Physician–Industry Payments in the Skin Substitute Market—Shedding Light From the Sunshine Act

Skin substitutes are vital in burn care. While physician-industry partnerships drive innovation and access, they also raise concerns regarding bias and conflicts in product promotion. This study analyzes current trends in physician-company financial relationships within the skin substitute market related to burn treatment. The Physician Payments Sunshine Act mandates transparency in reporting industry payments to physicians. Companies with the largest market share of skin substitutes and burn wound coverage products were evaluated. Physician payment records from 2017 to 2023 were extracted and analyzed by category, including consulting fees, speaker compensation for nonaccredited education, food and beverage, and travel. Eight companies representing 28 products distributed nearly $45 million in direct payments to physicians over 6 years; company totals varied by up to $13.5 million. Annual per-physician payments ranged from $0.35 to $1 088 405.68 (median $47.17, IQR $21.44-$130.57). The highest expenditure categories were nonaccredited speaker compensation ($2 741 643.65/year), which declined during COVID-19, and consulting fees ($1 046 408.71/year), which remained stable. Excluding pandemic years (2020-2021), total annual payments ranged from $3233.73 to $4 379 242.77 (median: $115 052.45). Only 2 companies, Kerecis and Avita, demonstrated consistent increases in payments over the past 3 years. Physician payments in the skin substitute market vary widely. The wide variability-from negligible sums to over a million dollars-questions the adequacy of blanket disclosure statements as a meaningful representation of physician involvement in research and product promotion. These findings suggest opportunity for greater transparency in disclosure statements.