Is Industry Funding Associated with Greater Scholarly Impact Among Academic Neurosurgeons?

Analysis of Research Activity Among Ophthalmology Fellows

PURPOSE

The academic success of ophthalmology fellows may be significantly impacted by their research engagement. Evaluating the research activity of fellows by subspecialty may provide insight into trends useful for prospective applicants. The objective of this study was to assess the research activity of ophthalmology fellows in the year 2023.

METHODS

Ophthalmology fellowship programs were compiled using the Association of University Professors of Ophthalmology and the American Society of Ophthalmic Plastic and Reconstructive Surgery websites. Program subspecialties were categorized as: Cornea and External Disease [CED]; Cornea, External Disease, and Refractive Surgery [CEDRS]; Glaucoma; Medical Retina [MR]; Neuro-Ophthalmology [NO]; Oculoplastics; Pediatric Ophthalmology [PO]; Surgical Retina [SR]; Uveitis; and Other. "Other" consisted of Oncology, Pathology, combined Oncology and Pathology fellowships. We identified current fellows using publicly available online information. Programs and fellows that did not have information available were excluded. Total publications, Hirsch index (h-index), and weighted-relative citation ration (w-RCR) were utilized as measures of research output, while total citations and mean-RCR (m-RCR) served as proxies for research impact. Duration of publishing was calculated using the years of the oldest and most recent publications. Statistical analysis was performed using Kruskal-Wallis H tests with an alpha value of .05.

RESULTS

A total of 373 fellows from 229 programs met our inclusion criteria. More than half of fellows were men (54.4%), and the most common degree type was MD (93.0%). Across all subspecialties, the median h-index was 3.0 (IQR = 4), m-RCR was .9 (IQR = 1.2) and w-RCR was 3.2 (IQR = 9.8). The median number of publications was six (IQR = 10, with 34 citations (IQR = 110) and 4 years of publishing (IQR = 6). We observed significant differences in h-index (p = .038), total publications (p < .001), and w-RCR (p = .028) by subspecialty.

CONCLUSION

We observed significant differences in research output, but no differences in research impact by subspecialty. Overall, Uveitis and Oculoplastics fellows had higher research activity, while Medical Retina and Other fellows had the lowest. This data is pertinent to better understand the landscape of ophthalmology fellowship applications.

Social Media Influence and Gender Are Correlated with Industry Payments to Orthopaedic Sports Surgeons

Social media, specifically Twitter, has become an increasingly used tool in academic orthopaedic surgery to help surgeons connect with patients and peers. This study seeks to understand correlations among social medial influence, academic influence, and gender among academic orthopaedic sport surgeons. A list of all orthopaedic sports surgeons serving as faculty of sports fellowships in the United States was compiled, along with publicly available demographic information. Their Hirsh indices (h-indices) were obtained using the Scopus database. The Physician Payments Sunshine Act Web site was used to determine their industry payments from 2014 through 2020. The number of Twitter followers was used as a measure of social media influence. Multivariable linear regression models were employed to explore the associations between these parameters and industry payments. Of the 633 surgeons, 33% had a Twitter account. Surgeons with > 1,000 followers (7.3%) were awarded 186% more in nonresearch funding (p = 0.01) and had a higher probability of receiving industry research funding compared with those with no followers (p = 0.03). Sports surgeons had an average h-index of 16, with 44% having ≤ 20 publications and 21% having ≥ 100 publications. Surgeons with ≥ 100 publications were awarded 453% more in nonresearch funding (p = 0.001) and had a 32% higher probability of receiving industry research funding (p < 0.001) when compared with their colleagues with ≤ 20 publications. Female sports surgeons accounted for only 7.9% of surgeons included in the study, and were awarded 65% less in industry nonresearch funding compared with their male colleagues (p = 0.004) when controlling for other factors. Both number of publications and a high level of Twitter activity (> 1,000 followers) had the strongest associations with the quantity of industry nonresearch funding and the highest probability of industry research funding. Female sports surgeons received significantly less industry nonresearch funding compared with their male colleagues. Future studies further exploring gender disparities in industry funding for orthopaedic surgeons may be warranted. LEVEL OF EVIDENCE:  Prognostic, Level III.

Surgical Instrument Designers and Inventors-Where are the Women?

Historically, surgical instruments were designed by men for male surgeons. Although instrumentation has changed with the changing paradigms of surgery, it has failed to adapt to the changing surgical workforce. Almost 30% of surgeons are female and nearly 90% of surveyed female surgeons report poor instrument design and associated musculoskeletal injuries from use. Understanding the current state of handheld surgical instrument design, published literature was reviewed, surgical instrument collections were contacted, and the U.S. Patent and Trademark databases were queried to identify public patents and pre-granted applications of female inventors of handheld surgical instruments. Twenty-five female inventors were identified from published literature and 1551 unique females hold patents. This number pales when the denominator of male inventors is considered. Hence, to address the female surgeon's lack of instrumentation and design, there is a critical need for participatory ergonomics whereby both the female surgeon and engineer collaborate on design.

Association of Practice Setting and Scholarly Activity With Medicolegal Claims in Otolaryngology-Head and Neck Surgery

OBJECTIVE

To characterize the association between scholarly activity, academic rank, practice setting, and malpractice claims among otolaryngologists over the past decade.

METHODS

Data was extracted from the two legal databases, WestLaw and LexisNexis. The records were obtained from January 2010 to January 2020. Scopus and PubMed databases were used to identify bibliometric data.

RESULTS

Of the 102 malpractice cases identified, 77.5% (N = 79) were ruled in favor of the defendant, 13.7% (N = 14) in favor of the plaintiff, and 8.8% (N = 9) were settled outside of the court. A total amount of $46,533,346.82 was rewarded to plaintiffs in 14 cases. Endoscopic sinus surgery was the procedure associated with the most malpractice claims (N = 16). Alleged improper performance (N = 51) was the most common underlying reason for litigation. Of the 102 defendant surgeons, 82 (80.4%) were in community/private settings. Among the 14 cases in that a surgeon was found at fault, 13 (92.8%) were in the community/private setting. Among the surgeons with at least one publication, the mean Hirsch Index (h-index) was 8.2. There was a statistically significant correlation between the mean h-index and litigation outcome (95% CI: -8.9 to -0.9, P = .017).

