Device Company Payments to Orthopedists


Today’s Managing Health Care Costs Indicator is $228 million

The Department of Justice settled lawsuits with 5 major artificial joint manufacturers in 2007.  The lawsuit required each to stop improper compensation to practicing physicians, to accept heightened oversight, and to divulge future payments to orthopedists.  The firms did not acknowledge any guilt.  These firms disclosed $198 million in payments to 939 orthopedist in 2007, and $228 million to 526 orthopedists in 2008.

Researchers have poured through the filings to compile a list of which physicians received how much compensation as consultants (published in Archives of Internal Medicine on October 24  Harvard Link)   Here’s what they found:
  • 4% of practicing orthopedists received payments
  • Payments averaged $190,331 in 2007, and $401,951 in 2008. (The 2008 number is inflated because of a large contract buyout by one orthopedic device manufacturer)
  • 43 Orthopedists received more than $1million in both 2007 and 2008. Over a third of these each year (16 and 17) had no academic affiliation.
  • Over a quarter of those orthopedists receiving payment as consultants had  one or fewer published papers

Orthopedists make important decisions about which implantable artificial joints to use, and these decisions are worth hundreds of millions to each of these companies.  These payments are large – and would represent a substantial portion of each of these physicians’ income.  Most or all of them deeply believe that these payments have no impact on their clinical decisions.  But that’s just not credible. 

Tools to diminish this kind of payment include
  • Transparency.   Putting this data in searchable databases will make physicians less likely to accept these dollars
  • Disclosure.  Physicians who recommend one course of treatment when they are getting payment from a manufacturer should fully disclose this to their patients. 
  • Professional ethics.   Many medical schools have implemented guidelines to diminish this type of unseemly influence. (On the other hand, collaborations between practicing orthopedists and research universities is should be continued)

We all want some sense of assurance that we’re getting a physician’s honest recommendation. We don't want our operating rooms to be full of product placements.