shorter label; that keeps the taxonomy honest (Allopathic & Osteopathic Physicians|Orthopaedic Surgery and …|Orthopaedic Surgery|Orthopaedic Surgery of the Spine are different specialties in the source) but forces a bit of scrolling.
• Products are position-1 only. Open Payments records can carry up to five associated products; fct_industry_payments exposes slot 1 (populated on ~94% of records) as product_name / product_category. The remaining slots stay in the staging layer.