Increasing Industry Support Is Associated with Higher Research Productivity in Orthopaedic Surgery

Orthopaedic surgeons receive a disproportionately small share of funding from the National Institutes of Health, but they receive the largest amount of funding from industry sources. The purpose of this study was to examine the association between payments from industry partners and research productivity among orthopaedic research authors, as well as to identify predictors of high research productivity.

United States-based physicians who published an article in 2016 in The Journal of Bone & Joint Surgery or The American Journal of Sports Medicine were included in this study. These authors were queried in the Centers for Medicare & Medicaid Services Open Payments database (OPD) to determine the amount of industry payments received, and on Scopus, a bibliometric web site, to assess the quantity (total publication count) and quality (Hirsch index [h-index]) of each author's research. Nonparametric testing was used to compare the h-index and the total publication count of authors by payments received and academic position. Multivariate regression was used to identify independent predictors of high research productivity.

Of the 766 included authors, 494 (64.5%) received <$10,000 per year, 162 (21.1%) received between $10,000 and $100,000, and 110 (14.4%) received >$100,000 in total payments. The h-index increased significantly from a mean (and standard deviation) of 13.1 ± 12.9 to 20.9 ± 14.4, and to 32.3 ± 16.7, from the lowest to highest payment cohorts, as did total publication count. When authors were stratified by academic position (assistant professor, associate professor, full professor, and nonacademic), those who received more industry payments (>$100,000) had a higher h-index and total publication count at all academic levels relative to lower-earning (<$10,000) authors. Independent predictors of a high h-index included industry payments of between $10,000 and $100,000 (odds ratio [OR], 1.63; p = 0.048), payments of >$100,000 (OR, 5.87), associate professorship (OR, 6.53), full professorship (OR, 33.38), and last authorship (OR, 2.22) (p < 0.001 for all comparisons unless otherwise noted).

Although this study does not establish a causal relationship, we identified increasing industry payments as an independent predictor of research productivity among authors at all academic levels who had published peer-reviewed orthopaedic research.