A total of 8,333 dermatologists – 73% of those practicing in the United States – received $34.8 million from industry in 2014, mostly from pharmaceutical companies, according to an Oct. 5 report in JAMA Dermatology.

The bulk of the money went to a fraction of the dermatologists. Just 10% – 833 – collected $31.2 million. Eighty-three dermatologists – 1% of the total – pulled in about $15 million, each receiving at least $93,622. The 10 highest-paid dermatologists were mostly in private practice, not academia, and three were women (JAMA Dermatol. 2016 Oct 5. doi: 10.1001/jamadermatol.2016.3037).

Speaker fees accounted for 32% of the total payment amount, consulting fees for 22%, research payments for 17%, and food and beverage payments for 13%. Lesser amounts went towards travel and honoraria, among other things.

Almost $29 million came from pharmaceutical companies. AbbVie and Allergan led the way with payments of nearly $6 million each. Pharmaceutical company largesse is “not surprising” since companies have “financial incentives to promote their medications,” and having “thought leaders being advocates and spokespersons may help shift clinical practices,” said lead investigator Hao Feng, MD, a dermatology resident at New York University, and his colleagues. Recent studies “show that receipt of industry payments and industry-sponsored meals was associated with an increased rate of prescribing several class[es] of brand-name medications.”

The data come from the CMS Open Payments database, which records industry payments to physicians and is searchable by name. The investigators analyzed data from 2014 because it was the first year with a full 12 months of data.

For most dermatologists, industry payments didn’t amount to much: the overall median payment was $298, and 63% received less than $500. Almost 80% of the 208,613 payments in 2014 were for $50 or less.

The investigators were careful to note that industry payments are common in other specialties as well, with most of the money going to a select few. Dermatologists received 0.5% of the $6.5 billion that companies paid to U.S. physicians in 2014. Companies paid U.S. physicians $7.52 billion in 2015, according to CMS.

The Open Payments database was launched as part of the Affordable Care Act in the belief that transparency would combat the untoward effects of commercial interests and conflicts of interest on patient care, but it doesn’t catch everything. CMS only requires companies that make government-reimbursed products to report payments. For dermatologists, that means, for example, laser and other cosmetic device companies are exempt. Physicians also can direct payments to third parties. Such issues led Dr. Feng and his associates to conclude that CMS captures “only a fraction of … physician-industry financial relationships.”

Another problem, they said, is that CMS does not judge between industry payments that advance science and help patients and those that are “harmful,” so the database does little to counter public concerns about “dishonesty and selfishness” when doctors deal with industry. “Ultimately, the impact of financial disclosure from industry to dermatologists, and physicians in general, remains to be seen,” they wrote.

The investigators did not report any conflicts of interest.