CONCLUSION

Our analysis showed that most malpractice litigations were among otolaryngologists practicing in community/private settings. We also found that higher scholarly activity measured by the h-index was associated with verdicts in favor of the defendant/surgeon. This study was limited by not all-inclusive aspects of the legal databases that were used, the small sample size, and the lack of multivariable analysis.

Women in Neurosurgery: A PRISMA-Compliant Systematic Review of Where We Stand and a Pilot Study on How to Move Forward

BACKGROUND

Surgical specialties struggle to recruit women. In this study, the authors performed a systematic review to describe progress of women in neurosurgery and highlight areas where further research is needed.

METHODS

PubMed, Embase, and Cochrane Library were queried with "women in neurosurgery" OR "female neurosurgeon," and publications with empiric research were included. Bias was assessed on the basis of study designs.

RESULTS

We found 127 papers, and 36 met inclusion criteria. Much of this research is recent-85% has been published within the past 3 years. These papers detail differences between genders and examine possible causes, but they do not test interventions to remedy inequities. The authors designed an intervention focusing on medical students' perceptions of gender issues within neurosurgery. A seminar was designed with 2 objectives: inform medical students about changes within neurosurgery and introduce them to a female neurosurgery attending who could serve as a potential future mentor. Student attitudes were assessed before and after the seminar by survey. Fourteen students completed both surveys: 10 females and 4 males.

CONCLUSIONS

The 1-hour seminar significantly reduced the mean perceived difficulty to enter neurosurgery from 4.4 to 4.1 (P = 0.014); additionally, the mean perceived additional difficulty for career advancement faced by women in neurosurgery decreased from 3.6 to 2.8 (P = 0.026). Much research has gone into documenting the advancement and potential impediments for women in neurosurgery. Less research has tested solutions. Our pilot was small and susceptible to bias, but given that some results achieved significance, it merits more rigorous study.

Trends in Industry Payments to Physicians in the First 6 Years After Graduate Medical Training

IMPORTANCE

Financial incentives and conflicts of interest may influence physician decision-making. It is important to understand financial interactions between the pharmaceutical and medical device industries and newly independent physicians who have recently completed their graduate medical education using a national transparency program.

OBJECTIVE

To identify trends in industry payments to recent graduates of Accreditation Council for Graduate Medical Education-accredited residency or fellowship programs in orthopedic surgery, neurosurgery, and internal medicine.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study analyzed Open Payments reports of industry payments made between July 1, 2015, and June 30, 2021, to newly independent physicians from residency or fellowship programs in neurosurgery, orthopedic surgery, and internal medicine who graduated between January 1, 2015, and December 31, 2019.

EXPOSURES

Specialties (neurosurgery and orthopedic surgery, with internal medicine as a comparison group).

MAIN OUTCOMES AND MEASURES

Industry payments to newly independent physicians, including any general payments (noninvestment or nonresearch) and at least $5000 of general payments in aggregate value per year, which are considered significant financial conflicts of interest. The percentage of newly independent physicians accepting general payments during the first 6 years after graduation was analyzed by specialty and sex using cumulative incidence curves and hazard ratios (HRs) in univariable and multivariable analyses.

RESULTS

There were 45 745 recent graduates (28 137 men [62%]; median age at graduation, 33.0 [IQR, 31.0-35.0 years]) in neurosurgery (n = 595), orthopedic surgery (n = 3481), and internal medicine (n = 41 669). In the first 2 years of independent practice, 95% (n = 3297), 92% (n = 546), and 59% (n = 24 522) of newly independent physicians in orthopedic surgery, neurosurgery, and internal medicine, respectively, accepted any general payments. A higher percentage of the newly independent physicians in orthopedic surgery and neurosurgery accepted any general payments (orthopedic surgery vs internal medicine: HR, 5.36 [95% CI, 4.42-6.51] for women and 7.01 [95% CI, 6.35-7.73] for men; neurosurgery vs internal medicine: HR, 3.25 [95% CI, 2.24-4.72] for women and 4.08 [95% CI, 3.37-4.94] for men; P = .03). A higher percentage of male physicians compared with female physicians accepted any general payments (orthopedic surgery, 2884 of 3026 [95%] vs 413 of 455 [91%]; P < .001; neurosurgery, 466 of 502 [93%] vs 80 of 93 [86%]; P = .01; and internal medicine, 15 462 of 24 609 [63%] vs 9043 of 17 034 [53%]; P < .001) and at least $5000 of general payments (orthopedic surgery, 763 of 3026 [25%] vs 71 of 455 [16%]; P < .001; neurosurgery, 87 of 502 [17%] vs 5 of 93 [5%%]; P < .001; and internal medicine, 882 of 24 609 [4%] vs 210 of 17 034 [1%]; P < .001).

CONCLUSIONS AND RELEVANCE

In this cohort study of newly independent physicians in orthopedic surgery, neurosurgery, and internal medicine, the financial relationship with potential conflicts of interest between newly independent physicians and industry began to develop soon after training programs and continued to expand in the early years of newly independent physician practice. Newly independent physicians in surgical specialties and male physicians accepted significantly higher industry payments. Further studies are needed to evaluate whether modifiable factors are associated with the future outcome of newly independent physicians accepting general payments.

Disparities in industry funding among Colorectal Surgeons: a cross-sectional study

BACKGROUND

Health Industry and physician collaboration generates innovation. Colorectal Surgeon (CRS) selection to collaborate might not be random. We aim to identify CRS personal and professional characteristics that facilitate collaboration with the Industry.

METHOD

Cross-sectional study of Industry payments to CRS (2014-2018) using Open Payments Database from Centers for Medicare & Medicaid Services. Multivariable regression compared variables predicting payment amount including gender, years in practice, leadership positions, H-index, Twitter presence and geographic location.

