Follow the money: Investigating gender disparity in industry payments among senior academics and leaders in plastic surgery

Association Between Gender and Payments Received From Pharmaceutical Companies Among Medical Professors and Associate Professors in Japan

Introduction While prior research showed gender gaps in industry payments for medical professionals in the United States, there are limited data in Japan. So, this study seeks to investigate the potential gender gap in the receipt of pharmaceutical companies (PFCs) across all medical fields in Japan. Based on the results of previous studies, we developed a hypothesis that male doctors get more PFC than female doctors. Materials and methods Data from 92 pharmaceutical companies in Japan, covering 2016 to 2019, were analyzed. The analysis was conducted on professors and associate professors at all national and public medical universities in Japan, with gender as a factor variable and payments as an outcome variable, and variables that may have influenced the factor or outcome variables in previous studies, such as specialization, university type, region, rank and years since graduation, as control variables. Payments were converted to US dollars using the December 31, 2021, rate of 115 yen to the dollar for comparison purposes. Results Out of 1,825 subjects, 1,755 were males and 70 females. Males consistently received higher median payments from pharmaceutical companies (PFCs) than females across categories. In particular, among physicians specializing in internal medicine, the median PFC for men was $25 compared to $8 for women. For physicians affiliated with former imperial universities (the seven former imperial universities founded before World War II), the median PFC for men was $32 compared to $5 for women. Multivariate analysis confirmed significantly higher total benefits for males from 2016 to 2019, with the gender gap widening during this period (incidence rate ratio (IRR) for 2016: 0.51, IRR for 2019: 0.44). Conclusions Japanese male professors and associate professors received significantly higher PFCs than their female counterparts, and this gender gap expanded from 2016 to 2019, highlighting persistent gender inequality in the medical field in Japan, similar to trends observed in the United States.

Gender parity at the podium in UK plastic surgery conferences

BACKGROUND

Despite the increase in the proportion of female plastic surgeons in the United Kingdom (UK), all-male panels continue to prevail. This article sought to establish whether the genders of speakers at conferences hosted by leading UK plastic surgery associations, the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), and the British Association of Aesthetic Plastic Surgeons (BAAPS), are representative of the consultant workforce.

METHODS

Data on the gender distribution of plastic surgeons in the workforce over the last decade were obtained from NHS Digital Workforce Statistics. The demographics of invited speakers were sought from conference agendas for both BAPRAS (from 2012 to 2022) and BAAPS (from 2014 to 2021) posted on their association's websites.

RESULTS

The proportion of female consultants increased from 16% in 2012 to 22% in 2022. The average proportion of female speakers at BAPRAS conferences was 16% ± 9% SD that was similar to the proportion of female consultants in practice (p = 0.432). In contrast, the average proportion of female speakers at BAAPS conferences was lower than those in practice (7.88% ± 8.29% SD, p = 0.0032). At BAAPS, 43% of speakers were UK plastic surgeons.

CONCLUSIONS

Although the podium speakers at BAPRAS were reflective of the consultant population, BAAPS had little to no representation of UK based female plastic surgeons. Therefore, the conference organisers need to intentionally ensure that representation at podium is reflective of the workforce.

The Association of Subspecialty and Sex with Industry Payments to Internal Medicine Physicians Who Recently Completed Training

BACKGROUND

Financial relationships with drug and medical device companies may impact quality of care and academic research. However, little is known when and how these financial relationships develop among newly independent physicians who recently completed from residency or fellowship programs in internal medicine (IM).

OBJECTIVE

To compare patterns of industry payments among IM graduates.

DESIGN

Retrospective, observational cohort study.

SUBJECTS

IM graduates from residency or fellowship programs between January 2015 and December 2019.

MAIN MEASURES

We analyzed Open Payments reports made between July 2015 and June 2021 to recent graduates of U.S. Accreditation Council for Graduate Medical Education (ACGME)-accredited residency and fellowship programs in IM. The primary outcome was general payments accepted by these physicians, stratified by procedural (i.e., critical care medicine/pulmonary medicine, cardiac/cardiovascular disease, and gastroenterology) and non-procedural (i.e., infectious disease, general internal medicine, and other specialties) subspecialties. The secondary outcomes included general payments stratified by sex and age at residency or fellowship training completion.

KEY RESULTS

There were 41,669 IM physicians with a median age of 33.0 years. In the first 3 years after completion, the proportion of physicians accepting any general payments was 72.6%, 91.9%, and 86.8% in Critical Care Medicine/Pulmonary Medicine, Cardiac/Cardiovascular Disease, and Gastroenterology, compared to 56.1%, 52.6%, and 52.3% in Infectious Disease, General Internal Medicine, and Other Specialties (p<0.0001). After adjusting for confounding variables, the procedural group showed an increased hazard ratio (HR) for accepting any general payments and at least $5000 of general payments compared to the non-procedural group. The HRs of accepting any general payments in the procedural subspecialty were 2.26 (95% CI, 2.11-2.42) and 2.83 (95% CI, 2.70-2.97) in female and male physicians, respectively (p-value < 0.0001).

CONCLUSION

Industry financial relationships among newly independent physicians in IM exist immediately after completion of training and are influenced by subspecialty, sex, and age.

How Many Plastic Surgeons Does It Take to Write an Article? A 10-Year Bibliometric Analysis of Authorship Inflation

BACKGROUND

Publications measure academic productivity; they can affect research funding and career trajectory. There is a trend of increased authors per publication in surgery journals. We sought to determine whether authorship inflation exists in the plastic surgery literature and identify independent predictors of the number of co-authors.

METHODS

We performed a bibliometric analysis of articles published in 3 high impact plastic surgery journals at 2-year intervals between 2010 and 2020. For each publication, we collected details on year of publication, article type, plastic surgery topic, gender of senior author, geographical origin of study, and the number of authors.

