Park Yong Hyun, Domenico Henry John, Su Zhuo Tony, Trock Bruce J, Jing Yuezhou, Hickson Gerald, Cooper William O, Han Misop
James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Urology, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
JAMA Netw Open. 2025 Aug 1;8(8):e2526643. doi: 10.1001/jamanetworkopen.2025.26643.
Both commitment to patient welfare and conflict of interest management are important components of physician professionalism. However, the interplay between them has not been well explored.
To examine the association between unsolicited patient complaints, measured by Patient Advocacy Reporting System (PARS) Index, and acceptance of general (nonresearch) payments from industry, including significant payments, defined as exceeding $5000 annually.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study included physicians at health care sites participating in the PARS program. General payments accepted by physicians from industry were identified from the Open Payments Program database. Data were collected from July 1, 2015, through June 30, 2020, and linked using National Provider Identifier numbers. Data were analyzed from April 5, 2024, to May 12, 2025.
The physician's highest PARS Index score, categorized as 0, 1 to 20, 21 to 50, and 51 or greater.
The outcome of interest was acceptance of general payments, any or exceeding $5000 annually. Ordinal regression was used to assess the association between PARS Index scores and general payments.
This analysis included 71 944 physicians (27 065 [37.6%] female; mean [SD] age in 2015, 45 [12.5] years), with 44 296 (61.6%) practicing in academic settings. The most common specialties were internal medicine (30 043 physicians [41.8%]), general surgery (6819 physicians [9.5%]), and anesthesiology (4461 physicians [6.2%]). Of the included physicians, 49 169 (68.3%) received at least 1 general payment, and 8067 (11.2%) received more than $5000 in a year; 30 979 physicians (43.1%) received unsolicited patient complaints. Median (IQR) PARS Index score was 2 (0-17). A higher PARS Index score was significantly associated with higher general payments accepted per year (eg, PARS Index score ≥51: odds ratio [OR], 1.69; 95% CI, 1.56-1.82; P < .001). This association remained significant after adjusting for physician gender, age, region, practice setting, and specialty. Male physicians (OR, 1.90; 95% CI, 1.84-1.97) and physicians practicing at nonacademic settings (OR, 1.15; 95% CI, 1.10-1.19) were also more likely to receive higher general payments per year.
In this cross-sectional study of nearly 72 000 physicians across the US, physicians with higher PARS Index scores, indicative of a higher risk of medical malpractice claims, worse patient outcomes, and well-being concerns, were more likely to accept industry payments, particularly in higher amounts. These findings underscore the importance of conflict of interest review and management to support medical professionalism and patient trust.
致力于患者福祉和管理利益冲突都是医生职业素养的重要组成部分。然而，它们之间的相互作用尚未得到充分探讨。
通过患者权益倡导报告系统（PARS）指数衡量的非主动患者投诉与接受行业的一般（非研究）付款（包括每年超过5000美元的大额付款）之间的关联。
设计、设置和参与者：这项回顾性横断面研究纳入了参与PARS项目的医疗机构中的医生。医生从行业接受的一般付款从公开付款项目数据库中识别。数据收集时间为2015年7月1日至2020年6月30日，并使用国家提供者识别号进行链接。数据分析时间为2024年4月5日至2025年5月12日。
医生的最高PARS指数得分，分为0、1至20、21至50以及51或更高。
感兴趣的结局是接受一般付款，包括任何付款或每年超过5000美元的付款。使用有序回归来评估PARS指数得分与一般付款之间的关联。
该分析纳入了71944名医生（27065名[37.6%]为女性；2015年的平均[标准差]年龄为45[12.5]岁），其中44296名（61.6%）在学术机构执业。最常见的专业是内科（30043名医生[41.8%]）、普通外科（6819名医生[9.5%]）和麻醉学（4461名医生[6.2%]）。在纳入的医生中，49169名（68.3%）至少接受过1次一般付款，8067名（11.2%）一年收到超过5000美元的付款；30979名医生（43.1%）收到过非主动患者投诉。PARS指数得分的中位数（四分位间距）为2（0 - 17）。较高的PARS指数得分与每年接受的较高一般付款显著相关（例如，PARS指数得分≥51：比值比[OR]，1.69；95%置信区间，1.56 - 1.82；P <.001）。在调整医生性别、年龄、地区、执业环境和专业后，这种关联仍然显著。男性医生（OR，1.90；95%置信区间，1.84 - 1.97）以及在非学术机构执业的医生（OR，1.15；95%置信区间，1.10 - 1.19）每年也更有可能收到较高的一般付款。
在这项对美国近72000名医生的横断面研究中，PARS指数得分较高的医生，表明医疗事故索赔风险较高、患者结局较差且存在福祉问题，更有可能接受行业付款，尤其是金额较高的付款。这些发现强调了利益冲突审查和管理对于支持医疗职业素养和患者信任的重要性。