RESULTS

Surgeons who were male received 3.1 times the amount in Industry payments as compared to females (p = 0.014). Chairs and Division Chiefs received 2.7 times the amount in payments as compared to those without these leadership positions (p = 0.003). Surgeons with an H-index ≥ 8 received 2.2 times the amount in payments as compared to those with H-index < 8 (p = 0.001). Surgeons in practice for 12-19 and 20-30 years received 3 times and 4.4 times the amount in payments as compared to surgeons in practice for 1-11 years (p = 0.036 and p = 0.017, respectively). Surgeons in the South received 3.2 times and 2 times the amount in payments as compared to surgeons in the Northeast (p < 0.0005) and in the Midwest (p = 0.006). Surgeons with Twitter accounts received 1.7 times the amount in payments as compared to surgeons without Twitter (p = 0.036). Among Twitter users, those with 321-17,200 followers received 4.7 times and 9.5 times the amount in payments as compared to those with 0-15 and 16-79 followers, respectively (p = 0.008 and p = 0.009).

CONCLUSION

Industry payments are more commonly addressed to male, senior surgeons in leadership tracks with strong social media outreach. With the increasing gender and racial variety in the CRS field, it is expected that collaborations between industry and surgeons will become more diverse and inclusive.

Gender differences in the medical industries’ payments to physicians: a systematic review

Purpose

This paper aims to explore gender differences in payments made to physicians by the pharmaceutical and medical device industries via the performance of a systematic review of articles based on the Open Payments Database (OPD).

Design/methodology/approach

Three databases (Scopus, Web of Science and PubMed) were searched for articles published from September 30, 2014 to May 10, 2019, using two search terms: “Sunshine Act” and “Open Payments.” The systematic review is reported according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.

Findings

The search identified 359 abstracts. Thirty-nine articles were selected for full review, and 17 of these met the inclusion criteria. Although the articles considered are based on the same database, they adopt diverse approaches and analyses are conducted in different ways. A substantial proportion of the studies show total payments from the two industries to be higher for male physicians than for female physicians. However, a few exceptions exist, higher female mean or median values occurring for payments involving research, ownership, honoraria, grants, royalties/licenses and travel/lodgings. Also, in the case of obstetric–gynecological specializations, a higher proportion of women than men are shown to cooperate with the industries.

Originality/value

There is gender inequality in terms of industries’ funding for doctors. While analyses of secondary OPD data show that a gender inequality exists, they do not provide an understanding of why this occurs. However, from the exceptions identified, it can be speculated that this phenomenon is connected with greater adherence to ethical standards on the part of female physicians and/or the likelihood that fewer opportunities for industrial cooperation are extended to them.

Gender Disparity in 2013-2018 Industry Payments to Plastic Surgeons

BACKGROUND

The gender pay gap in medicine has been under intense scrutiny in recent years; female plastic surgeons reportedly earn 11% less than their male peers. "Hidden" pay in the form of industry-based transfers exposes compensation disparity not captured by traditional wage-gap estimations.

OBJECTIVES

The aim of this study was to reveal the sex distribution of industry payments to board-certified plastic surgeons across all years covered by the Center for Medicare and Medicaid Services Open Payment Database (CMS OPD).

METHODS

We obtained the National Provider Identifier (NPI) for each surgeon in the American Society of Plastic Surgeons (ASPS) member directory to record gender. Next, "General Payments" data points from annual files for all years present in the CMS OPD, 2013 to 2018, were aggregated and joined to provider details by Physician Profile ID before quantitative analysis was performed.

RESULTS

Of 4840 ASPS surgeons, 3864 (79.8%) reporting ≥1 industry payment were included with 3220 male (83.3%) and 644 female (16.7%). Over 2013 to 2018, females received mean [standard deviation] 56.01 [2.51] payments totaling $11,530.67 [$1461.45] each vs 65.70 [1.80] payments totaling $25,469.05 [$5412.60] for males. The yearly ratio of male-to-female payments in dollars was 2.36 in 2013, 2.69 in 2014, 2.53 in 2015, 2.31 in 2016, 1.72 in 2017, and most recently 1.96 in 2018.

CONCLUSIONS

Individual male plastic surgeons received over twice the payment dollars given to their female counterparts, accepting both more frequent and higher-value transfers from industry partners. Payment inequity slightly declined in recent years, which may indicate shifting industry engagement gender preferences.

Industry Payments and Their Association With Academic Influence in Total Joint Arthroplasty

BACKGROUND

The relationship between industry payments and academic influence, as measured by the Hirsch index (h-index) and number of publications, among adult reconstruction surgeons is not well characterized. The aims of the present study are to determine the relationship between an adult reconstruction surgeons' academic influence and their relevant industry payments and National Institutes of Health (NIH) funding.

METHODS

Adult reconstruction surgeons were identified through the websites for the orthopedic surgery residency programs in the United States during the 2019-2020 academic year. Academic influence was approximated by each physician's h-index and total number of publications. Industry payment data were obtained through the Open Payments Database, and NIH funding was determined through the NIH website. Mann-Whitney U testing and Spearman correlations were performed to examine relevant associations.

RESULTS

Surgeons who received industry research payments had a higher mean h-index (16.1 vs 10.2, P < .001) and mean number of publications (79.1 vs 35.9, P < .001) than physicians who received no industry research payments. Surgeons receiving NIH funding had a higher mean h-index (48.1 vs 10.4, P < .001) and mean number of publications (294.5 vs 36.8, P < .001) than surgeons who did not receive NIH funding. There was no association between the average h-index (P = .668) and number of publications (P = .387) among adult reconstruction surgeons receiving industry nonresearch funding.

CONCLUSION

h-index and total publications do not seem to be associated with industry nonresearch payments in the field of total joint arthroplasty. Altogether, these data suggest that industry bias may not play a strong role in total joint arthroplasty.

Minimally Invasive Glaucoma Surgery: A Critical Appraisal of the Literature

Micro- or minimally invasive glaucoma surgeries (MIGS) have been the latest addition to the glaucoma surgical treatment paradigm. This term refers not to a single surgery, but rather to a group of distinct procedures and devices that aim to decrease intraocular pressure. Broadly, MIGS can be categorized into surgeries that increase the trabecular outflow [Trabectome, iStent (first and second generations), Hydrus microstent, Kahook Dual Blade and gonioscopy-assisted transluminal trabeculotomy], surgeries that increase suprachoroidal outflow (Cypass microstent and iStent Supra), and conjunctival bleb-forming procedures (Xen gel stent and InnFocus microshunt). Compared to traditional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves), MIGS are touted to have less severe complications and shorter surgical time. MIGS represent an evolving field, and the efficacy and complications of each procedure should be considered independently, giving more importance to high-quality and longer-term studies.

