The Sunshine Act led to the recent availability of comprehensive data on pharmaceutical industry payments to hospitals and physicians via the Open Payments system. Primary care physicians are the chief way many Americans interact with the healthcare industry. However, there is not much literature on the relationship between these gateway physicians and the pharmaceutical industry. This study analyzes data from the Open Payments system from 2015-2020 for payment characteristic, geospatial, and temporal trends. The highest amount of payments went to primary care physicians for vague and often non-medical reasons. Primary care physicians in dense ZIP codes in states in the western United States were found to receive significantly higher average payments. These results highlighted the need for more research into how these pharmaceutical industry-physician relationships adapted to the COVID-19 pandemic.


I would like to thank my advisor, Dr. Amy Herring, for her incredible support throughout this project. I would be nowhere without her guidance and advice. I would also like to thank Dr. Joan Durso and Dr. Mine Çetinkaya-Rundel for being amazing mentors and for their tireless work in leading the Duke Department of Statistical Science.


To my parents and siblings, who never fail to uplift and humble me.