When it comes to receiving payments from drug companies or medical-device makers, the top 10 physicians in Philadelphia are in elite territory.
Each got more than $400,000 in 2015, with the top three pulling in more than $1 million apiece — compared with a national median of less than $200.
Eight of the 10 work at the same place: the Rothman Institute.
The companies are required to report these funds to the federal Open Payments database so that consumers can identify potential conflicts of interest — if, say, pharmaceutical firm X flies doctors to Florida to share the latest news about a drug, or buys them lunch to promote some new research.
But this category of payments also includes royalties and consulting fees, which is where the top recipients in Philadelphia make their mark.
Nine of them invented or helped to develop a new joint replacement, and one, Thomas Jefferson University's Demetrius Bagley, developed endoscopes for use in urology.
In an interview, Rothman said the payments were for a hip implant he designed, called the Accolade. He said he welcomed the requirement for disclosure of the payments.
"This scorecard just reflects the creativity and energy and talents of our faculty," he said.
There are several different models through which physicians are compensated for their intellectual property. In the case of royalties, physician-inventors typically earn 1 percent to 3 percent of the price per device that is implanted by others, Rothman said. They do not earn anything for devices they use in their own patients to avoid a conflict of interest, he said.
That arrangement still does not satisfy Michael A. Carome, director of the Health Research Group at Public Citizen, a Washington-based consumer advocacy group.
"All of these financial payments can influence physician behavior," he said.
Rothman acknowledged that some might worry about a conflict, but he said patients overwhelmingly are impressed to be getting an implant that their surgeon designed.
"Almost uniformly, they're thrilled that they're seeing one of my partners or me who are creating new implants that are safer and more effective and more durable," he said. "It gives them comfort. It doesn't raise their eyebrows. Patient reaction, you always wonder, but it always has been in my experience very positive."
Rothman said he had worked on two generations of the Accolade, always striving for a simple design.
"We want anybody to be able to use these implants and get good results," he said.
Though $1 million in industry payments is a lot by Philadelphia standards, the top earners nationally were well above that in 2015. Five physicians cleared more than $10 million each.