Date of Award

January 2020

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Jonathan N. Grauer


Background: The Open Payments Database (OPD), mandated by the Sunshine Act, is a listing of physician-industry payments. With the growing scrutiny of such transactions, the present study aims to characterize and investigate trends in industry payments to orthopaedic surgeons using four full years of data available. The study assessed payments to four orthopaedic sub-specialties: (1) pediatric surgery, (2) foot and ankle (F&A) surgery, (3) spine surgery, (4) adult reconstructive surgery. As the majority of industry payments were classified as General (other categories are Research and Ownership), the present study primarily focused on General payments.

Methods: Industry payments were characterized by number of compensated surgeons and total industry sum for each sub-specialty. Payments were analyzed annually for median payment per surgeon, sub-type, and geography for each sub-specialty. Due to the non-normal distribution of payments, the top five percent of compensated surgeons in each orthopaedic sub-specialty were studied in depth through median payment per surgeon. The nonparametric Mann-Whitney U tests were used for statistical comparisons.

Results: For each orthopaedic sub-specialty, the number of compensated surgeons increased from 2014 to 2017. The median General payment per compensated surgeon remained stable across the four years for each orthopaedic sub-specialty: pediatric surgery ($201 to $197, p=0.82), orthopaedic spine surgery ($1051 to $978, p=0.561), adult reconstructive surgery ($774 to $612, p=0.093). When considering General, Research, and Ownership payments together, the median annual industry payment to orthopaedic F&A surgeons remained stable as well ($616 to $336, p=0.084). Additionally, when averaged across the four sub-specialties, 81% of the total compensation was made to the top five percent of compensated surgeons. For pediatric orthopaedic surgeons, the median payment for the top five percent cohort saw a significant increase in median payment ($14,624 to $32,752, p=0.006). Across all specialties, payments attributed to food and beverage made up the majority of industry-surgeon transactions, though less than 10% of the total monetary value. Payments related to education saw significant increases from 2014 to 2017 in each of the four sub-specialties.

Conclusion: Though many expected payments to surgeons to decrease under the growing scrutiny of the Sunshine Act, there was no overall change in median payment over four years across four orthopaedic sub-specialties. These findings shed insight into the orthopaedic surgeon-industry relationship in the current age of increased transparency.


This thesis is restricted to Yale network users only. It will be made publicly available on 09/10/2022