Patients complain about their doctors for all sorts of reasons. Sometimes it’s smaller stuff like bedside manner, wait times, how rushed the visit felt. Other times, the concerns go much deeper: questionable diagnoses, risky treatment decisions, or poor communication. But no matter the reason, a new study suggests that doctors who rack up more patient complaints are also significantly more likely to accept money from pharmaceutical and medical device companies.

The study, led by scientists at Johns Hopkins University School of Medicine and Vanderbilt University Medical Center, connected two major national databases. They used the Patient Advocacy Reporting System (PARS), which logs unsolicited complaints from patients, and the federal Open Payments Program, which tracks financial relationships between physicians and industry.

The researchers analyzed data from nearly 72,000 U.S. physicians collected between 2015 and 2020. And the findings were striking. “Physicians with higher PARS Index scores, reflective of a greater number and severity of unsolicited patient complaints, were more likely to receive general payments from industry, especially in higher amounts,” the authors write.

Taking Money from Big Pharma

Doctors accept money from the pharmaceutical and medical device industries for all kinds of reasons — consulting gigs, speaking at conferences, research involvement, meals, travel, and honoraria. While technically legal, this practice remains highly controversial. Critics argue it can bias medical decisions, and there’s a great deal of data showing that physicians who take money from a pharmaceutical company are more likely to write prescriptions for that company’s products.

In this study, more than two-thirds (68.3%) of physicians received at least one general payment. About 11.2%, roughly one in nine, received more than $5,000 in a single year. That’s an important benchmark: the U.S. Department of Health and Human Services considers $5,000 the threshold for a significant financial conflict of interest.

Things got even more concerning when researchers dug deeper. When physicians were grouped by complaint history, those with the highest PARS scores were 70% more likely to accept high-value payments compared to doctors with no complaints. And this held true even after adjusting for factors like age, gender, specialty, and workplace setting.

Some patterns also emerged: male physicians were nearly twice as likely as female physicians to receive large payments. And doctors working in nonacademic settings were more likely to accept industry money compared to those in academic medical centers, which tend to have stricter conflict-of-interest rules.

What Does This Mean?

Of course, correlation doesn’t equal causation. Just because a doctor takes money from industry and gets more complaints doesn’t mean one causes the other. But the relationship is suspicious enough to raise red flags.

In an accompanying editorial, Dr. Aaron P. Mitchell of Memorial Sloan Kettering Cancer Center called the findings “potentially concerning and [one that] warrants careful consideration.” His leading hypothesis? That industry payments may directly influence how doctors treat patients — and not in a good way.

There’s precedent for this. Previous research has shown that even small payments can nudge physicians toward prescribing newer, heavily promoted drugs — ones that might be more expensive, less effective, or carry higher risks than older alternatives.

Another scenario is that both high complaint rates and high payment acceptance stem from an underlying physician “phenotype” — a more transactional approach to the profession. Simply put, doctors that are more likely to accept payments do a worse job. This could manifest in briefer visits, less availability, or other behaviors patients perceive as unresponsive.

Mitchell also points to possible confounding factors. For example, physicians with higher patient volumes may naturally receive more complaints and also be targeted more aggressively by drug and device makers. Differences within broad specialty categories could also mask patterns — some procedural subspecialties may carry both higher complaint risk and greater industry engagement.

To be fair, a high number of complaints doesn’t always mean a physician is incompetent. Patient complaints can be subjective, and some great doctors still receive them. But high PARS scores have been previously linked to increased malpractice risk, poorer patient outcomes, and even physician burnout. In other words, it’s a red flag worth paying attention to.

Important Questions to Explore

“This finding highlights the complex interplay between patient complaints and financial conflicts of interest among physicians,” the study authors conclude. They recommend stronger conflict-of-interest oversight and targeted peer feedback programs for doctors with high complaint volumes.

Mitchell agrees that there’s more research needed in this field. However, he highlights the idea that payments are, in fact, worsening doctor care as a plausible idea, and one that could be modified by simply banning doctors from taking payments. If more research corroborates this idea, it could offer a straightforward way to improve treatment for many patients.

In the meantime, patients have to face an uncomfortable but important question: when choosing a doctor, should you be asking not just about their credentials, but also who’s paying them?

The study was published in JAMA.