{
  "study": {
    "slug": "open-payments-top-paid-specialties-2024",
    "title": "Which medical specialties take the most industry money?",
    "standfirst": "In 2024, U.S. orthopedic surgeons received $381.4 million in general industry payments — more than any other specialty and over three times the second-place field. Counting spine, joint and sports-medicine subspecialties, orthopedics drew $531.8 million, about 16% of the $3.31 billion total. The average orthopedic payment was $1,711; the average internal-medicine payment was $96.",
    "desk": "financial-distress",
    "article_type": "Original Research",
    "published": "2026-06-12",
    "issue": 61,
    "doi": "10.5072/fonteum/open-payments-top-paid-specialties-2024",
    "url": "https://fonteum.com/research/open-payments-top-paid-specialties-2024",
    "methodology_version": "open-payments/v1"
  },
  "data_as_of": "2026-01-23",
  "datasets": [
    {
      "slug": "cms-open-payments",
      "name": "CMS Open Payments",
      "publisher": "CMS — Open Payments",
      "upstream_url": null
    }
  ],
  "key_findings": [
    {
      "number": "$381.4M",
      "finding": "to orthopedic surgeons — the single highest-paid specialty in the 2024 file, across 222,891 general payments, driven by device royalties",
      "dataset": "cms-open-payments"
    },
    {
      "number": "$531.8M",
      "finding": "to the full orthopedic-surgery family once spine, joint-reconstruction and sports-medicine subspecialties are added — about 16% of all general-payment dollars",
      "dataset": "cms-open-payments"
    },
    {
      "number": "$1,711",
      "finding": "average orthopedic payment, versus $96 for internal medicine and $39 for a family nurse practitioner — procedural specialties get concentrated money",
      "dataset": "cms-open-payments"
    },
    {
      "number": "$102.3M",
      "finding": "to endodontists — third overall — almost entirely a single $91.1M acquisition-related transfer, a reminder that one deal can move a whole specialty's total",
      "dataset": "cms-open-payments"
    }
  ],
  "faqs": [
    {
      "q": "Which medical specialty receives the most industry money?",
      "a": "Orthopedic surgery. In 2024, orthopedic surgeons received $381.4 million in general (non-research) Open Payments — more than three times the next specialty, internal medicine, at $113.4 million. Adding spine, joint-reconstruction and sports-medicine subspecialties, the orthopedic family drew $531.8 million, about 16% of all general-payment dollars."
    },
    {
      "q": "Why do orthopedic surgeons get so much more than primary care?",
      "a": "Because of how the money is structured. Device makers pay surgeons royalties for implant and instrument designs — large, concentrated payments to a small number of high-volume specialists. Primary-care fields receive industry money mostly as small food, beverage and speaking payments. The average orthopedic payment was $1,711; the average internal-medicine payment was $96."
    },
    {
      "q": "Why is endodontics third on the list?",
      "a": "An artifact of one transaction. Endodontists received $102.3 million in 2024, but a single $91.1 million acquisition-related payment from one dental-device company accounts for almost the entire total. Without that one deal, endodontics would rank far lower — a reminder that one large transfer can lift a small specialty's annual total."
    },
    {
      "q": "Do nurse practitioners and physician assistants appear in this data?",
      "a": "Yes. Family nurse practitioners ($58.4M across 1.49 million payments) and physician assistants ($58.8M across 1.39 million payments) are among the most-paid recipient categories by total — but the lowest by intensity, averaging $39 and $42 per payment. Their money is broad and shallow: millions of small meals, not concentrated royalties."
    },
    {
      "q": "Does taking industry money affect how a doctor practices?",
      "a": "This study cannot answer that. It reports who receives industry money and how much, by specialty — a measure of scale and structure, not of clinical influence. Peer-reviewed research has examined associations between payments and prescribing, but Open Payments itself is a disclosure record. Correlation in this file is not evidence that any payment changed any decision."
    },
    {
      "q": "Is specialty self-reported or assigned?",
      "a": "Specialty is the recipient's primary specialty as listed in the federal taxonomy and attached to the payment record by the reporting company. It is a single primary specialty per recipient, so a physician with multiple roles is counted under one. Subspecialties (for example, spine surgery) appear as distinct categories from their parent field."
    },
    {
      "q": "Can I reproduce these specialty rankings?",
      "a": "Yes. Every figure aggregates the cms_open_payments table (16,146,544 records, program year 2024) through the open_payments_by_specialty_mv materialized view. The exact SQL is in the reproducibility block below. Specialties are reported as the CMS pipe-delimited taxonomy; this study shows the most-specific segment. No individual physician is named."
