Hello, my name is Michael McCurdy, and I'm a current spine research fellow at the Rothman Orthopaedic Institute in Philadelphia. Today, I will be presenting factors associated with industry payments in academic spine surgery. The recent establishment of the Open Payments Database has allowed for a more transparent record of industry payments to physicians. With some studies of characterized distribution of industry payments among spine surgeons, the factors associated with specific payments have not been as well studied. Therefore, the objective of our study was to highlight associations between industry payments and surgeon descriptors, as well as investigate predictors for different types of industry payments. The query was conducted of the North American Spine Society Spine Fellowship Directory from 2021 to 2022. We identified all orthopedic or neurosurgical spine fellowship selection committee members for each program participating in the spine fellowship match. The query of the Centers for Medicare and Medicaid Services Open Payments website from 2015 to 2021 was also conducted to collect payment records of spine fellowship selection committee members. In total, we identified 310 orthopedic and neurosurgical spine surgeons in our query search, representing 76 different fellowship programs. Regression analysis identified total publications, attending years, and publication rate as predictive of greater general payments and higher royalties. Having a Twitter or X account, being a fellowship director, total publications, and publication rate were also all predictive of greater consulting payments. Here we find a descriptive table of the cohort that we found in our query. Certain factors include sex of the surgeon, geographic location, whether they're on Twitter or X or not, their number of followers, whether they're a fellowship director, their total publications as well as different authorship levels, number of attending years, their attending publication rate, and where their residency program is ranked. Here we have a table showing our regression analysis for each type of payment in the database. As you can see, general payment value was independently associated with total publications, attending years, and publication rate. The general number of payments paid out to surgeons was independently associated with total publications and publication rate. Research payments were associated with being from the Southeast as well as being a fellowship director. Policy payments were associated with total publications, attending years, and publication rate. Consulting payments were associated with being on Twitter or X, being a fellowship director, total publications, and publication rate. Education payments were not seen to be independently associated with any of our factors. Policy slash CME speaking were associated with being from the West. Our findings show that industry relationships and payments may be significantly associated with experience, leadership roles, academic productivity, and social media engagement among academic spine surgeons. Our study found that more productive spine surgeons who are seen as leaders in the field may carry significant influence, which could contribute to why they see greater general payments. Robust research infrastructure can support large, prospective, randomized trials needed for regulatory approval in the private sector, and this also may contribute to why we see these findings. Additionally, surgeon experience was also associated with increased payments, likely reflective of larger networks among more senior attendings and the potential to influence fellows or residents in their program. Our subset of orthopedic spine surgeons was relatively small due to concentration on leadership roles and fellowship that were more likely to represent academically productive surgeons. As previously stated, our cohort consisted of 310 such surgeons, and therefore, these cannot be generalized to non-academic spine surgeons. The Open Payments Database is also not without inaccuracies. However, this database represents the most complete resource for evaluation of industry funding beyond self-reported disclosure databases, and therefore, is valid for use in this study. Additionally, our surgeon cohort is significantly skewed toward the Northeast with a net of 101 out of 310. As many surgeons pursued becoming and attending in the same region as they completed residency, the total number of publications may be skewed toward the Northeast as well. To conclude, spine surgeons who are experienced, academically productive, fellowship directors, and engage with social media receive greater payments on average than their peers across various payment types. Experienced leaders in their respective fields will shoulder the responsibility to integrate private innovation in an effective and scientifically rigorous manner moving forward. Studies in academic spine surgery that have relationships with industry can act as regulators of industry-driven innovation, helping nurture novel devices and products to improve future care for our patients. Thank you very much.

Michael McCurdy

spine research fellow

industry payments

academic spine surgery

Open Payments Database