Author Insights: Leaders at Academic Centers Often on Drug Company Boards

Walid F. Gellad, MD, MPH, of the University of Pittsburgh and staff physician at the Pittsburgh VA Medical Center and colleagues, found many leaders at academic medical centers are paid to serve on pharmaceutical company boards. Image: iStock.com/graffoto8

Walid F. Gellad, MD, MPH, of the University of Pittsburgh and colleagues, found many leaders at academic medical centers are paid to serve on pharmaceutical company boards. Image: iStock.com/graffoto8

Many leaders at academic medical centers are doing double duty, serving on the boards of pharmaceutical companies and being paid handsomely for it, finds an analysis published in JAMA today.

Nearly half of the top 50 pharmaceutical companies worldwide have leaders from top academic medical centers on their boards. Of the 17 US drug companies, 16 count academic center leaders. These individuals, who included 2 university presidents, 6 deans, 6 hospital system executives, and 7 department chairs or directors. The average compensation they received for board service was $312 564. By comparison, the average dean of medicine earns $445 781, and the average associate dean at a medical school makes $196 212, according to a 2012-2013 survey by the College and University Professional Association for Human Resources.

Walid F. Gellad, MD, MPH, assistant professor of medicine at the University of Pittsburgh and staff physician at the Pittsburgh VA Medical Center, discussed the study’s findings with news@JAMA:

news@JAMA: Why did you and your colleagues decide to do this study?

Dr Gellad: There’s a lot of interest in identifying potential conflicts of interest in medicine. There is the Physician Payment Sunshine Act, which reveals payments companies make to physicians. The issue is of great interest to medical trainees, especially because there are limits on receiving free pens or lunches. The issue of dual leadership at academic centers and on corporate boards has received less attention.

news@JAMA: Do you think this is a new phenomenon?

Dr Gellad: I don’t think it is new at all. One study in 2007 in JAMA looked at the corporate relationships of department chairs.

news@JAMA: Were you surprised by the number of administrators serving on pharmaceutical company boards?

Dr Gellad: Yes. There are different grades of leadership represented. They are not all deans or chief executives, but all have some leadership role. This is about individuals holding dual leadership responsibilities at academic and pharmaceutical companies.

news@JAMA: What about the magnitude of the compensation?

Dr Gellad: I think it is pretty standard for someone who serves on a corporate board. This is from public data. It also includes stock and charitable donations made on behalf of these individuals. These numbers are striking when the salaries of most academic center leaders are not that much higher than what they are receiving for serving on a corporate board. It is way greater than the average salary of most people in the country.

news@JAMA: What do you think can or should be done?

Dr Gellad: Our hope is that this paper gets people to ask that question. It’s up to university ethicists and other university leaders to decide what should happen. We need to understand the risks and benefits of these relationships. I think a lot of people are not aware these relationships exist.

news@JAMA: Is there anything you’d like to add?

Dr Gellad: We wanted to make clear in putting this together that we wanted this study to focus not on individuals but on the topic.

Author Insights: Generous Pay for Nonprofit Hospital CEOs Not Tied to Quality of Care, Community Benefits

Ashish K. Jha, MD, MPH, professor of health policy and management at Harvard University, and his colleagues found that generous compensation for nonprofit hospital CEOs is not tied to the quality of care patients receive. Image: Harvard University

Ashish K. Jha, MD, MPH, professor of health policy and management at Harvard University, and his colleagues found that generous compensation for nonprofit hospital CEOs is not tied to the quality of care patients receive. Image: Harvard University

The average chief executive officer (CEO) of a nonprofit US hospital makes more than half a million dollars, yet CEO pay is not linked to the quality of care the institution provides, suggests a study published today in JAMA Internal Medicine.

The financial behavior of nonprofit hospitals has received increased scrutiny in recent years, with investigations probing how much charity care they provide and whether they are fulfilling their obligations to the communities they are bound to serve. Among the controversies has been the fact that many CEOs at these institutions receive compensation packages that are comparable with those at for-profit corporate entities. But what hospitals are getting for the money isn’t necessarily clear.

