Device makers vs. drug makers

Two very different payment patterns hiding inside one dataset.

Open Payments treats pharmaceutical and medical-device manufacturers identically. Their behaviour is not identical at all.

The pharmaceutical pattern

Very high volume, very low value. Millions of small food-and-beverage records spread across hundreds of thousands of prescribers, plus a concentrated layer of speaking and consulting. Breadth is the strategy, because prescribing decisions are distributed across a huge population of clinicians.

The device pattern

Low volume, very high value. Device companies concentrate on a small number of high-volume proceduralists — orthopaedic, spine, cardiac, ophthalmic surgeons. Royalties, proctoring fees, design consulting and heavy travel. A single surgeon may account for more device-company money than a thousand primary-care physicians account for in pharmaceutical money.

Why the difference exists

Devices require training. A surgeon must be taught to implant a new system, usually by another surgeon, and that teaching is paid. The relationship is technical as well as commercial, which makes it both more defensible and more entangled.

What this means when comparing doctors

Comparing a spine surgeon’s total to an internist’s total tells you almost nothing. Compare within specialty. The specialty pages on this site exist for exactly that reason.