How Much Does Industry Pay Physicians? New Study | Orthopedics This Week

How Much Does Industry Pay Physicians? New Study

Source: Wikimedia Commons and Dr. Ibrahim Kamel

It’s complicated. But one thing we know for certain, the practice of medicine is a collaborative enterprise. Medicine can not advance without industry. Everytime someone asks the question, which COVID vaccine are you getting, Pfizer, Moderna or JNJ, they are implicitly acknowledging the role that private industry plays in advancing medical science.

It is equally certain, however, that industry’s payments and focus on commercial success has had a biasing effect on both clinical studies and clinicians. A new study brings a bit of light to the subject of industry payments to physicians and found that physician consulting contracts, which make up the vast majority of payments to physicians, were less than $10,000 per year.

Royalty payments for patented and licensed inventions, however, amounted to millions of dollars per year per inventor(0.3% of the physicians received royalties).

A team of researchers from Northwell Health Huntington Hospital in Huntington, New York, decided to calculate how much money orthopedic and sports medicine physicians are receiving using data from the Sunshine Act and the results that research, “The Influence of the Sunshine Act on Industry Payments to United States Orthopedic Sports Medicine Surgeons,” was published in the March 4, 2021 edition of Arthroscopy.

Why, we wondered, would a researcher want to delve into such a complicated and charged issues. Co-author co-author Matthew Partan, M.D., an orthopedic surgery resident PGY-3, Plainview Hospital, Northwell Health, explained, “We have a research team, comprised of current orthopedic residents at our program and a research assistant, that was originally formed after being approached by the senior author Dr. Adam Bitterman.”

“Dating back to an article in MedPage Today in 2015, Dr. Bitterman has had ongoing interest in the importance of industry in advancing training in orthopedic surgery. In an article titled ‘Let's Stop Shunning Industry in Academics,’ he expressed the value in the relationships between industry and physicians, particulary when discussing continuing medical education among surgeons and training residents. Given Dr. Bitterman's intersest in the topic, as well as the paucity of current research in the topic, he helped form the team (compromised of the listed authors) to explore the issue.”

“Collectively, the team has set goals to explore the effects of the Sunshine Act on industry-physician relationships. We feel that the relationship is integral in advancing not only innovations throughout orthopedic surgery, but also educational opprotunities for training surgeons. We felt that an updated account on the trends since the legislation would be paramount, as most literature on the subject was published shortly after the act was enabled.”

Using the currently available data (2014 to 2019), researchers found that there were 1,941,772 payments to 12,816 sports medicine orthopedic surgeons. The top five compensated surgeons received 45.8% of all industry contributions—a median total payment of $9.2 million.

“The median payments to surgeons demonstrated a significant upward trend,” said the authors…The majority of industry contributions in the top five earners were attributed to royalties and licenses (98.7%).”

“Across the study period, 89.4% of the total orthopedic sports medicine surgeons received a yearly total payment less than $10,000 which made up 8.3% of the total industry payment sum. Those receiving a yearly total payment greater than $500,000 accounted for 0.3% of surgeons, but received 53.4% of the sum payments.”

Dr. Partan told OTW, “The most important results of our research show that despite the transparency of the legislature, the relationships between industry and physicians remain strong.”

As for this topic as related to his colleagues in hip, spine, etc., Dr. Partan noted, “In regard to future research, our research team has particular interest in exploring the effects in other orthopedic subspecialities.We are currently working on additional research in trauma, total joint arthroplasty, and general orthopedics. Additionally, we have a current project much similar in format in regards to the effects of the Sunshine Act in orthopedic spine surgery.”

“We hope that our findings can lead to future research among other specialities to better define its effects across the orthopedic community as a whole.”

Additional study authors include Peter B. White, D.O., M.S., Nicholas Frane, D.O., and Cesar R. Iturriaga, D.O. and Adam Bitterman, D.O.


4 thoughts on “How Much Does Industry Pay Physicians? New Study

  1. I’ve read with interest your paper investigating the ties between surgeons and industry. The participation of surgeons in the research, development, and teaching of other surgeons has provided tremendous value in the advancement of new technologies in Orthopaedics.

    As you explore this area further; however, I would like to provide a cynics view to this collaboration. We have witnessed in previous decades with the DOJ’s intervention in the mid 00s the abuses that were rampant with such collaborations and so called sham consulting deals. A ‘pay to play’ arrangement which induces and influences surgeon prescriptive behaviors. While many innovations have relied heavily on the expertise of skilled surgeons would it not seem possible that such expertise could be found outside the setting of fellowship and resident programs? A cynic may hypothesize that the percentage of financial arrangements is greater within programs in which surgeons in training will most likely be influenced by industry consultants.

    Additionally it would be curious to uncover the relationship between surgeon pay and surgical volume as this may also suggest a reemergence of the types of sham arrangements that plagued the 90s and 00s and may also challenge the ethics of our next generation of surgeons.

    Is there a particular consulting value in which a surgeon does not feel ingratiated and biased? Is there a particular consulting value or royalty arrangement in which a surgeon does not necessarily become a ‘sales agent’ of industry? Is there a particular consulting value in which loyalty to one supplier may not be breached despite the availability of beneficial technologies or therapies of another organization?
    Beyond customary expenses associated with surgical training programs and demonstrations has there been an increase of the number of consultants and/or total expenditures, and furthermore are we setting ourselves up for another intervention?

    One may suggest that as we trend towards providing a sustainable model of value based care that the degree and necessity of these surgeon/industry relationships should be checked moving forward.

  2. And to provide further from a cynic’s point of view. What is it about a surgeon’s expertise that allows him/her to be worth, at times, millions of dollars in royalty fees while not necessarily having been issued the patent on such devices? Can not an appropriately experienced mechanical/bio materials/biomedical engineer invent such devices through 100% devotion to product development? Is this invention not worth more than the 100K salary offered to the engineer who may have devoted 50+ hrs/week over 6-8 years to innovate an additive manufacturing process or new bacterial resistant biomaterial yet multi millions to the surgeon consultant who devotes 30+ hours/week to a surgical practice, 20-30 hours/week to clinic, 10+ hrs/week to other related tasks and 2 hrs/month to consulting? Is it only the surgeons operating in the setting as instructors who offer such valuable expertise? Are there low volume surgeons out there operating as general practitioners in rural, non mentorship positions who are capable of earning multi million royalty payouts for brilliant ‘inventions’? Does she even get have the same opportunity to earn the 10-40K/year teaching 2 courses/year, meeting with marketing execs 1x per quarter? Or is this opportunity only reserved for the high profile, high volume up and coming assistant and associate professors?

    1. You have made some interesting points. However, your understanding of an orthopedic surgeons work week is unrealistic and atrociously misrepresented.

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