To provide some insight, Ashish K. Jha, MD, MPH, professor of health policy and management at Harvard University, and his colleagues set out to examine the factors that influence the pay of nonprofit hospital CEOs. They examined the relationship between pay for 1877 CEOs at 2681 private, nonprofit hospitals and how well the hospital performed on various metrics, including financial status, technology, quality of care, and benefit to the surrounding community. There was wide variation in CEO pay from as little as about $100 000, at primarily small rural facilities, to $2 million, at some urban teaching hospitals. On average, these CEOs received $595 881 in compensation; their compensation was associated with the number of beds in the facility (with an average of a $550 bump in compensation per additional bed), whether the hospital was a teaching hospital (with $425 078 more for CEOs at teaching hospitals), the facility’s technological level (with $135 862 more at more technologically advanced hospitals), and the level of patient satisfaction (with $51 706 more at hospitals with high patient satisfaction). There was no association, however, between CEO pay and the hospital’s profit margins, liquidity, capitalization, occupancy rates, quality of care, mortality rates, readmission, or community benefit.

Jha discussed the findings with news@JAMA.

news@JAMA: Why did you decide to do the study?

Dr Jha: Everyone is paying more attention to quality of care; hospitals are, too. We wondered whether senior leaders at hospitals are seeing their compensation tied to quality, so we looked at what factors explain the variation in CEO pay.

news@JAMA: Were you surprised by what you found?

Dr Jha: We were not surprised that larger hospitals pay more or that CEOs who oversee more hospitals are paid more. But we were surprised to see CEOs of teaching hospitals paid more. Maybe this is because teaching hospitals are more complex to manage or these hospitals draw from a different talent pool.

We were more surprised by the link between pay and hospital technology. We were a little disappointed about the quality findings. I was hoping quality metrics would account for a small portion of CEO pay, but we found essentially no relationship with patient outcomes.

news@JAMA: Why do you think patient satisfaction factors into CEO compensation?

Dr Jha: The patient experience is what everyone understands the best. It may be easier for hospital boards to measure.

news@JAMA: What would you like to see hospitals do with the results?

Dr Jha: I hope most hospitals see this information as an opportunity. The way incentives are structured affects behavior. If part of the goal is to improve care, one approach would be to tie senior management salaries to patient outcomes. I think it has the potential to have a profound impact on how well patients do in those hospitals.

news@JAMA: Is there any way patients or clinicians might want to use this information?

Dr Jha: From the health care provider perspective, physicians are increasingly seeing their salaries tied to quality, so it is only fair if senior management’s salaries are tied to quality as well. For patients, everyone from the physician to the senior executives should have incentives to improve care. If organizations would do that, patients would be better off.

news@JAMA: Some have questioned nonprofit hospitals’ contributions to their communities in recent years. Did your study add anything to this debate?

Dr Jha: There was not much of a relationship between community benefit and CEO pay. With nonprofit hospital CEOs, you would like to see CEOs rewarded for providing community benefits. But providing more charity care can be financially challenging for these hospitals, so there can be a downside. Certainly, nonprofit organizations should be prioritizing community benefits. I personally would like to see senior management compensation tied to community benefits.

Academic Training Policies Can Affect Brand-Name Prescribing Patterns, Says Study

New research shows that strict conflict-of-interest policies in academic medical centers influenced psychiatrists who trained there to prescribe lower rates of brand-name antidepressants than psychiatrists who trained earlier, before such policies were adopted. (Image: Chad McDermott/iStockphoto.com)

New research shows that strict conflict-of-interest policies in academic medical centers influenced psychiatrists who trained there to prescribe brand-name antidepressants at lower rates than psychiatrists who trained earlier, before such policies were adopted. (Image: Chad McDermott/iStockphoto.com)

Strict conflict-of-interest policies in academic medical centers may help resident physicians resist pharmaceutical company persuasion to prescribe expensive brand-name medications, according to a new study.

