Analysis of industry payments among orthopedic fellowship program directors in the United States

Background: Orthopedic fellowship directors play a crucial role in shaping patient care approaches of fellowship trainees under their guidance. Given the influence fellowship directors have over surgeons-in-training practices, their financial conflicts of interest are of notable significance. Methods: A list of 566 orthopedic fellowship program directors in the United States was compiled. Program directors from the following subspecialties were included: adult hip and knee, sports medicine, hand, spine, trauma, foot and ankle, pediatric orthopedics, shoulder and elbow, and musculoskeletal oncology. Demographic information was obtained from public physician profiles. General payments, research payments, associated research funding, and ownership interest data were collected using Open Payments. Descriptive statistics and independent samples t-tests were employed in the investigation. Results: The 566 directors collected a total of 57,610,923.47 USD in general payments in 2021 with a median of 7,180.56 USD. Fellowship directors specializing in shoulder and elbow earned significantly greater than sports medicine (75,580.42 USD v. 8,006.10 USD, P =0.031), hand (1,200.00 USD, P =0.012), spine (22,296.72 USD, P =0.048), trauma (6,104.73 USD, P =0.046), foot and ankle (38,584.57 USD, P =0.046), pediatric orthopaedics (1,480.46 USD, P =0.016), and musculoskeletal oncology (348.09 USD, P =0.011) directors. The top 5% of earners (n=28/566) accounted for 61.5% of the total value. Royalties accounted for 74.6% (43,004,029.50 USD) of the total value exchanged, followed by consulting at 13.7% (7,894,319.64 USD). Conclusions: Orthopedic fellowship directors receive considerable payments from the medical industry. We strongly encourage transparent conversations about these associations with trainees, aiming to offer positive models of physician-industry collaborations.