Nature and Magnitude of Industry Payments to Fellowship Program Directors in Orthopaedic Surgery

Previous research has highlighted conflicts of interest stemming from industry funding and education of orthopaedic surgeons. This study sought to define the nature and magnitude of industry payments to orthopaedic surgery fellowship program directors (FPDs) in the United States.

This was a retrospective cohort study of orthopaedic surgery FPDs during 2021. Data were obtained from the Accreditation Council for Graduate Medical Education (ACGME) and Centers for Medicare and Medicaid Services. Profiles of orthopaedic surgery FPDs were obtained for ACGME-accredited and non-ACGME-accredited training programs. Nonresearch industry payments from 2015 to 2021 were extracted and adjusted for inflation. Temporal trends were analyzed through the calculation of compound annual growth rates. Comparisons were made with nonparametric tests.

Of 600 orthopaedic surgery FPDs, 596 received industry funding (99%), which totaled $340.6 million over the study period. A trend toward greater total annual industry payments over the study period was observed (compound annual growth rate = 3.3%, P = 0.009). Most industry payments were for royalties or licensing ($246.6 million, 72.4%) and consulting fees ($53.6 million, 15.7%). The median total payment per orthopaedic surgery FPD was $49,971 (interquartile range [IQR], $291,674), with 22% receiving between $100,000 and $500,000 and 17% receiving more than $500,000. The highest annual industry payments existed in shoulder and elbow ($41,489, IQR, $170,613) and spine surgery ($26,103; IQR, $84,968). ACGME accreditation status did not influence the magnitude of industry compensation to orthopaedic surgery FPDs across subspecialties ( P > 0.05). Men had higher total median annual industry payments versus women ($7,799 [IQR, $47,712] versus $1,298 [IQR, $6,169], P < 0.001).

Industry payments to orthopaedic surgery FPDs are ubiquitous, but the magnitude varies by subspecialty. Most industry funding was found in shoulder and elbow and spine surgery. Standards for orthopaedic fellowship education, such as those upheld by accrediting bodies, should include guidelines on how FPDs handle and disclose financial relationships with industry.