Open Payments 2025: the top 1% of clinicians received 66.5% of industry payments
In CMS Open Payments data for 2025, published Jun 30, 2026, drug and device makers reported $2.89 billion in general payments to 1,020,608 individual clinicians; the top 1%, 10,206 people, received 66.5% of it, and the median clinician received $169.30 for the year.
Key findings
- $2.89 billion in general payments to 1,020,608 individual clinicians in 2025, up from $2.64 billion to 979,136 in 2024.
- The top 1% of those clinicians received 66.5% of the money (66% in 2024); the top 0.1%, 1,020 people, received 33.6%.
- The median clinician received $169.30; the mean was $2,827.38. 372,698 clinicians (36.5%) received less than $100.
- Orthopaedic surgery received $331.1 million, more than any other specialty.
Research Question
Open Payments totals are usually reported as one large number. How is that number shared out: does a typical clinician receive a meaningful sum, or is the money concentrated in a small group, and did that change from 2024 to 2025?
Methodology
CMS's 2025 General Payment file holds 16,131,856 payments totalling $3.92 billion: $2.62 billion to physicians as Open Payments defines them (medical and osteopathic doctors, dentists, podiatrists, optometrists and chiropractors), $0.27 billion to non-physician practitioners such as nurse practitioners and physician assistants, and $1.03 billion to teaching hospitals. This study sums the payments to individual clinicians per National Provider Identifier ($2.89 billion across 1,020,608 NPIs; payments without an NPI are left out), ranks the clinicians by their yearly total and measures the share held by each tier. The 2024 column is the same computation on the 2024 file. Specialty is each NPI's primary taxonomy in the CMS NPPES file of Aug 9, 2026 (1,016,434 of 1,020,608 matched). Research payments and ownership interests are separate CMS files and are not included. Scripts: scripts/op-aggregate.py and scripts/gen-op-study.py.
Findings
Two thirds of the money went to 1% of recipients
Ranked from largest to smallest, the top 1% of recipients, 10,206 clinicians, received 66.5% of the $2.89 billion paid to individual clinicians in 2025. CMS Open Payments, General Payment Data, Program Year 2025 (published Jun 30, 2026) The top 0.1%, 1,020 clinicians, received 33.6% by themselves, and the bottom half of recipients together 1.2%. The pattern barely moved from 2024, when the top 1% received 66%.
Share of general payment dollars by recipient tier
| Recipient tier | Share, 2025 | Share, 2024 |
|---|---|---|
| Top 0.1% (1,020 clinicians) | 33.6% | 33.9% |
| Top 1% (10,206 clinicians) | 66.5% | 66% |
| Received $100,000 or more (4,537 clinicians) | 53.5% | 52% |
| Received $1 million or more (173 clinicians) | 18.7% | 19.6% |
| Bottom half of recipients | 1.2% | 1.2% |
The typical clinician received under $200 for the year
The median recipient received $169.30 across the entire year, and 372,698 clinicians, 36.5% of all recipients, received less than $100. The mean of $2,827.38 is 17 times the median because a small number of very large totals pull it up: 4,537 clinicians received $100,000 or more and together account for 53.5% of all dollars, and 173 received $1 million or more, 18.7% of the total. The single largest total was $55.1 million.
Orthopaedic surgery leads by a wide margin
By primary specialty, orthopaedic surgery received $331.1 million, 11.5% of the payments to individual clinicians, 2.2 times the total for internal medicine even though internal medicine has 3.3 times as many paid clinicians. Some smaller specialties have very high averages: adult reconstructive orthopaedic surgery averaged $76,116 across 1,087 paid clinicians and orthopaedic surgery of the spine $40,160 across 1,731. A high average can be driven by a few very large individual totals, so it is not what a typical member of that specialty receives. Single payments also move the ranking between years: the largest individual total of 2025, $55.1 million, went to an internal medicine clinician, and the three largest recipients in that specialty account for $80.5 million of its $151.2 million; in 2024 one endodontics clinician's $91.1 million put that specialty near the top.
The ten specialties paid most, 2025
| Rank | Primary specialty | Clinicians paid | Total | Average per clinician |
|---|---|---|---|---|
| 1 | Orthopaedic Surgery Physician | 15,477 | $331.1 million | $21,390 |
| 2 | Internal Medicine Physician | 51,142 | $151.2 million | $2,956 |
| 3 | Neurology Physician | 11,129 | $102.7 million | $9,229 |
| 4 | Dermatology Physician | 10,525 | $99.7 million | $9,474 |
| 5 | Neurological Surgery Physician | 5,555 | $91.2 million | $16,423 |
| 6 | Adult Reconstructive Orthopaedic Surgery Physician | 1,087 | $82.7 million | $76,116 |
| 7 | Psychiatry Physician | 14,216 | $82.4 million | $5,799 |
| 8 | Cardiovascular Disease Physician | 16,730 | $81.1 million | $4,847 |
| 9 | Gastroenterology Physician | 13,323 | $75.4 million | $5,656 |
| 10 | Family Nurse Practitioner | 106,992 | $72.2 million | $675 |
What this analysis cannot tell us
These figures cover general payments matched to an individual clinician's NPI; payments to teaching hospitals, research funding and ownership interests are outside them, which is why they are smaller than the $3.92 billion general-payment total in CMS's file. Manufacturers report the data and clinicians can dispute records, so individual rows can change when CMS refreshes the file. A payment is not evidence of wrongdoing or of any effect on care: royalties and acquisition payments, for example, are payments for intellectual property or a business, not for prescribing.
Sources
- CMS Open Payments, General Payment Data, Program Year 2025 (published Jun 30, 2026), file OP_DTL_GNRL_PGYR2025_P06302026_06032026.csv: https://openpaymentsdata.cms.gov/
- CMS Open Payments, General Payment Data, Program Year 2024, for the comparison column.
- CMS National Plan and Provider Enumeration System (NPPES), file of Aug 9, 2026, for specialty: https://download.cms.gov/nppes/NPI_Files.html