Diversifying Researchers and Funding in Otolaryngology

Research productivity is a key metric used in evaluation for advancement and promotion in academic medicine. There are known gender, race, and ethnicity disparities in otolaryngology research and funding. Female academic otolaryngologists have been shown to lag in scholarly productivity, representation at national meetings, leadership positions on journal editorial boards, and National Institutes of Health and industry funding. Underrepresented minorities have been shown to be less successful at obtaining Centralized Otolaryngology Research Efforts grant funding. Directed approaches, such as research funding for women and minorities or targeted recruitment and retention of underrepresented faculty, may move the field toward parity.

Worldwide production on sleep apnea from 2009-2018. Analysis of the ability to secure funding and international collaboration networks

BACKGROUND

Obstructive sleep apnea (OSA) is an emerging health problem, but information on scientific production in this subject area is scarce. We aim to evaluate the scientific production on OSA from 2009 to 2018 to illustrate its worldwide distribution, topic areas, and ability to secure funding, as well as to describe international collaboration networks in this field.

METHODS

Articles published between 2009 and 2018 were extracted from the Science Citation Index Expanded via Web of Science (WoS) using the search term "obstructive sleep apn*". Publication year, number and country of authors, journal, subject category, key words, funding source and number of citations received were recorded. We also conducted network analyses for key words and international collaboration.

RESULTS

12,666 articles on OSA were located, which had increased from 895 documents in 2009 to 1592 in 2018. The progressive growth in scientific production on OSA had outpaced the growth rate of total WoS production since 2012.50% of the articles declared some type of funding, with a citation index higher than manuscripts that were not funded. The manuscripts were distributed in journals from 135 subject categories of the WoS, and keyword distribution showed a dispersed pattern with a high number of nodes. The international collaboration rate was 18.2%, and the country network showed the United States as the hegemonic node.

CONCLUSION

World production on OSA has grown at a higher rate than global production and shows notable thematic dispersion as well as a high ability to secure funding, which increases its impact.

Industry-Sponsored Research Payments in Neurosurgery-Analysis of the Open Payments Database From 2014 to 2018

BACKGROUND

The Open Payments Database (OPD) started in 2013 to combat financial conflicts of interest between physicians and medical industry.

OBJECTIVE

To evaluate the first 5 yr of the OPD regarding industry-sponsored research funding (ISRF) in neurosurgery.

METHODS

The Open Payments Research Payments dataset was examined from 2014 to 2018 for payments where the clinical primary investigator identified their specialty as neurosurgery.

RESULTS

Between 2014 and 2018, a $106.77 million in ISRF was made to 731 neurosurgeons. Fewer than 11% of neurosurgeons received ISRF yearly. The average received $140 000 in total but the median received $30,000. This was because the highest paid neurosurgeon received $3.56 million. A greater proportion ISRF was made to neurosurgeons affiliated with teaching institutions when compared to other specialties (26.74% vs 20.89%, P = .0021). The proportion of the total value of ISRF distributed to neurosurgery declined from 0.43% of payments to all specialties in 2014 to 0.37% in 2018 (P < .001), but no steady decline was observed from year to year.

CONCLUSION

ISRF to neurosurgeons comprises a small percentage of research payments made to medical research by industry sponsors. Although a greater percentage of payments are made to neurosurgeons in teaching institutions compared to other specialties, the majority is given to neurosurgeons not affiliated with a teaching institution. A significant percentage of ISRF is given to a small percentage of neurosurgeons. There may be opportunities for more neurosurgeons to engage in industry-sponsored research to advance our field as long as full and complete disclosures can always be made.

The most 100 cited papers in addiction research on cannabis, heroin, cocaine and psychostimulants. A bibliometric cross-sectional analysis

The number of citations a peer-reviewed article receives is often used as a measure of its importance and scientific impact. This paper identifies, describes and categorizes the highly cited papers in addiction research on cannabis, heroin, cocaine and psychostimulants. Highly cited papers were identified in the Web of Science Core Collection database. Several bibliometric indicators were calculated. Social network analysis was applied to draw groups of authors and institutions with the greatest number of collaborations and co-words. The number of citations for the top 100 cited articles ranged from 649 to 4,672. The articles were published in 40 journals. The subject category Substance Abuse included 10 papers. The United States was the most productive country (79 papers), followed by the United Kingdom (9). The main funding institutions were the National Institutes of Health in the United States. The network of collaboration between authors distributes the 352 researchers into 53 groups. The three most cited works address the neural basis of drug craving as an incentive-sensitization theory of addiction, the clinical and research uses of the Addiction Severity Index, and the neurocircuitry of addiction. Scientific literature on addictions is widely dispersed both in multidisciplinary and specific journals of neurology, psychiatry and addictions, with relatively few publications providing most of the citations. An ongoing challenge for this field is the concentration of highly cited papers coming from a select number of countries, with the United States being the research hub of the world, with the highest volume of publications and total citations.

Dissecting the Financial Relationship Between Industry and Academic Neurosurgery

BACKGROUND

Established by the Centers for Medicare and Medicaid Services (CMS), the Open Payments Database (OPD) has reported industry payments to physicians since August 2013.

OBJECTIVE

To evaluate the frequency, type, and value of payments received by academic neurosurgeons in the United States over a 5-yr period (2014-2018).

METHODS

The OPD was queried for attending neurosurgeons from all neurosurgical training programs in the United States (n = 116). Information from the OPD was analyzed for the entire cohort as well as for comparative subgroup analyses, such as career stage, subspecialty, and geographic location.

RESULTS

Of all identified neurosurgeons, 1509 (95.0%) received some payment from industry between 2014 and 2018 for a total of 106 171 payments totaling $266 407 458.33. A bimodal distribution was observed for payment number and total value: 0 to 9 (n = 438) vs > 50 (n = 563) and 0-$1000 (n = 418) vs >$10 000 (n = 653), respectively. Royalty/License was the most common type of payment overall (59.6%; $158 723 550.57). The median number (40) and value ($8958.95) of payments were highest for mid-career surgeons. The South-Central region received the most money ($117 970 036.39) while New England received the greatest number of payments (29 423). Spine surgeons had the greatest median number (60) and dollar value ($20 551.27) of payments, while pediatric neurosurgeons received the least (8; $1108.29). Male neurosurgeons received a greater number (31) and value ($6395.80) of payments than their female counterparts (11, $1643.72).

