Prevalence and extent of industry support for program directors of surgical fellowships in the United States

• Published in: Surgery 2020-12, Vol.168 (6), p.1101-1105
• Main Authors: Balch, Jeremy A., Cooper, Lou Ann, Filiberto, Amanda C., Chan, Patricia E., Sarosi, George A., Tan, Sanda A.
• Format: Article
• Language: English
• Subjects: Databases, Factual - statistics & numerical data; Disclosure - statistics & numerical data; Fellowships and Scholarships - economics; Fellowships and Scholarships - organization & administration; Humans; Industry - economics; Industry - statistics & numerical data; Physician Executives - economics; Physician Executives - statistics & numerical data; Practice Patterns, Physicians' - economics; Practice Patterns, Physicians' - statistics & numerical data; Specialties, Surgical - education; Surgeons - economics; Surgeons - statistics & numerical data; United States
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2020.07.035

Fellowship program directors have a considerable influence on the future practice patterns of their trainees. Multiple studies have demonstrated that industry can also exert substantial influence on the practice patterns of physicians as a whole. The purpose of this study is to quantify industry support of fellowship program directors across surgical subspecialties and to assess the prevalence of this support within specific subspecialties. Fellowship program directors for acute care, breast, burn, cardio-thoracic, critical care, colon and rectal, endocrine, hepato-pancreato-biliary, minimally invasive, plastic, oncologic, pediatric, and vascular surgery for 2017 were identified using a previously described database. The Open Payments Database for 2017 was queried and data regarding general payments, research, associated research payments, and ownership were obtained. The national mean and median payouts to nonfellowship program director surgeons were used to determine subspecialties with substantial industry support. Five hundred and seventy-six fellowship program directors were identified. Of these, 77% of the fellowship program directors had a presence on the Open Payments Database. The subspecialties with the most fellowship program directors receiving any industry payment, regardless of amount, included vascular (93.5%), cardio-thoracic (92.8%), minimally invasive surgery (90.5%), plastics (85.3%), and colon and rectal (81.0%). The subspecialty with the greatest mean payment was minimally invasive surgery (21,175 US dollars); the greatest median payment was vascular (1,871 US dollars). The 3 most common types of payments were for general compensation (31.4%), consulting fees (28.7%), and travel and lodging (14.7%). Vascular surgery had the greatest percentage of fellowship program directors receiving research payments (48%). The greatest amount paid to any individual fellowship program director was 382,368 US dollars. Excluding outliers, fellowship program directors received substantially more payments than those received on average by general surgeons. The majority of fellowship program directors receive some industry support. Most payments are for compensation for noncontinuing medical education related services and consulting fees. Certain specialties were more likely to have industry payments than others. Overall, only a minority of fellowship program directors received research support from industry. We advocate for transparent discussions betwee