{ "study": { "slug": "open-payments-physician-ownership-concentration-2024", "title": "Who owns the medical industry: the Open Payments file nobody opens", "standfirst": "CMS's Open Payments ownership file lists 4,591 stakes that 3,965 physicians held in medical companies in 2024, worth $1.34 billion. The median stake is $19,440, but the top 1% of records hold 62.3% of the value: most are token interests in physician groups, and the dollars sit in a handful of device-company stakes.", "desk": "financial-distress", "article_type": "Original Research", "published": "2026-06-17", "issue": 83, "doi": "10.5072/fonteum/open-payments-physician-ownership-concentration-2024", "url": "https://fonteum.com/research/open-payments-physician-ownership-concentration-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": "62.3%", "finding": "of the ownership file's $1.34 billion in reported value of interest sits in the top 1% of records — 46 of 4,591. The single largest record is 19.5% of the file and the top 10 are 43.5%; the bottom 90% of records hold 11.5%. Mean value ($291,057) is 15 times the median ($19,440)", "dataset": "cms-open-payments" }, { "number": "$1.34B", "finding": "in value of interest is reported across the 4,591 ownership records held by 3,965 physicians in 209 companies, against $147.8 million actually invested — a 9-to-1 ratio between what the stakes are worth and what was put into them in 2024. Snapshot published 2026-01-23", "dataset": "cms-open-payments" }, { "number": "73.4%", "finding": "of records — 3,371 — report a value of interest with zero dollars invested that year. These are standing equity stakes whose worth is disclosed, not fresh capital that changed hands; only a quarter of the file records a 2024 investment at all", "dataset": "cms-open-payments" }, { "number": "85.9%", "finding": "of ownership records belong to procedural and surgical specialties. Obstetrics & gynecology (17.8%), gastroenterology (14.9%), urology (12.9%) and orthopaedic surgery (9.1%) alone are 54.7% of the file by count — the specialties that buy implants, run ambulatory surgery centers, and back device startups", "dataset": "cms-open-payments" }, { "number": "4,591", "finding": "ownership and investment-interest records make up the program-year-2024 slice, across 3,965 physicians, 209 companies, and 50 states. Every figure here is a count or sum over published records — no individual physician is named, ranked, or scored", "dataset": "cms-open-payments" } ], "faqs": [ { "q": "What is a physician ownership interest in Open Payments?", "a": "Under the Sunshine Act, when a physician or an immediate family member holds an ownership or investment interest in a company that makes drugs, devices, or biologicals, that company must disclose the interest to CMS each year. The disclosure records the value of the interest and how much the physician invested. It is one of three Open Payments files, alongside general payments and research payments, and is by far the smallest — 4,591 records for 2024 against millions of general-payment records." }, { "q": "How concentrated is physician ownership?", "a": "Extremely. The 2024 ownership file reports $1.34 billion of value of interest, but the median record is worth just $19,440. The single largest record accounts for 19.5% of all the value in the file, the top 10 records for 43.5%, and the top 1% of records — 46 of 4,591 — for 62.3%. The bottom 90% of records together hold 11.5%. It is a textbook power-law distribution." }, { "q": "What is the difference between value of interest and amount invested?", "a": "Value of interest is the reported worth of the ownership stake; amount invested is the dollars the physician actually put in during the year. They are reported in separate columns and the gap is large: $1.34 billion of value against $147.8 million invested, a 9-to-1 ratio. 