CONCLUSION

From 2014 to 2018, payments to academic neurosurgeons have increased in number and value. Dollars received were dependent on geography, career stage, subspecialty and gender.

Characteristics of Reported Industry Payments to Neurosurgeons: A 5-Year Open Payments Database Study

OBJECTIVE

The aim of this study was to characterize the payments made by medical industry to neurosurgeons from 2014 to 2018.

METHODS

A retrospective study was performed from January 1, 2014 to December 31, 2018 of the Open Payments Database. Collected data included the total number of industry payments, the aggregate value of industry payments, and the mean value of each industry payment made to neurosurgeons per year over the 5-year period.

RESULTS

A total of 105,150 unique surgeons, with 13,668 (12.99%) unique neurosurgeons, were identified to have received an industry payment during 2014-2018. Neurosurgeons were the second highest industry-paid surgical specialty, with a total 421,151 industry payments made to neurosurgeons, totaling $477,451,070. The mean average paid amount per surgeon was $34,932 (±$936,942). The largest proportion of payments were related to food and beverage (75.5%), followed by travel and lodging (14.9%), consulting fees (3.5%), nonconsulting service fees (2.1%), and royalties or licensing (1.9%), totaling 90.4% of all industry payments to neurologic surgeons. Summed across the 5-year period, the largest paid source types were royalties and licensing (64.0%; $305,517,489), consulting fees (11.8%; $56,445,950), nonconsulting service fees (7.3%; $34,629,109), current or prospective investments (6.8%, $32,307,959), and travel and lodging (4.8%, $22,982,165).

CONCLUSIONS

Our study shows that over the most recent 5-year period (2014-2018) of the Centers for Medicare and Medicaid Services Open Payments Database, there was a decreasing trend of the total number of payments, but an increasing trend of the total amount paid to neurosurgeons.

Academic Rhinologists' Online Rating and Perception, Scholarly Productivity, and Industry Payments

INTRODUCTION

The emergence of popular online rating websites, social media platforms, and public databases for industry payments and scholarly outputs provide a complete physician online presence which may guide choice and satisfaction.

METHODS

Websites of all U.S. otolaryngology academic institutions were queried for fellowship-trained rhinologists. Additional well-known and academically active rhinologists were identified by the senior author. Online ratings and comments were collected from Google, Healthgrades, Vitals, and RateMD websites, and weighted rating scores (RS) were calculated on a 1-5 scale.

RESULTS

A total of 210 rhinologists with 16 ± 9 years of practice were included, where 6901 online ratings (33 ± 47 per rhinologist) provided an average RS of 4.3 ± 0.6. RS was not different according to gender (p = 0.58), geographic quartile (p = 0.48), social media presence (p = 0.41), or attending top-ranked medical school (p = 0.86) or residency programs (p = 0.89). Years of practice negatively correlated with RS (R = -0.22, p<0.01), and academic ranking significantly influenced RS, with professors, associate professors, and assistant professors scoring 4.1 ± 0.6, 4.3 ± 0.4, and 4.4 ± 0.6, respectively (p = 0.03). Of the 3,304 narrative comments analyzed (3.1 ± 11.6 per rhinologist), 76% (positive) and 7% (negative) had elements of clinical knowledge/outcomes, 56% (positive) and 7% (negative) of communication/bedside manner, and 9% (positive) and 7% (negative) of office staff, cost, and wait-time. All negative comment categories had moderate negative correlation with RS, while positive comment categories regarding knowledge/competence and bedside manner weakly correlated with higher RS. Number of publications (48 ± 54) positively correlated with 2018 industry payments ($11,384 ± $19,025) among those receiving industry compensation >$300 (n = 113). Attending a top-ranked medical school was associated with higher industry payments (p<0.01) and H-index (p = 0.02).

CONCLUSION

Academic rhinologists' online RS was not associated with gender, geographic location, or attending a top-ranked training program, and their scholarly productivity was significantly correlated with total industry payments.

Fellowship, gender, and scholarly productivity: trends among academic neurosurgeons in the US

OBJECTIVE

Current data on fellowship choice and completion by neurosurgical residents are limited, especially in relation to gender, scholarly productivity, and career progression. The objective of this study was to determine gender differences in the selection of fellowship training and subsequent scholarly productivity and career progression.

METHODS

The authors conducted a quantitative analysis of the fellowship training information of practicing US academic neurosurgeons. Information was extracted from publicly available websites, the Scopus database, and the Centers for Medicare and Medicaid Services Open Payments website.

RESULTS

Of 1641 total academic neurosurgeons, 1403 (85.5%) were fellowship trained. There were disproportionately more men (89.9%) compared to women (10.1%). A higher proportion of women completed fellowships than men (p = 0.004). Proportionally, significantly more women completed fellowships in pediatrics (p < 0.0001), neurooncology (p = 0.012), and critical care/trauma (p = 0.001), while significantly more men completed a spine fellowship (p = 0.012). Within those who were fellowship trained, the academic rank of professor was significantly more commonly held by men (p = 0.001), but assistant professor was held significantly more often by women (p = 0.017). The fellowships with the largest mean h-indices were functional/stereotactic, pediatrics, and critical care/trauma. Despite more women completing neurooncology and pediatric fellowships, men had significantly greater h-indices in these subspecialties compared to women. Women had more industry funding awards than men in pediatrics (p < 0.0001), while men had more in spine (p = 0.023).

CONCLUSIONS

Women were found to have higher rates for fellowship completion compared with their male counterparts, yet had lower scholarly productivity in every subspecialty. Fellowship choice remains unequally distributed between genders, and scholarly productivity and career progression varies between fellowship choice.

Men Receive Three Times More Industry Payments than Women Academic Orthopaedic Surgeons, Even After Controlling for Confounding Variables

BACKGROUND

In 2016, orthopaedic surgeons received nearly USD 300 million from industry, with the top 10% of recipients making more than 95% of the total amount. The degree to which gender may be associated with industry compensation has not been well explored; however, this may be confounded by a number of variables, including academic productivity, experience, and other factors. We wished to explore the variability in payment distribution by gender after controlling for these factors.

