Abstract
IMPORTANCE: 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. OBJECTIVE: 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. EXPOSURE: The physician's highest PARS Index score, categorized as 0, 1 to 20, 21 to 50, and 51 or greater. MAIN OUTCOMES AND MEASURES: 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. RESULTS: 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. CONCLUSIONS AND RELEVANCE: 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.