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Study Finds Gender Disparities in Financial Relationships Between Orthopedic Surgeons and Industry

A new study adds to a growing body of evidence showing gender inequities in payments that surgeons in various specialties receive from industry in the form of royalties, licensing and consulting fees. The latest research, conducted by investigators at Hospital for Special Surgery (HSS) and other medical institutions, finds such disparities pervasive in the field of orthopedic surgery.

This study is available online as part of the AAOS 2020 Virtual Education Experience. The results were also published in The Journal of Bone and Joint Surgery in February 2020.

“Orthopedic surgery is historically a male-dominated specialty, with women comprising only 6.5% of AAOS members. However, a growing number of women are entering training programs and now represent about 13% of orthopedic residents,” explained A. Holly Johnson, MD, a foot and ankle surgeon at HSS and senior investigator. “As the number of female orthopedic surgeons increases and efforts are made to establish workforce equality, it’s imperative to understand any disparities that may exist. We hypothesized that men receive a higher proportion of royalties and consulting fees than women after adjusting for the number of men and women in the orthopedic workforce.”

Dr. Johnson noted that the goal of working with industry is to advance the field of orthopedic surgery by developing new and better medical devices that will ultimately improve patient care.

Financial relationships that U.S. physicians have with medical device and pharmaceutical companies are publicly reported in the Centers for Medicare and Medicaid Services Open Payments database. Researchers used information from the database to analyze payments made to orthopedic surgeons from industry for royalties, licensing or consulting fees from 2016 to 2017. A physician’s profile was used to determine name, gender, practice location and subspecialty. Years of experience were recorded from publicly available websites. The total number of payments and amounts were compared among men and women, subspecialties and locations.

The study found that total industry payments based on those parameters amounted to more than $700 million. Approximately 11% of orthopedic surgeons received 88% of payments during this time period. Among these physicians, 98% were men and 2% were women.

In addition, the study found that the average male orthopedic surgeon received more than five times the amount paid to any woman. Men were more likely to receive royalty payments than women, and median royalty payments were found to be much higher than consulting fees. Orthopedic surgeons with more years of experience earned a greater number of payments.

“Recent studies have demonstrated that women are grossly underrepresented in positions of leadership within the field of orthopedics,” Dr. Johnson noted. “It is possible that the low number of women in leadership positions contributes to a lack of opportunities to work with industry to advance the field.”

As the number of women entering the specialty of orthopedics rises, addressing inequities is of paramount importance, according to the study authors. “As we promote equal and fair opportunities within the workplace for all orthopedic surgeons, we must ensure that resources are equally and fairly distributed,” they noted. “This responsibility should be shared among surgeons, industry partners, hospital administrators and government officials. Only with concerted and directed efforts will we ensure that financial incentives and research funding are allocated based on merit rather than gender or race.”

Disclosures: Dr. Johnson has no disclosures that are relevant to this study. 

About HSS

HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 14th consecutive year), No. 2 in rheumatology by U.S. News & World Report (2023-2024), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fourth consecutive year (2023). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.