QUESTIONS/PURPOSES

(1) Do men or women academic orthopaedic surgeons receive more payments from industry? (2) To what degree do any observed differences between the genders persist, even after accounting for identifiable factors, including academic rank, scholarly productivity, regional location of university, subspecialty selection as identified by fellowships completed, and years since completion of residency?

METHODS

This study was a cross-sectional retrospective analysis of surgeons practicing in orthopaedic surgery academic departments in the United States. Academic orthopaedic surgery departments were identified using the Fellowship and Residency Electronic Interactive Database. Publicly available data on gender, academic rank, scholarly productivity, regional location of university, fellowships completed, and years since residency graduation were collected from institutional websites. Industry funding data for 2016 were obtained from the Centers for Medicare & Medicaid Services Open Payments Database, and scholarly productivity data through 2017 were collected from Scopus. A total of 2939 academic orthopaedic surgeons, 2620 (89%) men and 319 (11%) women from 126 programs were identified. Men and women surgeons were different in most of the variables collected, and all except region of university were associated with differences in industry payments.

RESULTS

The median payment for men surgeons was greater than that for women (USD 1027 [interquartile range USD 125-USD 9616] versus USD 177 [IQR USD 47-USD 1486]; difference of medians, USD 850; p < 0.001]. After accounting for potentially confounding variables like faculty rank, years since residency, H-index and subspecialty choice, women faculty members still received only 29% of payments received by otherwise comparable men orthopaedists (beta coefficient for gender = 0.29 [95% CI 0.20 to 0.44; p < 0.001]).

CONCLUSIONS

Women academic orthopaedic surgeons received only 29% of the industry payments received by men, even after controlling for faculty rank, years since residency, H-index, and subspecialty selection. This gender-related disparity may hinder the career advancement of women orthopaedic surgeons.

CLINICAL RELEVANCE

Increased transparency by companies can help guide orthopaedic surgeons who wish to receive industry funding.

Industry Payments in Colon and Rectal Surgery: A Cross-Sectional Analysis of Open Payments Data

BACKGROUND

The Physician Payments Sunshine Act of 2010 mandated publication of all financial relationships between companies and physicians on the Centers for Medicare and Medicaid Services' Open Payments Data to elucidate potential conflicts of interest. This study seeks to illuminate the financial relationships that the pharmaceutical, medical device, biologics, and medical supply industries maintained with colon and rectal surgeons across the United States from 2014 to 2018.

MATERIALS AND METHODS

We extracted and analyzed all colon and rectal surgeon data from the Open Payments Data for 2014-2018 using Microsoft Excel 2018 and JMP PRO 13.2.0 (SAS Institute). We calculated descriptive statistics and displayed prominent trends in the data.

RESULTS

From 2014 to 2018, totals of $26,841,274 in general payments and $7,492,822 in research payments were made to 1935 and 150 colorectal surgeons, respectively. Intuitive Surgical, Inc paid the most money in general payments every year, ranging from 39.0% to 58.8% of the total payment amount. Intuitive Surgical, Inc's product, da Vinci Surgical System, had the greatest number of payments, totaling 21,191 general payments. The year with the highest amount paid for research was 2017, in which a total of $2,810,558 was paid to colorectal surgeons.

CONCLUSIONS

Companies across industries paid millions of dollars to colorectal surgeons from 2014 to 2018. However, further research is required to determine the causal effects of these surgeons' financial relationships with the industry on research, prescription, and technology adoption practices.

Academic Productivity of Neurosurgeons Practicing in Joint Residency Advisory and Accreditation Committee Accredited Programs

BACKGROUND

Bibliometric indexes are often used to evaluate and compare neurosurgeons and departments, and they have been shown to correlate with academic rank and department reputation. We evaluated academic productivity of neurosurgeons practicing in departments accredited by the Joint Residency Advisory and Accreditation Committee and European Association of Neurological Surgeons.

METHODS

In a cross-sectional study, we calculated number of publications, citations, h-index, and m-quotient from PubMed and Web of Science databases for 285 neurosurgeons affiliated with 19 departments that are accredited or in progress of accreditation by the Joint residency Advisory and Accreditation Committee. Academic productivity was compared as a function of academic rank and research degree.

RESULTS

Median number of publications in PubMed and Web of Science indexed journals were 13 (range, 0-352) and 15 (range, 0-323), respectively. Median h-index was 4 (range, 0-41), and median m-quotient was 0.56 (range, 0-2.86). There was a significant variability between the studied departments in median number of publications and h-index (P = 0.001). Professors and associate professors had significantly higher bibliometric indexes than neurosurgeons without academic rank (all P values < 0.001). Department chairmen had higher bibliometric indexes than other faculty members (all P values < 0.001). Neurosurgeons holding a research degree authored more publications and had higher bibliometric indexes than faculty members not holding a research degree (P < 0.001).

CONCLUSIONS

This is the first study to evaluate academic productivity of neurosurgeons practicing in Europe and Turkey. Higher academic rank and advanced research degree were associated with greater academic productivity. Further studies exploring regional differences in academic productivity of European neurosurgeons are encouraged.

Gender Disparities in Financial Relationships Between Industry and Orthopaedic Surgeons

BACKGROUND

Recent studies in a number of surgical subspecialties have demonstrated that financial relationships with industry differ between men and women. This study aimed to determine if gender disparities exist in industry relationships with orthopaedic surgeons.

METHODS

This retrospective study utilized publicly available data from the Centers for Medicare & Medicaid Services (CMS) at OpenPayments.cms.gov. Data were extracted for payments made to orthopaedic 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. Total number of payments and amounts were compared among men and women, subspecialties, and locations. Multivariable linear regression models were used to determine predictors of total payments and number of payments.

