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Disparities in Industry Payments Between Orthopaedic Surgery and General Surgery Residents
Cemil C Gedik1, Claire Saltzman1, Parker D Boyce2
1Department of Orthopedic Surgery, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri.
Background:
Industry funding may support surgical training but also raises conflict-of-interest concerns, particularly among financially vulnerable residents. This study examined whether the prevalence and magnitude of Centers for Medicare & Medicaid Services (CMS) Open Payments general payments differed between postgraduate year 5 (PGY-5) orthopaedic surgery (OS) and general surgery (GS) residents graduating in 2025, and whether these payments varied by institution type and geographic region.
Methods:
We performed a cross-sectional analysis of CMS Open Payments (2018-2024) for PGY-5 residents in OS and GS graduating in 2025. Residency programs were identified, and PGY-5 rosters were compiled from program websites. Residents were linked to Open Payments records. Payments were categorized as Consulting Fees/Grants/Charity, Travel/Education Support, and Hospitality. Payment prevalence and payment amounts were compared between specialties, with adjustment for institution type and geographic region.
Results:
Across 150 institutions (120 GS programs, 117 OS programs), 1,591 residents were analyzed. Overall, 861 of 1,591 residents (54%) had ≥1 payment; OS residents had higher prevalence than GS (57% vs. 52%; OR 1.25, 95% confidence interval [CI]: 1.03-1.53; p = 0.03). Unadjusted mean payments were $3,176 (OS) versus $798 (GS) (p < 0.0001). Adjusted mean payments remained higher for OS ($3,202) than GS ($653), a 4.90-fold difference (p < 0.0001), with significant interactions by institution type and region.
Conclusions:
Over half of PGY-5 GS and OS residents receive industry payments, although OS receive substantially more overall. These payments are highly concentrated at the top tier of recipients. Training programs, governing bodies, and other key stakeholders should consider developing a structured approach that capitalizes on the industry financial support while minimizing bias in resident education and delivering a more equitable distribution to all residents.
Level Of Evidence Or Clinical Relevance:
Level III (cross-sectional observational study); clinically relevant to graduate medical education policy and conflict-of-interest oversight. See Instructions for Authors for a complete description of levels of evidence.