Industry sponsorships remain an essential source of funding for postgraduate medical education.1,2 Since 2013, Portuguese legislation has required the public disclosure of all financial benefits granted to healthcare professionals by pharmaceutical and medical device companies.3 Despite the existence of this transparency framework, little is known about sponsorship patterns during cardiology residency. We evaluated trends in the volume and amount of industry sponsorships received by cardiology residents over a decade and explored regional, institutional, and structural correlates of access.

A retrospective cross-sectional analysis examined cardiology residents who began training in 2014, 2016, 2018, or 2020. Cohorts were identified from the Administração Central do Sistema de Saúde,4 which discloses annual residency allocations by specialty and hospital. Sponsorship data were retrieved from INFARMED's transparency and publicity communications platform,5 which requires the reporting of all transfers of a monetary value from pharmaceutical and device companies to healthcare professionals. Names were cross-referenced to assign sponsorships to individual residents during their five years of training. Residents were grouped into regions according to the official statistical classifications based on geographical area (Nomenclatura das Unidades Territoriais para Fins Estatísticos II [NUTS II]). Due to small strata, the east and Tejo valley was added to the ‘Center’ (central Portugal region); the Sétubal Pennisula, Alentejo and the Algarve were merged into the ‘South’, and the Autonousmous Regions of the Azores and Madeira into ‘Islands’ (Ilhas). Co-primary outcomes were the total number of sponsorships per resident and the total value per resident throughout their residency; secondary analyses compared regions, hospitals, and the number of residents per hospital per year.

We included 127 residents (2014: n=29; 2016: n=29; 2018: n=35; 2020: n=34). Across cohorts, the median number of sponsorships per resident were 20, and the median value was €8424. Although cohort size increased over time, overall funding did not scale proportionally. The frequency of sponsorships per resident rose significantly (p<0.001), yet the monetary value per resident declined with later entry year: linear regression showed a negative association between year of entry and per-resident value (B=−€772.18; 95% confidence interval −€1471.31 to −€73.05; p=0.031), indicating an average annual decrease of ∼€772. By cohort, the highest median value per resident occurred in 2016 (€10585; P25–P75: €7544–€14296), while 2018 was significantly lower than both 2016 (p=0.010) and 2014 (p=0.026). These results are summarized in Table 1.

Regional analyses showed marked heterogeneity (Figure 1). Median counts ranged from 16 in Sul (P25–P75: 13–22) to 25 in Center (P25–P75: 19–29), and median funding per resident ranged from €5453 in Sul (P25–P75: €4332–€9904) to €9629 in Greater Lisbon (Grande Lisboa) (P25–P75: €6485–€11815). Differences across regions were significant for both counts (Kruskal–Wallis p=0.029) and value (p=0.018). As a share of national totals, Greater Lisbon accounted for 35.0% of sponsorships and 35.9% of value; North (Norte) for 27.7% and 27.8%; Center for 25.4% and 24.7%; South for 8.4% and 7.4%; and Islands for 3.6% and 4.2%, respectively. The evolution of median sponsorship value by entry year within each region is displayed in Figure 1 (Panel C). Hospital affiliation and the number of residents per hospital per year were not significantly associated with per-resident sponsorship counts or value.

Figure 1.

Median sponsorship (A) and median value (B) per resident across five Portuguese regions (Center, Islands, Greater Lisbon, North, South). The dashed grey lines mark the overall median number of sponsorships (n=20) and the overall median sponsorship value (€8424); percentages indicate each region's median deviation from the overall median. Panel C shows the median sponsorship values per entry year across five Portuguese regions (Center, Islands, Greater Lisbon, North, South).

Our findings reveal a paradox: while industry support for cardiology training has become more frequent, it is less generous per resident. This likely reflects a redistribution of relatively fixed budgets across larger cohorts and potential recalibration of industry strategies within a transparency-driven environment. Regional variability underscores unequal access to educational opportunities, which may influence exposure to scientific events and ultimately shape professional development. While institutional comparisons were not statistically significant – possibly due to there being a large number of hospitals with few residents – observable variability warrants further monitoring.

Despite rising training demands, the number and value of industry sponsorships vary substantially among Portuguese cardiology residents.