Some call it a cozy relationship that could go too far. Drug companies are paying Tennessee doctors millions of dollars to promote their products, raising concerns about medical ethics and conflict of interest. Some Midstate doctors have earned hundreds of thousands of dollars speaking for drug companies. Many will tell you they're filling a vital need for education, but others worry it could compromise integrity. Doctors and drugs work together to keep the rest of us healthy, but there may be deeper connections between your physician and the drug companies that raise ethical concerns.

"People don't realize the amount of money that is changing hands behind the scenes," says TN Health Care Campaign's Beth Uselton.

Uselton is with the Campaign, which advocates on behalf of patients. Her group has seen the data compiled by Propublica, a nonprofit news organization. The numbers show Tennessee doctors ahve been paid over $20 million by drugmakers over the last few years, most of it for speaking and consulting.

"While it's not explicitly illegal for physicians or doctors to receive payments from pharmaceutical companies, I think it would make a lot of their patients uncomfortable to know that," says Uselton.

According to Propublica data, at least 4 Midstate doctors have earned over $200,000 working for drug companies. Psychiatrist Jon Draud leads the way with an income topping $600,000. Endocrinologist Dr. Terri Jerkins is also on the list.

"I have totally clean hands in this," says Dr. Jerkins. "What I'm doing is a very important service."

Dr. Jerkins was the top earning physician contacted by FOX17 NEWS who agreed to talk to us on camera. She lectures on behalf of Insulin drugmakers about 40 times a year to supplement her income. Dr. Jerkins says the main purpose is educating other health professionals.

"This has allowed people to still get some education that is really important to them, keeping up to standards," says Dr. Jerkins.

Dr. Jerkins says all of her patients know about her speaking, which she says is often reviewed by the FDA. Dr. Jerkins says she would never allow her work to affect her prescribing patterns.

"The day I could sacrifice what is best for the patient over some reimbursement over a drug would be the day I would need to quit," says Dr. Jerkins.

Drug companies paid U.S. doctors over $220 million in 2010, but OBGYN Dr. Omar Hamada, who serves on the Tennessee Medical Association's Judicial Council, says the vast majority of doctors are not being ethically compromised.

"We try to maintain ethical boundaries, and we try to maintain very academic intellectual decisions," says Dr. Hamada.

However, Dr. Hamada acknowledges that drug-sponsored seminars will create influence. Beth Uselton says drug companies wouldn't pay doctors to speak unless it boosted sales.

"If it didn't affect their prescribing, why would pharmaceutical companies invest that sort of money?" asks Uselton.

Vanderbilt Medical Center has taken a stand against allowing its doctors to be paid by drug companies. Doctors are still allowed to speak, but they can only be reimbursed for travel and other out of pocket expenses.

"The University takes this very seriously," says Vanderbilt Medical Center's John Howser.

Vanderbilt implemented its Conflict of Interest Policy in 2009. Doctors are not allowed to accept gifts from drugmakers, although they still work together on research. Speaking on behalf of drug companies has been largely curtailed.

"We're doing everything we can to represent the public's best interest, and so this policy was implemented for that very reason," says Howser.

Whether it's a $10 meal or a high-dollar seminar, thousands of doctors across Tennessee have accepted payment from drug companies. Now that the money is being disclosed, we're gaining a better understanding of the drug company/doctor relationship. All drug and medical device companies will be legally required to disclose how much they pay doctors beginning next year, but many drug makers have already begun revealing those payments. To see if your doctor has received money, go to Fox17.com and click on FOX LINKS. We don't know which prescriptions doctors write, but by disclosing how much money they are paid by drug companies, it's hoped patients will begin to ask more questions.SPECIAL REPORT: Doctors and Drugs