In 2024 the sixty best-paid US psychiatrists took $28 million of the $71 million industry paid the whole specialty

Havlik's paper says one percent of psychiatrists take three quarters of the money. This is what the top of that one percent looks like in the federal file for 2024: who, how much, for what, and attached to which products.

Significant findings

The Open Payments 2024 general payment file lists $71,386,487 paid to physicians whose first specialty is psychiatry or a psychiatry subspecialty, across 352,705 payment records. Nine in ten records are food and beverage; they add up to 11.6 percent of the money. Speaker fees, the category CMS labels "compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program", are 4 percent of the records and 55.8 percent of the money. Havlik's series put the top one percent at 74.7 percent of the money over 2015 to 2021; the sixty below are the top of that one percent for 2024.

The sixty best-paid psychiatrists received $28,258,476, 39.6 percent of the total; the top ten received $8,870,542. For the sixty, 63.0 percent was speaker fees, 20.0 percent consulting fees and 12.9 percent travel and lodging. None of it was royalties or acquisitions.

The ten largest totals, with the products the paying companies attached to the payments: Rakesh Jain, Lake Jackson TX, $1,170,656 (Vraylar, Auvelity, Rexulti); Andrew Cutler, Lakewood Ranch FL, $1,095,695 (Caplyta, Auvelity, Vraylar); Gustavo Alva, Costa Mesa CA, $1,050,541 (Fanapt, Uzedy, NeuroStar TMS); Leslie Citrome, Pomona NY, $1,041,528 (Rexulti, Uzedy); Gregory Mattingly, St. Charles MO, $839,406 (Auvelity, Vraylar, Ingrezza); Craig Chepke, Huntersville NC, $831,214 (Vraylar, Auvelity); Henry Nasrallah, Cincinnati OH, $786,557 (Uzedy, Caplyta, Invega Sustenna); Rakesh Amin, Nashville TN, $734,674 (Auvelity, Vraylar, Ingrezza); Mark Reynolds, Durham NC, $678,215 (Uzedy, Caplyta, Invega Sustenna); Richard Petty, Loganville GA, $642,055 (Fanapt, Auvelity, Vraylar).

Ten companies paid 94 percent of the sixty's money: Axsome, Intra-Cellular Therapies, Otsuka, AbbVie, Teva, Alkermes, Neurocrine, Vanda, Janssen and Bristol Myers Squibb. The products are the branded launches of the last decade: Caplyta, Auvelity, Vraylar, Rexulti, Ingrezza, Fanapt, Lybalvi, Uzedy, Austedo XR, Abilify Maintena, Invega Sustenna, Spravato and Cobenfy. No generic appears.

The names repeat. Nineteen of the 2024 sixty were in the top thirty in each of 2021, 2022 and 2023; twenty six were there in at least two of those years.

What they have done. The group splits in two. Some are prolific authors: PubMed returns 572 records for Citrome, 296 for Nasrallah, 289 for El-Mallakh, over 100 for Cutler and over 70 each for Mattingly and Meyer, and the recent titles are largely post hoc analyses, narrative reviews and consensus panels on the same branded drugs. Eight of the sixty were also principal investigators on industry research payments in 2024, led by Maguire ($1,755,467, including KarXT trials), Mattingly ($1,002,662) and Alva ($656,148). For a number of the sixty, including several in the top twenty, a PubMed search on the name with a psychiatry term returned no indexed publication; their money is almost entirely speaker fees.

Worth asking

Every dollar here was reported by the company under federal law and is legal. A speaker fee buys a company-approved presentation delivered to other prescribers; the Inspector General's 2020 alert in this library says what it thinks that is for. Havlik's median psychiatrist got $0 a year. This is the other end of that line, by name, from the same file.