Evaluation of Conflict of Interest in Consulting Fee Payments in Plastic Surgery and Related Specialties

Background:The Physician Payments Sunshine Act was enacted to increase transparency regarding physician and industry financial interests. Consulting fee payments constitute a large proportion of these financial relationships. The authors hypothesized that there are discrepancies among industry-derived consulting payments to medical and surgical specialties. The purpose of this study was to evaluate the distribution of consulting fee payments to plastic surgery and related specialties.Methods:This cross-sectional study used the publicly available Centers for Medicare & Medicaid Services Open Payments Program database for 2018. Consulting fee payments to physicians practicing in dermatology, internal medicine, neurosurgery, orthopedic surgery, otolaryngology, and plastic surgery were isolated and analyzed to identify discrepancies in consulting payments among these specialties and within plastic surgery.Results:A total of $250,518,240 was paid in consulting fees to specialties analyzed, with the largest average payment made to orthopedic surgeons and neurosurgeons. Nearly half of physicians were paid at least $5000 for consulting fees in 2018. Most payments were not associated with contextual information. Among U.S. plastic surgeons, 4.2% held financial relationships with corporations and were likely to be paid more when consulting for small companies.Conclusions:Consulting payments make up a large proportion of payments included in the Open Payments Database. Although sex, state, company type, and sole proprietorship did not correlate with higher pay, plastic surgeons who consulted for small companies were paid more per payment than those working for large companies. Future studies are warranted to determine whether these industry financial relationships impact physician behavior.