Physician professionalism and changes in physician-industry relationships from 2004 to 2009

Background: One tenet of medical professionalism is managing conflicts of interest related to physicianindustry relationships (PIRs). Since 2004 much has been done at the institutional, state, and national levels to limit PIRs. This study estimates the nature, extent, consequences, and changes in PIRs nationally. Methods: We performed a national survey of a stratified random sample of 2938 primary care physicians (internal medicine, family practice, and pediatrics) and specialists (cardiology, general surgery, psychiatry, and anesthesiology). A total of 1891 physicians completed the survey, yielding an overall response rate of 64.4%. The main outcome measure was prevalence of several types of PIRs and comparison with PIRs in 2004. Results: Overall, 83.8% of all respondents reported some type of relationship with industry during the previous year. Approximately two-thirds (63.8%) received drug samples, 70.6% food and beverages, 18.3% reimbursements, and 14.1% payments for professional services. Since 2004 the percentage of each of these benefits has decreased significantly. Higher rates of PIRs are significantly and inversely associated with low levels of Medicare spending. Conclusion: Among a random sample of physicians, the prevalence of self-reported PIRs in 2009 was 83.8%, which was lower than in 2004.