AAOS Article on Industry Payments to General Orthopaedic Surgeons Shows Increase Over Time
Recently, the Journal of the American Academy of Orthopaedic Surgeons published an article reviewing industry payments made to general orthopaedic surgeons from 2014 to 2019, using the Open Payments Database as the data source. The article authors, Johann Braithwaite, DO; Nicholas Frane, DO; and Matthew Partan, DO all orthopedic residents at Northwell Health in New York, reviewed the Open Payments Database and identified all industry payments to all general orthopaedic surgeons (i.e., not subspecialized) from 2014 to 2019, then analyzed total payments and subtype payments for yearly trends and performed a regional analysis.
According to the article, orthopaedic surgery has maintained one of the most substantial industry relationships because of its “extensive use of technology, devices, or implants” and orthopaedic surgeons regularly “work intimately with industry representatives or companies to research and develop new technology.” When Open Payments first started reporting data in 2014, orthopedic surgeons accounted for only 3.4% of the physicians studied but received almost 20% of the total payments – and nearly 25% of the general payments made to physicians. Two years later, in 2016, general orthopaedic surgeons accounted for nearly 80% of all industry payments to orthopaedic surgeons.
The article concluded that industry payments made to general orthopaedic surgeons between 2014 and 2019 increased with “a considerable disparity in payments among the top-paid orthopaedic surgeons.”
Annual Trends of General Payments
Between 2014 and 2019, the number of general orthopaedic surgeons receiving payments increased from 17,861 to 18,373 while the median payment value increased from $292.54 to $508.66. The top 25% of surgeons received payments of at least $1,475.80 in 2014, increasing to $2,467.84 in 2019; the bottom 25% of surgeons received payments of a maximum of $80.48 in 2014, which increased to $115.83 in 2019.
From 2014 to 2019, the total amount paid increased each year, from $260,472,564.51 to $394,133,594.07. A net increase was also observed in the percent of the total payments made to the five highest-paid surgeons from 10.18% of total payments (2014) to 22.96% (2019).
General Payment Subtypes
A review of general payment subtypes revealed a trend of increasing median payment values from 2014 to 2019 in several categories, including: faculty/speaker fees, consulting fees, education, entertainment/food/beverages, gifts, grants, honoraria, and traveling/lodging. There was no evidence of a trend of increasing median payment value over the years in ownership/investment interest or in royalty/license.
Conclusion
The six-year trend analysis found in the article shows the median payment per general orthopaedic surgeon consistently increasing between 2014 and 2019. There was also an increase in the total number of general orthopaedic surgeons receiving payments (17,861 in 2014 versus 18,373 in 2019) and an increase in the number of annual payments (215,439 in 2014 versus 246,794 in 2019). The authors of the article found that across the 6-year study period, there was a “notable overall increase” observed in median industry payments per surgeon (173.9%).
However, the article notes that the study has some “critical limitations aside from those stemming from its retrospective nature.” The results and analysis of the article are also limited by the accuracy and inclusivity of the Open Payment data, which “have been questioned in the previous literature” because of its dependency on honest, consistent disclosure (studies have demonstrated inconsistent reporting in orthopaedic joint surgeons and general orthopaedic surgeons, and orthopaedic sports medicine surgeons).