73.4% of records report a value of interest with zero dollars invested that year — standing equity whose worth is disclosed, not new money changing hands." }, { "q": "Which specialties hold the most ownership interests?", "a": "Procedural and surgical specialties — 85.9% of all ownership records. Obstetrics & gynecology (17.8% of records), gastroenterology (14.9%), urology (12.9%), and orthopaedic surgery (9.1%) lead by count. These are the fields that use implantable devices, operate ambulatory surgery centers, and invest in device and specialty-care companies, which is why ownership concentrates there rather than in primary-care or behavioral specialties." }, { "q": "Does holding an ownership interest mean a physician did something wrong?", "a": "No. An ownership disclosure is a transparency record required by statute, not a disciplinary or quality signal. It records that a physician held a financial interest in a reporting company and is entirely separate from exclusion, sanction, or any assessment of conduct or competence. This study draws no inference about any physician from the presence of a record." }, { "q": "Why do some companies have hundreds of owners and others only a few?", "a": "Because the file contains two different kinds of ownership. Physician-group and group-purchasing entities show hundreds of physician-owners each holding a small or token interest — one such company has 875 records totalling $875 of value, about a dollar each. Device and biotech makers show the opposite: a handful of records holding multimillion-dollar equity. The first pattern drives the record counts; the second drives the dollars." }, { "q": "Can I reproduce these figures?", "a": "Yes. Every number is a direct count or sum over the public cms_open_payments table filtered to record_type = 'ownership', program year 2024, snapshot published 2026-01-23 — with no modeling. The exact SQL for the concentration curve, the value-versus-invested split, the two manufacturer rankings, and the specialty and state breakdowns is published in the reproducibility block below." } ], "citation": { "apa": "Fonteum Research. (2026, June 17). Who owns the medical industry: the Open Payments file nobody opens. Fonteum Research, Issue 83. https://doi.org/10.5072/fonteum/open-payments-physician-ownership-concentration-2024", "url": "https://fonteum.com/research/open-payments-physician-ownership-concentration-2024" }, "reproducible_sql": "-- Physician OWNERSHIP and investment interest in the medical industry — the\n-- untouched third slice of CMS Open Payments. Fully reproducible query.\n--\n-- Question: when a physician (or an immediate family member) holds an ownership\n-- or investment interest in a company that makes drugs or devices, the Sunshine\n-- Act requires that company to disclose it. What does the resulting ownership\n-- file look like — how much value does it hold, who holds it, and how evenly is\n-- it spread? The lead figure: the top 1% of records (46 of 4,591) hold 62.3% of\n-- the file's $1.34 billion in reported value of interest; the median stake is\n-- just $19,440. Ownership is a coverage/disclosure record, NOT a quality, fraud,\n-- or wrongdoing signal of any kind.\n--\n-- Source:\n-- public.cms_open_payments WHERE record_type = 'ownership' — the OP_DTL_OWNRSHP\n-- disclosure file of CMS Open Payments (Sunshine Act §6002), published\n-- annually at openpaymentsdata.cms.gov. 4,591 ownership records for program\n-- year 2024; payment_publication_date 2026-01-23. Public, read-only.\n-- License: US-Government-Works (17 U.S.C. Sec. 105).\n-- methodology_version = 'open-payments/v1'.\n--\n-- Universe: this study reads the ownership slice of program year 2024 AS A WHOLE\n-- — every row is one disclosed physician/immediate-family ownership or\n-- investment interest in a reporting company. value_of_interest_usd is the\n-- reported worth of the interest; total_amount_usd on ownership rows is the\n-- Total_Amount_Invested_USDollars (dollars the physician actually put in).\n-- The two are different measures and are reported separately below.\n--\n-- Counting note: 3,965 distinct NPIs across 4,591 records (a physician can hold\n-- interests in more than one company). 2 rows carry no NPI. No individual is\n-- named, ranked, or scored in the study; every figure is an aggregate.\n\n-- ============================================================================\n-- (1) Universe reconciliation — the ownership file at a glance.