Evaluation of Industry Payments to US Advanced Practice Clinicians in 2021

Importance: Advanced practice clinicians (APCs) are a growing part of the US health care system, and their financial relationships with pharmaceutical and medical device companies have not been well studied.

Objectives: To examine the value, frequency, and types of payments made to APCs and the association of state scope-of-practice laws with these payments.

Design, setting, and participants: This cross-sectional study used 2021 Open Payments Program data to analyze payments from pharmaceutical or medical device companies to physicians or APCs between January 1 and December 31, 2021. Doctors of medicine and osteopathy were categorized as physicians, and nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists, certified nurse midwives, and anesthesiologist assistants as APCs.

Main outcomes and measures: The total value and total number of payments were calculated in aggregate and per clinician for each type of APC, all APCs, and physicians. These calculations were repeated by submitting manufacturer, form of payment, nature of payment, and state scope-of-practice law for nurse practitioners, physician assistants, and physicians.

Results: A total of 412 000 physicians and 232 000 APCs collectively received 1.99 billion dollars in payments from industry in 2021, of which APCs received 121 million dollars (6.1%). The median total value of payments per clinician for physicians was 167 dollars (IQR, 45-712 dollars) and for APCs was 117 dollars (IQR, 33-357 dollars). The median total number of payments per clinician was equal for physicians and APCs (n = 4). The most common payments to APCs included food and beverage (69 million dollars [57.6%]), compensation for services other than consulting (32 million dollars [26.4%]), and consulting fees (8 million dollars [6.6%]). Advanced practice clinicians in states with the most restrictive scope-of-practice laws received 15.9% lower total value of payments than those in the least restrictive states (P = .002). Physician assistants received 7.6% (P = .005) higher value and 18.1% (P < .001) greater number of payments than nurse practitioners.

Conclusions and relevance: In this cross-sectional study, 232 000 APCs collectively received $121 million in industry payments in 2021. The frequency of industry interactions with APCs was similar to that for physicians, but the average value was lower. The greater value of payments to APCs who practice in states with the least restrictive scope-of-practice laws suggests that industry payments may be related to clinician autonomy.