Researchers at the University of Pennsylvania’s Perelman School of Medicine analyzed data from 2009 about the antidepressant prescribing patterns of 1652 psychiatrists from 162 US residency programs. “Our study focuses on antidepressants because they have been among the most heavily marketed drug classes,” said lead author Andrew J. Epstein, PhD. He noted that antidepressant use increased by nearly 400% from 1988 to 2008. Continue reading

Author Insights: Gender-Based Pay Gap Persists Even for Top Medical Researchers

Reshma Jagsi, MD, DPhil, associate professor in the department of radiation oncology at the University of Michigan, and her colleagues found that sex-based pay disparities exist even among high-achieving physician researchers. (Image: University of Michigan Health System)

Among elite medical researchers in the prime of their careers, those who are female are paid about $12 000 less per year than their male counterparts, according to an analysis of survey results published in JAMA today. This disparity persisted even when the authors of the analysis adjusted for factors such as hours worked and the specialty of the researcher.

Previous studies have suggested that women physicians are paid less than men, but there has been a persistent debate about whether this disparity could be explained by different choices made by men and women physicians. Some have argued, for example, that the pay gap is the result of women choosing lower-paying specialties or working fewer hours than male physicians. To probe whether such choices explain this pay gap, a team of researchers surveyed a select group of US physicians who had received K08 or K23 grants from the National Institutes of Health between 2000 and 2003 and analyzed the responses of 800 actively practicing at US academic institutions.

Lead author Reshma Jagsi, MD, DPhil, associate professor in the department of radiation oncology at the University of Michigan, discussed the results with news@JAMA. Continue reading

A Mixed Reception for NIH Conflict-of-Interest Rules

New rules from the National Institutes of Health require institutions to provide more detail about the money their scientists receive from industry. (Image: Mark Kostich/iStockphoto.com)

A long-awaited update to the National Institutes of Health (NIH) rules governing conflicts of interest requires institutions receiving federal funding to disclose more detail about their investigators’ financial relationships with industry.

Since the previous set of rules was established in 1995, several high-profile scandals involving conflicts of interest have roiled major academic medical centers and led many organizations to call for stronger oversight by the NIH. The new rules, which took 3 years to produce, lower the disclosure threshold for financial ties with industry that a researcher must disclose from $10 000 to $5000. The rules will also require investigators to disclose all such interests that are related to their roles within their institution, require institutions to report to the funding agency specific details about the financial relationships of their investigators and their plans for managing them, and require institutions to provide training for investigators on conflict-of-interest rules and policies. Academic institutions will have 1 year to implement the changes. Continue reading

Analysis Finds Care Suffers During July Turnover

A new analysis links turnover of medical trainees in July with less efficient medical care and higher patient mortality. (Image: Michael Monu/iStockphoto.com)

Patients may want to avoid hospitalization during July, if possible, when the annual turnover of medical trainees occurs. The reason: the change is associated with an increase in mortality rates and a decrease in the efficiency of care, according to a new analysis of the literature published online by the Annals of Internal Medicine.

The systematic review of 39 studies, most conducted in the United States, bolsters the evidence of a “July effect,” in which the departure of experienced trainees and the arrival of less experienced trainees is associated with poorer care. The reviewers found that higher-quality studies found that the relative risk of mortality increased from 4.3% to 12%, depending on the study, during this turnover in trainees. Many lower-quality studies failed to find such an increased risk, but many may have lacked the statistical power to do so. Additionally, the review detected a reduction in efficiency, such as longer hospital stays, during the turnover. Continue reading

Telemedicine Aids Hepatitis C Treatment in Rural Areas

Treatment for chronic hepatitis C virus infection can be as effective at rural primary care centers as at academic medical centers, according to a new study. (Image: E. H. Cook Jr/CDC)

Rural primary care centers can treat chronic hepatitis C virus (HCV) infection as effectively as academic medical centers, given the proper tools and training. A study released online today in the New England Journal of Medicine says the primary care model used in rural New Mexico could bring much-needed care to underserved populations with complex, chronic illnesses in other parts of the United States and the world.

Investigators tracked treatment success rates at 21 Extension for Community Healthcare Outcomes (ECHO) sites, which included 16 community primary care centers and 5 prisons. The University of New Mexico Health Sciences Center in Albuquerque launched the program in 2003 to improve access to care for HCV infection and to study treatment outcomes. The model uses video and telephone conferences to link community health professionals with specialists at the university for discussions of patients’ cases and brief teaching sessions. Continue reading