RESULTS

A total of 5593 articles were collected. The median number of authors per article increased over time (ρ = 0.20, P < 0.001). Cohort studies, basic science investigations, literature reviews, and systematic reviews experienced a significant increase in the number of authors per article from 2010 to 2020 (P < 0.001). The rise in the number of authors was consistent across all plastic surgery topics (P < 0.001). Both male and female senior authors had a significant increase in the number of co-authors (P < 0.001). The regression model demonstrated that article type (cohort studies, basic science investigations, and systematic reviews) predicted more co-authors, whereas geographical region (Africa, Middle East, South and Southeast Asia, and United Kingdom and Ireland) and plastic surgery topics (aesthetic and hand surgery) predicted fewer authors.

CONCLUSIONS

The number of authors per publication is increasing in plastic surgery. Author proliferation was consistent across most article types and unaffected by gender. Possible reasons behind this trend include research complexity, increased collaboration, or gift authorship.

Analysis of Industry-Related Payments Among Physician Editors of Pathology Journals

OBJECTIVES

Gender inequities in editorial board representation and physician compensation are well documented, but few studies have focused on how editors of journals are compensated.

METHODS

In this cross-sectional study, we examined industry-related compensation (from 2014 to 2020) among physician editors of 35 pathology journals using publicly available data from the Centers for Medicare & Medicaid Services Open Payments Database.

RESULTS

Of the physician editors included, 135 (69.9%) were men and 58 (30.1%) were women. Similar percentages of men and women physicians who were eligible received payments (112/135 [83.0%] men and 51/58 [87.9%] women; P = .38, χ2 test). Of the total transfer of value ($211,192,532), 112 men received $192,727,555 (91.3%), and 51 women received $18,464,978 (8.7%). Mean total payment per person was $1,720,782 for men and $362,058 for women (P = .05). The payment range for men was $18-$47,568,400 and the range of payments for women was $31-$2,375,637.

CONCLUSIONS

The findings highlight significant gender inequities in industry-related payments to physician editors of pathology journals. The financial relationships of journal editors and industry deserve further study, particularly as they relate to advancing science and closing both workforce and patient care inequities.

Industry payments made to academic endodontists: Sex differences and other insights into financial relationships

BACKGROUND

Industry payments made to health care providers can create competing interests. The purpose of this study was to define the overall financial relationships between industry and academic endodontics faculty members, detail any variation in such payment data as related to individual faculty member characteristics and leadership position by institution type, and comment on the potential impacts from conflicts of interest (COIs) created by such relationships.

METHODS

The author identified and characterized academic endodontists from information on their institutional websites. The author obtained reported industry payments from 2013 through 2019 from the Centers for Medicare & Medicaid Services Open Payments database. The author also noted the distributions of academic endodontists and industry payments by institution, academic rank, sex, and residency program director position. The author subjected the data to descriptive and nonparametric analyses.

RESULTS

Of the 302 academic endodontists included, 240 (80%) accepted reported industry payments totaling $4,260,316.97. Overall, the median of total industry payments for all 302 faculty members was $217.89 (interquartile range [IQR], $34.06-$3,070.00). Among those accepting payments, the median amount was $382.80 (IQR, $110.40-$6,234.00). The top decile of paid academic endodontists received $3,669,291.47 in industry payments (86% of the total), with a median payment of $24,013 (IQR, $17,043-$91,190). Significant sex-associated industry payment differences were seen among the overall faculty and among those with the residency program director position.

CONCLUSIONS

Most academic endodontists accept industry payments. Significant sex differences exist in overall faculty member academic rank distribution, leadership role, and accepted median industry payment amounts. COI issues have the potential to arise among academic endodontists when such industry payments are accepted.

PRACTICAL IMPLICATIONS

Existing sex disparities in academic endodontics within the United States ideally should be acknowledged. COI issues can arise when academic faculty members accept industry payments. Public knowledge of these conflicts could negatively affect individual faculty members, their institutions, and related areas such as academic publishing. Appropriate faculty member COI disclosure, attestation, annual updates, and transparency are important mitigation measures.

Hitting the Books: A Nationwide Analysis of Advanced Degrees in Academic Plastic Surgery Faculty

OBJECTIVE

Plastic surgery is one of the most competitive and innovative fields in medicine. The role of the academic plastic surgeon continues to grow beyond clinical care, and many surgeons have pursued advanced degrees (AD) to expand their professional skillset. We present an analysis of ADs of academic plastic surgery faculty in the USA, with consideration of timing of AD attainment.

METHODS

All academic plastic surgery faculty members were identified from plastic surgery program websites, as recognized by the American Council of Academic Plastic Surgeons. ADs were defined as additional degrees beyond the primary medical degree. Outcomes included timing of AD attainment, residency rankings, institutional standings, and research productivity.

RESULTS

949 faculty members were identified, and 167 had ADs. The most common ADs were PhD (30%), MS/MSc (18%), and MBA/EMBA (17%). Timing of AD attainment was available for 146 faculty members (84.7%). Having an AD before residency was associated with matching into higher-tiered and integrated residency programs (both p < 0.05). For attending physicians, having an AD was associated with more journal editorial board positions, more publications, higher H-index, receiving NIH funding, and median number of NIH grants (adjusted for years in practice, all p<0.05). Institutional analysis revealed that employing more faculty with an AD was associated with having an integrated residency program, higher residency research ranking, and higher tier integrated residency (all p < 0.05).

CONCLUSION

ADs are growing in popularity in academic plastic surgery and are temporally associated with specific advantages in terms of residency placement, research productivity, and institutional standing.

LEVEL OF EVIDENCE V

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