Special Article
Health Care Reform
Oct 24, 2011

Financial Payments by Orthopedic Device Makers to Orthopedic Surgeons

Author Affiliations

Author Affiliations: Department of Health Management and Policy, The University of Iowa (Dr Hockenberry and Ms Weigel), Comprehensive Access and Delivery Research and Evaluation Center, Iowa City Veterans Affairs Medical System (Drs Hockenberry and Cram), and Division of General Medicine, Department of Internal Medicine, The University of Iowa Carver College of Medicine (Dr Cram), Iowa City; and Division of Hospital Medicine, University of California, San Francisco, San Francisco (Dr Auerbach). Dr Hockenberry is now with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.

Arch Intern Med. 2011;171(19):1759-1765. doi:10.1001/archinternmed.2011.454

Background There is ongoing concern over potential conflict of interest inherent in physician relationships with industry. However, there are limited empirical data detailing the prevalence and magnitude of these relationships. Our objective was to use data made available by a US Department of Justice (DOJ) lawsuit to describe the extent of orthopedic surgeons' financial relationships with implant manufacturers.

Methods We used data made available by the 2007 DOJ settlement with 5 major joint implant manufacturers to detail the number of orthopedic surgeons receiving payments, the size of these payments, the aggregate dollar amount, and the proportion going to academically affiliated orthopedic surgeons between 2007 and 2010.

Results In 2007, 1041 payments totaling in excess of $198 million were made to 939 orthopedic surgeons. In 2008, following the DOJ settlement, the implant makers made 568 payments totaling more than $228 million to 526 orthopedic surgeons (which included $109 million in one-time royalty buyouts by a single firm). The proportion of surgeons receiving payments who had academic affiliations rose from 39.4% in 2007 to 44.9% in 2008. Similar patterns were observed in 2009 and 2010 for 3 firms that continued to disclose by choice. We also noted substantial variation across firms in the details provided in the disclosed data.

Conclusions The impact of the DOJ settlement in the short term appears complex, with an increase in payments, a decline in the number of consultants, and an increase in the proportion of consultants drawn from academia. There is a need for clearer specific requirements for disclosure to allow for meaningful long-term analyses to be performed.