Conflicts of Interest

One estimate of the average annual salary for an orthopedic surgeon is $459,000. This is is contrast to all workers in the United States at $25,149, a factor of 18.3 times as much for the surgeon. On the one hand, it would seem that this level of compensation should be sufficient. On the other, this is America where market forces reign and one should be able to make what one can make. Yet the average orthopedic surgeon sees that the average neurosurgeon makes $541,000 and this perhaps engenders some envy.

Now I have used orthopedic surgery and neurosurgery as a matter of convenience as they are at the high end of the pay scale but physicians and the money they make are a topic rich for conversation. We as surgeons know all the arguments: high income, but far less per unit work than before (and seemingly less each year), after training we are aged close to Medicare eligibility, enormous loans for medical school, discrepancies between primary care and specialists, etc., etc.

Set against these income levels, let us focus upon "consultation fees" that device manufacturers provide these doctors. Last year the five major companies that make hip and knee joints provided at least $227 million in such payments. Now set against a quarter of a billion dollars being paid for these "consults" by doctors, can we focus upon the topic of this post? These same surgeons who are getting supplementary payments of thousands (and in some instances quite a bit more) are coming to our hospitals asking that new expensive equipment and supplies be purchased. I am certain that the overwhelming majority of surgeons are asking for the betterment of their patients. Yet despite some publicly available lists, we are not always certain who is on what company's payroll, and if a company is paying a surgeon, should that surgeon be able to influence the hospital's purchase of equipment?

At a minimum, we need transparency in such interactions. In my opinion, we need more: anyone with a financial relationship with a company should not have any influence at all upon the institution's purchases.