Exploring the relationship between industry payments and institutional factors among American shoulder and elbow surgery fellowship programs

Abstract

Background

While previous studies have examined trends in industry funding among orthopedic surgeons across various subspecialties, there is limited research focusing on institutional-level evaluations. The purpose of this study was to investigate the relationship between shoulder and elbow surgery fellowship program characteristics and industry payments.

Methods

This cross-sectional analysis examined characteristics of shoulder and elbow surgery fellowship programs, including program reputation, academic productivity metrics, region of practice, and total number of fellows, in relation to industry lifetime earnings as of March 2024. Fellowship faculty were identified from the American Shoulder and Elbow Surgeons (ASES) directory, while program data were collected from individual program websites. All ASES fellowship faculty members were confirmed on individual program websites. Each surgeon was searched on the Open Payments Database for their compensation earnings. Prestige factors, including fellowship-affiliated residency rankings, were gathered from Doximity and Newsweek rankings, respectively. Academic productivity metrics, including the Hirsch index (H-index), M-index, Relative Citation Ratio (RCR), weighted RCR, and attending publication rates, were obtained using iCite, Scopus, and ResearchGate databases.

Results

We identified 151 ASES fellowship faculty members, including 145 male faculty members and 5 female faculty members, from 34 shoulder and elbow surgery fellowship programs. The mean number of payments per fellowship was 999.32 ± 687.51, resulting in mean fellowship lifetime earnings of $1,125,924.05 ± $1,788,302.048. The top sources of industry funding included royalties ($ 766,904.11 ± $765,382.42; 77.3%) followed by consulting ($163,148.43 ± $337,926.35; 15.8%). While there was a statistically significant increase in total lifetime earnings in fellowship programs associated with a Newsweek ranking of the fellowship-affiliated hospital (Kruskal-Wallis, H = 10.806, P = .029), there were no significant correlations between total lifetime fellowship earnings with the Doximity ranking of fellowship-affiliated residency programs (P = .600), region of the United States (P = .129), the number of fellows per program (P = .139), practice type (academic vs. private; P = .287), or academic productivity metrics (fellowship H-index [P = .203], M-index [P = .408], RCR [P = .844], weighted RCR [P = .385], attending publication rate [P = .140]).

Conclusion

Our findings indicate that institutional prestige influences industry funding among ASES shoulder and elbow surgery fellowship programs irrespective of academic productivity metrics. Further investigation of this correlation is warranted to better inform policies aimed at promoting transparency and ethical considerations within medical education. By identifying these influences, future studies can help to refine guidelines that govern interactions between industry and medical professionals, ultimately supporting integrity and transparency in medical education and practice.