\n-- ============================================================================\nSELECT\n count(*) AS records,\n count(DISTINCT recipient_npi) AS distinct_npi,\n count(*) FILTER (WHERE recipient_npi IS NULL OR recipient_npi = '') AS null_npi,\n count(DISTINCT manufacturer_id) AS companies,\n count(DISTINCT recipient_specialty) AS specialties,\n count(DISTINCT recipient_state) AS states,\n round(sum(value_of_interest_usd)::numeric, 0) AS value_of_interest,\n round(sum(total_amount_usd)::numeric, 0) AS amount_invested,\n max(payment_publication_date) AS published\nFROM public.cms_open_payments\nWHERE record_type = 'ownership';\n-- records 4,591 · distinct_npi 3,965 · null_npi 2 · companies 209\n-- specialties 121 · states 50 · value_of_interest 1,336,244,024\n-- amount_invested 147,781,836 · published 2026-01-23\n\n-- ============================================================================\n-- (2) HEADLINE: concentration of value. The file is a power law — the largest\n-- single record is 19.5% of all value, the top 10 records 43.5%, and the\n-- top 1% of records (46) hold 62.3%. The bottom 90% hold 11.5%. Mean value\n-- ($291,057) is 15x the median ($19,440): a short head, a very long tail.\n-- ============================================================================\nWITH r AS (\n SELECT value_of_interest_usd AS v,\n row_number() OVER (ORDER BY value_of_interest_usd DESC NULLS LAST) AS rn,\n sum(value_of_interest_usd) OVER () AS total\n FROM public.cms_open_payments\n WHERE record_type = 'ownership'\n)\nSELECT\n round(100.0 * sum(v) FILTER (WHERE rn = 1) / max(total), 1) AS top1_record_pct,\n round(100.0 * sum(v) FILTER (WHERE rn <= 10) / max(total), 1) AS top10_record_pct,\n round(100.0 * sum(v) FILTER (WHERE rn <= 46) / max(total), 1) AS top1pct_pct, -- 1% of 4,591\n round(100.0 * sum(v) FILTER (WHERE rn <= 459) / max(total), 1) AS top10pct_pct, -- 10% of 4,591\n round(percentile_cont(0.5) WITHIN GROUP (ORDER BY v)::numeric, 0) AS median_value,\n round(avg(v)::numeric, 0) AS mean_value\nFROM r;\n-- top1_record 19.5% · top10_record 43.5% · top1pct 62.3% · top10pct 88.5%\n-- median_value 19,440 · mean_value 291,057 (bottom 90% of records = 11.5%)\n\n-- ============================================================================\n-- (3) Value of INTEREST vs amount INVESTED. The file reports $1.34B of value\n-- against $147.8M actually invested — a 9.0x ratio — and 73.4% of records\n-- (3,371) report a value of interest with ZERO dollars invested that year.\n-- These are standing equity stakes whose worth is disclosed, not fresh\n-- capital that changed hands in 2024.\n-- ============================================================================\nSELECT\n round(sum(value_of_interest_usd)::numeric, 0) AS value_of_interest,\n round(sum(total_amount_usd)::numeric, 0) AS amount_invested,\n round(sum(value_of_interest_usd)::numeric\n / nullif(sum(total_amount_usd), 0), 1) AS value_to_invest_ratio,\n count(*) FILTER (WHERE (total_amount_usd IS NULL OR total_amount_usd = 0)\n AND value_of_interest_usd > 0) AS value_no_invest,\n round(100.0 * count(*) FILTER (WHERE (total_amount_usd IS NULL OR total_amount_usd = 0)\n AND value_of_interest_usd > 0) / count(*), 1) AS value_no_invest_pct\nFROM public.cms_open_payments\nWHERE record_type = 'ownership';\n-- value_of_interest 1,336,244,024 · amount_invested 147,781,836 · ratio 9.0x\n-- value_no_invest 3,371 · value_no_invest_pct 73.4%\n\n-- ============================================================================\n-- (4) TWO PATTERNS in one file. Ranked by RECORD COUNT the leaders are\n-- physician-group / GPO entities where hundreds of physician-owners each\n-- report a small or token interest; ranked by VALUE the leaders are\n-- device and biotech makers where a few owners hold multimillion-dollar\n-- equity. Unified Women's Healthcare: 875 records, $875 of value in total\n-- (~$1 each). The two rankings barely overlap.