In the academic world, there is an unspoken rule under which faculty, residents, and fellows collectively live and work. Educational programs are to be separate from industry and its financial stronghold.
I understand the rule and its application in certain scenarios and clinical departments. But I would like to challenge it within my specialty of orthopedic surgery.
As I finish up residency and look ahead to fellowship, I am constantly thinking about my ability to handle musculoskeletal issues. I certainly have completed my fair share of operative cases, but transitioning to the role of attending physician — while an exciting time in my life — is also somewhat unnerving.
Most of my education has come from experiences with my superiors, both senior residents and attendings, but some is the result of didactics and lab sessions, which were subsidized by implant manufacturers. Having spent time at the corporate campuses of some of the largest orthopedic implant and surgical providers, I have been able to receive individualized attention with a penalty-free atmosphere. Having cadaveric specimens, as well as an endless supply of implants, is an experience that can’t be reproduced in a hospital setting. In fact, some residency programs actually require resident attendance at various corporate courses throughout their five years of training, in order to successfully graduate.
Orthopedic surgery is frequently referred to as the human body’s carpentry service. As Augusto Sarmiento, MD, and Eric Schiffman, MD, have stated, we are cosmetic surgeons of the skeleton. While not every complaint that comes into the office is one which requires the work of a scalpel, those that do require a significant understanding of anatomy as well as the surgical techniques to solve and ultimately fix the problem.
Orthopedics is hands-on. Surgeons must know their equipment and the tools required for successful implantation of whatever modality is chosen. Becoming comfortable with the instruments and proprietary technology takes time and repetition of technique. Given that, residents and fellows must be exposed to the implants available as well as the competitors’ options, so they can gain familiarity and comfort with their surgical options.
There is not a week that goes by when I am not invited to attend an educational seminar or course to learn specific operative techniques. I am frequently asked to leave my family behind for a weekend in order to hop on a plane and travel for a company-sponsored lab and didactic session. In fact, I welcome the opportunity and prefer to take full advantage of these situations. These are all-expense paid trips to practice orthopedics in an environment where I can explore and learn without putting patient health in jeopardy.
While it has been said that these offerings serve primarily as marketing ventures — that is to some degree true — they also serve as a significant educational tool. Although the company’s goal is purely financial, residents and fellows must utilize these opportunities to learn new tips and tricks in performing procedures. Physicians must compartmentalize the sales pitch and take away from the event new techniques and skills.
Research is another area of concern among academicians. With suspicion for conflict of interest at an extremely high level, it is hard for a conclusion to go by unchallenged when financial support was provided by industry. Despite this, peer-reviewed journals with the highest impact factor within the specialty continue to publish these reports. As costs continue to rise, universities and private entities are unable to finance the supplies needed for specific projects; thus, industrial subsidy seems the perfect answer.
The financial impact of industry’s involvement with academic medicine is an obvious risk. Certainly, I am not one to condone any type of situation where financial kickbacks are exchanged. My main point is to discourage the automatic disregard for surgical implant companies’ involvement in the education of orthopedic surgery residents and fellows. In the end, I believe that the surgical device industry needs to maintain its role as a source of education within the orthopedic community and not be pushed back by heavy sanctions from the federal government.
Adam Bitterman is an orthopedic surgery resident. This article originally appeared in MedPage Today.
