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Survey: Patients have favorable view of orthopedic surgeon, industry relationships
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DALLAS — Although results of a prospective, self-administered survey of 218 patients found 62% expressed they should be somewhat concerned about financial relationships between orthopedic surgeons and the industry, most patients had supportive attitudes towards these relations and believe they are beneficial to patients.
“The majority of patients view relationships between orthopedic surgeons and the industry favorably,” Paul H. Yi, MD, a resident from the University of California, San Francisco, said during his presentation at the American Association of Hip and Knee Surgeons Annual Meeting. “However, they also desire a disclosure of this information, and much work remains to improve communications of these disclosures to patients. Nevertheless, given their desires for disclosure and their favorable views of these relationships, as well as support of surgeons engaged in these relationships, we encourage orthopedic surgeons to have open discussions regarding any financial relationships they may have with orthopedic companies, which may improve the physician-patient relationship.”
Potential conflicts of interest
Yi and his colleagues asked 302 consecutive patients at outpatient arthroplasty clinics at Rush and Washington University in St. Louis to complete an anonymous, self-administered questionnaire to explore patient perceptions about three types of physician-industry relationships: consultancy, research support and product royalty. The survey, which used a 5-point Likert scale, was developed in conjunction with an expert in survey design, and the researchers used cognitive interviewing to ensure question clarity and patient comprehension. Overall, 81% of patients surveyed completed the questionnaire.
“For all three potential conflicts of interest, the majority of patients did perceive these relationships favorably,” Yi said, noting that 75% of respondents believed that surgeons with these relationships were top experts in the field. Two-thirds of patients believed surgeons engaged in these financial relationships would serve their patients better than those who were not and the same proportion said physicians with these relationships would treat their patients the same compared with surgeons who did not have financial relationships.
Researchers found 87% of patients agreed orthopedic companies could not make good products without working with surgeons. However, more than 80% of patients believed those relationships would lead to the surgeon being more likely to use the company’s products despite possible high health care costs.
Although most patients perceived all three potential conflict of interests favorably, Yi said patients had more favorable attitudes toward physicians who received product royalties than those who were consultants.
“However, two-thirds also disagreed that the government should control what kinds of relationships orthopedic surgeons should have with the industry, and another 62% thought that patients should be somewhat concerned about these relationships,” he said.
While 58% of patients were aware that some orthopedic surgeons received money through the industry, 65% of those surveyed did not know if their own surgeon was engaged in any of these relationships.
According to results, surgeons who designed products were viewed more favorably among patients, and two-thirds of patients did not think government should control what kinds of relationships orthopedic surgeons should have with the industry.
“Ultimately, we hope that our study will encourage orthopedic surgeons, both that are engaged in the financial relationships within the industry and those who are not, to have open and honest conversations with their patients regarding the issue and that ultimately we can best serve our patients both in body and giving them peace of mind,” Yi told Orthopedics Today.
Future areas of research
According to Yi, the patient population in this study was fairly homogenous with most patients being about 60 years old, white, female, with private insurance, and possessing some college education and having private insurance. He noted patients of other socioeconomic or ethnic groups may have different opinions. The researchers were also unable to comment on differences between different demographics and attitude toward surgeon conflicts of interest due to sample size limitations.
“There are two next steps on this topic. One is assessing attitude toward varying degrees of financial compensation that orthopedic surgeons may receive from the industry and not simply the type of financial relationship,” Yi told Orthopedics Today. “Secondly, assessing the attitudes amongst different demographic and social economic groups as well as regions given that the patients surveyed came from two academic centers set in the Midwest.” – by Casey Tingle
Reference:
Yi PH, et al. Paper #44. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 6-9, 2014; Dallas.
For more information:
Paul H. Yi, MD, can be reached at the University of California San Francisco, Department of Orthopaedic Surgery, 505 Parnassus Ave., San Francisco, CA 94143; email: paulyi88@gmail.com.
Disclosure: Yi reports no relevant financial disclosures.
Perspective
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Jack M. Bert, MD
I think these comments would be expected when a patient visits a highly recognized surgeon who works with industry in attempts at designing products to improve patient care. Interestingly, physicians who do this type of work tend to stay abreast of new developments and hopefully are offering their patients the “best” technology available. Unfortunately, there is some concern from patients at this time when cost becomes a consideration for a particular procedure that they are not getting the “newest” product available.
A controversial example would be total knee replacement technology. There is growing evidence that “stable technology implants” have 12-year to 15-year survivorships which are equal to or better than current technology implants (such as custom designs), and several articles written in the past 2 years have confirmed these conclusions. Have we reached a point of convergence of technology in this particular field, much like we have in airline travel using airplanes that are 30 years to 40 years old or is there still room for improvement utilizing more recent technology to improve function? Thus, it is important for the designing surgeon to explain to the patient why his recommendation for a product that he may be involved with just “may” be better, but he is unable to confirm the longevity of an implant or a particular procedure. The metal-on-metal hip fiasco has to make everyone think about touting a surgical procedure that does not have long-term survivorship data and recommending a particular product when it is supposedly “improved technology.”
As value-based purchasing and bundled payments become the norm, using the “latest and greatest” products may require a more thoughtful approach when clinically proven implants with 15-year, 98% survivorship are available at a fraction of the cost of “new technology” where only short-term clinical survivorship data is available.Click Here to Manage Email Alerts