RESULTS

Royalties and consulting fees were paid to 3,418 individual physicians (11% of 29,996 physicians in the American Academy of Orthopaedic Surgeons [AAOS] census) and accounted for 88% of total payments. The majority of the total payment amount (99.6%) was made to men, while only 0.4% went to women. Male gender was a predictor of total number of payments (β = 5.17, p < 0.001), as were years of experience (β = 0.15 [95% confidence interval (CI): 0.10 to 0.20], p < 0.001), Mountain region (β = 2.77 [95% CI: 0.37 to 5.17], p = 0.02), and adult reconstructive subspecialty (β = 4.07 [95% CI: 1.89 to 6.25], p < 0.001). Years of experience (β = 0.046 [95% CI: 0.039 to 0.052], p < 0.001), male gender (β = 1.09 [95% CI: 0.67 to 1.51], p < 0.001), Mountain region (β = 0.35 [95% CI: 0.020 to 0.68], p = 0.04), and adult reconstructive subspecialty (β = 0.33 [95% CI: 0.030 to 0.63], p = 0.03) were associated with higher payments.

CONCLUSIONS

Male gender, years of experience, Mountain region, and adult reconstructive subspecialty are independent predictors of a higher number of industry payments and payment amount. These disparities in industry payments may contribute to continued inequities in scholarship, academic rank, and leadership opportunities.

The Impact of Corporate Payments on Robotic Surgery Research: A Systematic Review

OBJECTIVE

To quantify the influence of financial conflict of interest (COI) payments on the reporting of clinical results for robotic surgery.

DATA SOURCES AND STUDY SELECTION

A systematic search (Ovid MEDLINE databases) was conducted (May 2017) to identify randomized controlled trials (RCTs) and observational studies comparing the efficacy of the da Vinci robot on clinical outcomes. Financial COI data for authors (per study) were determined using open payments database.

MAIN OUTCOMES AND MEASURES

Primary outcomes assessed were receipt of financial COI payments and overall conclusion reported between robotic versus comparative approach. Quality/risk of bias was assessed using Newcastle-Ottawa Scale (NOS)/Cochrane risk of bias tool. Disclosure discrepancies were also analyzed.

DATA EXTRACTION AND SYNTHESIS

Study characteristics, surgical subspecialty, methodological assessment, reporting of disclosure statements, and study findings dual abstracted. The association of the amount of financial support received as a predictor of reporting positive findings associated robotic surgery was assessed at various cut-offs of dollar amount received by receiver operating curve (ROC).

RESULTS

Thirty-three studies were included, 9 RCTs and 24 observational studies. There was a median, 111 patients (range 10 to 6420) across studies. A little more than half (17/33) had a conclusion statement reporting positive results in support of robotic surgery, with 48% (16/33) reporting results not in favor [equivocal: 12/33 (36%), negative: 4/33 (12%)]. Nearly all (91%) studies had authors who received financial COI payments, with a median of $3364.46 per study (range $9 to $1,775,378.03). ROC curve demonstrated that studies receiving greater than $9557.31 (cutpoint) were more likely to report positive robotic surgery results (sensitivity: 0.65, specificity: 0.81, area under the curve: 0.73). Studies with financial COI payment greater than this amount were more likely to report beneficial outcomes with robotic surgery [(78.57% vs 31.58%, P = 0.013) with an odds ratio of 2.07 (confidence interval: 0.47-3.67; P = 0.011)]. Overall, studies were high quality/low risk of bias [median NOS: 8 (range 5 to 9)]; Cochrane risk: "low risk" (9/9, 100%)].

CONCLUSION AND RELEVANCE

Financial COI sponsorship appears to be associated with a higher likelihood of studies reporting a benefit of robotic surgery. Our findings suggest a dollar amount where financial payments influence reported clinical results, a concept that challenges the current guidelines, which do not account for the amount of COI funding received.

The Role of Gender, Academic Affiliation, and Subspecialty in Relation to Industry Payments to Orthopaedic Surgeons

BACKGROUND

The Physician-Payments-Sunshine-Act (PPSA) was introduced in 2010 to provide transparency regarding physician-industry payments by making these payments publicly available. Given potential ethical implications, it is important to understand how these payments are being distributed, particularly as the women orthopaedic workforce increases. The purpose of this study was thus to determine the role of gender and academic affiliation in relation to industry payments within the orthopaedic subspecialties.

METHODS

The PPSA website was used to abstract industry payments to Orthopaedic surgeons. The internet was then queried to identify each surgeon's professional listing and gender. Mann-Whitney U, Chi-square tests, and multivariable regression were used to explore the relationships. Significance was set at a value of P < 0.05.

RESULTS

In total, 22,352 orthopaedic surgeons were included in the study. Payments were compared between 21,053 men and 1299 women, 2756 academic and 19,596 community surgeons, and across orthopaedic subspecialties. Women surgeons received smaller research and non-research payments than men (both, P < 0.001). There was a larger percentage of women in academics than men (15.9% vs 12.1%, P < 0.001). Subspecialties with a higher percentage of women (Foot & Ankle, Hand, and Pediatrics) were also the subspecialties with the lowest mean industry payments (all P < 0.001). Academic surgeons on average, received larger research and non-research industry payments, than community surgeons (both, P < 0.001). Multivariable linear regression demonstrated that male gender (P = 0.006, P = 0.029), adult reconstruction (both, P < 0.001) and spine (P = 0.008, P < 0.001) subspecialties, and academic rank (both, P < 0.001) were independent predictors of larger industry research and non-research payments.

CONCLUSIONS

A large proportion of the US orthopaedic surgeon workforce received industry payments in 2014. Academic surgeons received larger payments than community surgeons. Despite having a larger percentage of surgeons in academia, women surgeons received lower payments than their male counterparts. Women also had a larger representation in the subspecialties with the lowest payments.

