Disparities in Industry Payments to Orthopedic Surgeons: A Retrospective Observational Analysis of Institutional Prestige and Financial Distribution

Financial relationships between orthopedic surgeons and industry partners shape innovation and surgical advancements, yet these payments are highly concentrated among a small subset of surgeons. This retrospective observational analysis examines industry payment disparities using the Centers for Medicare & Medicaid Services (CMS) Open Payments Database for 2021, comparing payments between orthopedic surgeons affiliated with U.S. News & World Report (USNWR) top 10 orthopedic centers and those at large academic medical centers in the 25 most populous U.S. states. A total of 1,612 surgeons were included. Industry payments exhibited a right-skewed distribution, with a Gini coefficient of 0.91 for USNWR institutions and 0.93 for state-based academic centers, indicating significant financial stratification. Royalty and licensing fees accounted for 93.25% of payments exceeding $500,000, disproportionately benefiting surgeons at USNWR-ranked institutions. Surgeons at these institutions had 3.01 times higher odds of receiving over $500,000 in payments compared to those at state medical centers (OR = 3.01, 95% CI: 1.50-6.04, p < 0.001). Geographic disparities were also significant, with payments concentrated in states housing top-tier orthopedic programs. These findings highlight the role of institutional prestige in industry compensation and raise ethical considerations regarding equity in financial relationships and access to industry collaborations.