\n-- ============================================================================\n-- By record count:\nSELECT manufacturer_name,\n count(*) AS records,\n round(sum(value_of_interest_usd)::numeric, 0) AS value_of_interest\nFROM public.cms_open_payments\nWHERE record_type = 'ownership'\nGROUP BY manufacturer_name\nORDER BY records DESC\nLIMIT 6;\n-- Unified Women's Healthcare, LP 875 875\n-- GastroGPO, LLC 686 15,123,999\n-- SN Holdings, LLC 480 32,734,155\n-- US Retina LLC 191 30,870,471\n-- Cornerstone Specialty Network LLC 124 735,294\n-- Spinal Simplicity, LLC 117 36,390,846\n\n-- By value of interest (209 companies in the file; the top 6 firms below hold\n-- 51.3% of all value; the top firm BY RECORD COUNT holds 875 records / 19.1%\n-- of all 4,591 records):\nSELECT manufacturer_name,\n count(*) AS records,\n round(sum(value_of_interest_usd)::numeric, 0) AS value_of_interest,\n round(100.0 * sum(value_of_interest_usd)\n / sum(sum(value_of_interest_usd)) OVER (), 1) AS pct_of_value\nFROM public.cms_open_payments\nWHERE record_type = 'ownership'\nGROUP BY manufacturer_name\nORDER BY value_of_interest DESC\nLIMIT 6;\n-- Midmark Corporation 3 385,901,836 28.9%\n-- TriMed, Inc. 2 110,000,000 8.2%\n-- Innovation Technologies Inc 71 75,247,808 5.6%\n-- Imperative Care, Inc 21 39,887,900 3.0%\n-- Scientia Vascular 32 39,081,890 2.9%\n-- Spinal Simplicity, LLC 117 36,390,846 2.7%\n\n-- ============================================================================\n-- (5) Ownership is a procedural/surgical-physician story. 85.9% of records sit\n-- with procedural and surgical specialties; obstetrics & gynecology,\n-- gastroenterology, urology and orthopaedic surgery alone are 54.7% of the\n-- file by record count.\n-- ============================================================================\nWITH g AS (\n SELECT\n CASE WHEN recipient_specialty ILIKE '%Surgery%' OR recipient_specialty ILIKE '%Orthopaedic%'\n OR recipient_specialty ILIKE '%Urology%' OR recipient_specialty ILIKE '%Gastroenterology%'\n OR recipient_specialty ILIKE '%Ophthalmology%' OR recipient_specialty ILIKE '%Cardiolog%'\n OR recipient_specialty ILIKE '%Cardiovascular%' OR recipient_specialty ILIKE '%Obstetrics%'\n OR recipient_specialty ILIKE '%Otolaryngology%' OR recipient_specialty ILIKE '%Dermatology%'\n OR recipient_specialty ILIKE '%Radiology%' OR recipient_specialty ILIKE '%Pain%'\n THEN 'procedural/surgical' ELSE 'other' END AS grp,\n value_of_interest_usd AS v\n FROM public.cms_open_payments\n WHERE record_type = 'ownership'\n)\nSELECT grp,\n count(*) AS records,\n round(100.0 * count(*) / sum(count(*)) OVER (), 1) AS pct_records,\n round(100.0 * sum(v) / sum(sum(v)) OVER (), 1) AS pct_value\nFROM g GROUP BY grp ORDER BY records DESC;\n-- procedural/surgical 3,943 · 85.9% records · 56.3% value\n-- other 648 · 14.1% records · 43.7% value (value skewed by outlier records)\n\n-- Top specialties by record count (the hero-chart bars):\nSELECT recipient_specialty,\n count(*) AS records,\n round(100.0 * count(*) / sum(count(*)) OVER (), 1) AS pct_records\nFROM public.cms_open_payments\nWHERE record_type = 'ownership'\nGROUP BY recipient_specialty\nORDER BY records DESC\nLIMIT 6;\n-- Obstetrics & Gynecology 816 17.8%\n-- Internal Medicine|Gastroenterology 686 14.9%\n-- Urology 593 12.9%\n-- Orthopaedic Surgery 417 9.1%\n-- Ophthalmology 208 4.5%\n-- Neurological Surgery 163 3.6%\n\n-- ============================================================================\n-- (6) WHERE the owners are — top states by record count, each with its own\n-- share of the file's value. Texas leads by count (13.5%); Florida leads\n-- among the large states by value (11.3%).\n-- ============================================================================\nSELECT\n recipient_state,\n count(*) AS records,\n round(100.0 * count(*) / sum(count(*)) OVER (), 1) AS pct_records,\n round(100.0 * sum(value_of_interest_usd)\n / sum(sum(value_of_interest_usd)) OVER (), 1) AS pct_value\nFROM public.cms_open_payments\nWHERE record_type = 'ownership' AND recipient_state IS NOT NULL\nGROUP BY recipient_state\nORDER BY records DESC\nLIMIT 8;\n-- TX 619 13.5% val 5.9% · FL 525 11.4% val 11.3% · CA 377 8.2% val 6.8%\n-- IL 235 5.1% val 1.9% · NC 220 4.8% val 0.9% · MD 207 4.5% val 1.1%\n-- NJ 207 4.5% val 1.1% · NY 203 4.4% val 4.5%", "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." }