Industry Consulting Payments to Orthopedic Surgeons Are Associated With Increased Publications

In accordance with the Physician Payment Sunshine Act, all industry payments to physicians in the United States have become publicly available. Previous research has indicated that orthopedic surgeons receive the greatest amount of industry compensation compared with other surgical subspecialists. However, the relationship between this compensation and research productivity is less clear. This study sought to investigate the relationship between consulting fees paid to orthopedic surgeons and academic productivity. Using the Centers for Medicare & Medicaid Services Open Payments Database, this study identified 2555 orthopedic surgeons who received at least one industry consulting fee in 2015. Physicians who received total consulting fees of at least $20,000 (US) were stratified into the high payment group. The number of publications and the h-index for each physician were used as metrics of scholarly impact. Mean publication number and h-index for the high payment group were compared with all other physicians in the sample using an independent-samples t test. A total of 2555 orthopedic surgeons received consulting payments totaling $62,323,143 in 2015. The mean consulting payment was $24,393 (SD, $45,465). The publication number was greater for the high payment group (mean, 61.6; SD, 135.6) compared with all other physicians in the sample (mean, 36.1; SD, 95.6). Additionally, the mean h-index for the high payment group was 13.7 (SD, 14.3) compared with 10.0 (SD, 11.6) for all other orthopedic surgeons. These findings indicate that the orthopedic surgeons who receive more in industry consulting fees are also those who contribute most substantially to the body of orthopedic literature. [Orthopedics. 2019; 42(3):137-142.].

[Bibliometric analysis of neurosurgery publications in France]

Bibliometrics are methods used to quantitatively analyze the scientific literature. The application of bibliometrics in neurosurgery is emerging and has not yet been studied in the French neurosurgical community. In France, the most used statistical method is named SIGAPS; the scores are based on the position of the author and the impact factor of the journal. The SIGAPS score, which can be calculated for a research team or an individual, impacts the public financial support of university hospitals in France. We analyzed retrospectively the publication productivity and the SIGAPS score of university neurosurgery departments in France for the period 2009-2016. This was supplemented by a list of current academic research protocols granted by the Minister of Health. The SIGAPS score is higher in large university hospitals even though all teams are dedicated to publishing more in the traditional neurosurgery journals (Neurosurgery, Journal of Neurosurgery, World Neurosurgery, J Neuro-oncology, Neuro oncology, Eur Spine J). Of note, the national Neurochirurgie journal (publishing in French and English) is progressively improving its impact factor (0.8). The most common themes are functional neurosurgery, neuro-oncology and spine. There are 14 on-going national multicenter research programs, 4 of them focused on the health economics of treatment innovations. These data provide the most accurate available snapshot of the scholarly efforts of all the French university neurosurgery departments. It is based on a national statistics method (SIGAPS). For future evaluation, it should be combined with internationally available parameters such as the h-index and m-quotient. Publication productivity has broad implications for the success of both academic departments and individual faculty members and their financial support.

Academic Influence and Its Relationship to Industry Payments in Orthopaedic Surgery

BACKGROUND

The Hirsch index (h-index) quantifies research publication productivity for an individual, and has widely been considered a valuable measure of academic influence. In 2010, the Physician Payments Sunshine Act (PPSA) was introduced as a way to increase transparency regarding U.S. physician-industry relationships. The purpose of this study was to investigate the relationship between industry payments and academic influence as measured by the h-index and number of publications among orthopaedic surgeons. We also examined the relationship of the h-index to National Institutes of Health (NIH) funding.

METHODS

The h-indices of faculty members at academic orthopaedic surgery residency programs were obtained using the Scopus database. The PPSA web site was used to abstract their 2014 industry payments. NIH funding data were obtained from the NIH web site. Mann-Whitney U testing and Spearman correlations were used to explore the relationships.

RESULTS

Of 3,501 surgeons, 78.3% received nonresearch payments, 9.2% received research payments, and 0.9% received NIH support. Nonresearch payments ranged from $6 to $4,538,501, whereas research payments ranged from $16 to $517,007. Surgeons receiving NIH or industry research funding had a significantly higher mean h-index and number of publications than those not receiving such funding. Surgeons receiving nonresearch industry payments had a slightly higher mean h-index and number of publications than those not receiving these kinds of payments. Both the h-index and the number of publications had weak positive correlations with industry nonresearch payment amount, industry research payment amount, and total number of industry payments.

CONCLUSIONS

There are large differences in industry payment size and distribution among academic surgeons. The small percentage of academic surgeons who receive industry research support or NIH funding tend to have higher h-indices. For the overall population of orthopaedic surgery faculty, the h-index correlates poorly with the dollar amount and the total number of industry research payments. Regarding nonresearch industry payments, the h-index also appears to correlate poorly with the number and the dollar amount of payments. These results are encouraging because they suggest that industry bias may play a smaller role in the orthopaedic literature than previously thought.

Increasing Industry Support Is Associated with Higher Research Productivity in Orthopaedic Surgery

BACKGROUND

Orthopaedic surgeons receive a disproportionately small share of funding from the National Institutes of Health, but they receive the largest amount of funding from industry sources. The purpose of this study was to examine the association between payments from industry partners and research productivity among orthopaedic research authors, as well as to identify predictors of high research productivity.

METHODS

United States-based physicians who published an article in 2016 in The Journal of Bone & Joint Surgery or The American Journal of Sports Medicine were included in this study. These authors were queried in the Centers for Medicare & Medicaid Services Open Payments database (OPD) to determine the amount of industry payments received, and on Scopus, a bibliometric web site, to assess the quantity (total publication count) and quality (Hirsch index [h-index]) of each author's research. Nonparametric testing was used to compare the h-index and the total publication count of authors by payments received and academic position. Multivariate regression was used to identify independent predictors of high research productivity.

RESULTS

Of the 766 included authors, 494 (64.5%) received <$10,000 per year, 162 (21.1%) received between $10,000 and $100,000, and 110 (14.4%) received >$100,000 in total payments. The h-index increased significantly from a mean (and standard deviation) of 13.1 ± 12.9 to 20.9 ± 14.4, and to 32.3 ± 16.7, from the lowest to highest payment cohorts, as did total publication count. When authors were stratified by academic position (assistant professor, associate professor, full professor, and nonacademic), those who received more industry payments (>$100,000) had a higher h-index and total publication count at all academic levels relative to lower-earning (<$10,000) authors. Independent predictors of a high h-index included industry payments of between $10,000 and $100,000 (odds ratio [OR], 1.63; p = 0.048), payments of >$100,000 (OR, 5.87), associate professorship (OR, 6.53), full professorship (OR, 33.38), and last authorship (OR, 2.22) (p < 0.001 for all comparisons unless otherwise noted).

CONCLUSIONS

Although this study does not establish a causal relationship, we identified increasing industry payments as an independent predictor of research productivity among authors at all academic levels who had published peer-reviewed orthopaedic research.