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Where the Sun Shines: Industry's Payments to Hand Surgeons
Rizwan Ahmed, MD1; Joseph Lopez, MD1; Sunjae Bae, MD2; Eric K. Chow, BS1; Babak J. Orandi, MD, PHD2; Scott D. Lifchez, MD1; Suhail K. Mithani, MD1; Dorry L. Segev, MD2
1Duke University Medical Center, Durham, NC; 2Johns Hopkins University School of Medicine, Baltimore, MD

Background: The Physician Payment Sunshine Act (PPSA) was recently implemented in the US to provide transparency regarding the financial transactions between industry and physicians. Under this law, the Open Payments Program (OPP) was created to publically disclose all transactions and inform patients of potential conflicts-of-interest (COI). Awareness of the OPP is crucial for hand surgeons, as its interpretation or misinterpretation can potentially affect trust between patients and hand surgeons. The goals of this study are to comprehensively evaluate non-research payments made to hand surgeons by industry and explore whether certain quantitative and qualitative variables affect payment amounts.
Methods: We performed a retrospective cross-sectional review of the first wave of OPP data (August 2013-December 2013) to quantify industry payments made to hand surgeons.
Results: Hand surgeons (N=352) received a total of $598,705. Among these surgeons, 43% received payments <$100 and 4% received payments >$9,999. The median (IQR) was $127 ($42-337) and mean was $1,701. The largest payment to an individual was $93,591. The largest payment categories were for royalties ($250,854) and consulting (,110). Hand surgeons in academic practice received higher payments compared to those in private practice (median [IQR] $250 [121-2,284] vs. $110 [37-274], p<0.001).
Conclusion: Among hand surgeons, 50% received <$127. Academic hand surgeons received greater payments compared to those in private practice. Although the PPSA brings transparency to the physician-industry landscape, it also highlights the OPP's risk for misinterpretation.

Industry Payments by Expense Category

Payment Category Total Payment (%) Median (IQR) per Hand Surgeon Number of Hand Surgeons
Royalty or License $250,854 (41.90%) $8,069 (4,808-16,099) 16
Consulting Fee $95,110 (15.89%) $2,750 (700-7,250) 59
Speaker non-CEP $86,937 (14.52%) $4,000 (2,000-6,543) 17
Investment Interest $58,010 (9.69%) $58,010 1
Food and Beverage $50,973 (8.51%) $100 (33-203) 331
Travel and Lodging $38,210 (6.38%) $541 (141-1,072) 52
Education $12,594 (2.1%) $102 (3-277) 32
Honoraria $4,023 (0.67%) $2,011 (1,023-3,000) 2
Gifts $1,563 (0.26%) $114 (40-742) 4
Grant $431 (0.07%) $215 (131-300) 2

Payments Received per Hand Surgeon by Amount Category

Payments by Hand Surgery Subspecialty

Category Payments of the Top 10 Companies

Total Payments made to Hand Surgeons by State

Average Payments/Surgeon by State

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