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.