    }
  ],
  "citation": {
    "apa": "Fonteum Research. (2026, June 12). Which medical specialties take the most industry money?. Fonteum Research, Issue 61. https://doi.org/10.5072/fonteum/open-payments-top-paid-specialties-2024",
    "url": "https://fonteum.com/research/open-payments-top-paid-specialties-2024"
  },
  "reproducible_sql": "-- Which medical specialties take the most industry money? — reproducible query.\n--\n-- Source:   CMS Open Payments, program year 2024 (PGYR2024, published 2026-01-23).\n-- Table:    public.cms_open_payments (16,146,544 records, public, read-only).\n-- Scope:    General (non-research) payments only  (record_type = 'general').\n-- Grain:    recipient_specialty (CMS pipe-delimited provider taxonomy). No recipient named.\n--\n-- Reads open_payments_by_specialty_mv; definition reproduced for audit.\n\n-- Top 15 specialties by general-payment dollars (open_payments_by_specialty_mv):\nSELECT\n  recipient_specialty                  AS specialty,\n  count(*)                             AS payments,\n  round(sum(total_amount_usd))::bigint AS total_usd\nFROM public.cms_open_payments\nWHERE record_type = 'general' AND program_year = 2024 AND recipient_specialty IS NOT NULL\nGROUP BY recipient_specialty\nORDER BY total_usd DESC\nLIMIT 15;\n--  ...|Orthopaedic Surgery                         381,416,269   222,891  <- highest specialty; avg $1,711\n--  ...|Internal Medicine                           113,403,390 1,182,047  <- avg $96\n--  Dental Providers|Dentist|Endodontics            102,330,286     6,127  <- ~$91.1M from one acquisition\n--  ...|Psychiatry & Neurology|Neurology             89,611,200   459,825\n--  ...|Dermatology                                  89,106,518   521,576\n--  ...|Neurological Surgery                          83,073,789    83,869  <- avg $991\n--  ...|Internal Medicine|Cardiovascular Disease      71,590,219   452,186\n--  ...|Internal Medicine|Hematology & Oncology       68,550,441   331,168\n--  ...|Psychiatry & Neurology|Psychiatry             66,292,782   317,401\n--  ...|Internal Medicine|Gastroenterology            65,513,271   455,469\n--  ...|Surgery                                       65,168,098   175,944\n--  ...|Ophthalmology                                 60,804,258   198,993\n--  Physician Assistant                               58,785,970 1,386,673  <- avg $42\n--  Nurse Practitioner|Family                         58,448,657 1,492,157  <- avg $39\n--  ...|Orthopaedic Surgery of the Spine              54,760,634    32,616\n\n-- Orthopedic-surgery family total (primary + the three subspecialties shown above):\nSELECT round(sum(total_amount_usd))::bigint AS ortho_family_usd                   -- 531,816,444\nFROM public.cms_open_payments\nWHERE record_type = 'general' AND program_year = 2024\n  AND recipient_specialty IN (\n    'Allopathic & Osteopathic Physicians|Orthopaedic Surgery',\n    'Allopathic & Osteopathic Physicians|Orthopaedic Surgery|Orthopaedic Surgery of the Spine',\n    'Allopathic & Osteopathic Physicians|Orthopaedic Surgery|Adult Reconstructive Orthopaedic Surgery',\n    'Allopathic & Osteopathic Physicians|Orthopaedic Surgery|Sports Medicine'\n  );\n\n-- Intensity contrast — average payment, orthopedics vs internal medicine:\nSELECT\n  recipient_specialty                               AS specialty,\n  round(sum(total_amount_usd) / count(*), 0)        AS avg_per_payment\nFROM public.cms_open_payments\nWHERE record_type = 'general' AND program_year = 2024\n  AND recipient_specialty IN (\n    'Allopathic & Osteopathic Physicians|Orthopaedic Surgery',     -- 1,711\n    'Allopathic & Osteopathic Physicians|Internal Medicine'        -- 96\n  )\nGROUP BY recipient_specialty;",
  "license": "U.S. Government Works (federal sources; 17 U.S.C. §105)",
  "generated_by": "Fonteum — https://fonteum.com",
  "notes": "Aggregate, source-traced figures frozen to the snapshot above. Reproduce by running reproducible_sql against the cited federal dataset; no per-entity records are included."
}