title: Implant vendors and hospitals: competing influences over product choice by orthopedic surgeons.
abstract: BACKGROUND
  Vendors of hip and knee implants court orthopedic surgeons to adopt their products. Hospitals, which have to pay for these products, now court the same surgeons to help reduce the number of vendors and contain implant costs.
  
  
  OBJECTIVE
  This study measures the surgeon's perceived alignment of interests with both vendors and hospitals and gauges surgeons' exposure and receptivity to hospital cost-containment efforts.
  
  
  METHODS
  We surveyed all practicing orthopedists performing 12 or more implant procedures annually in Pennsylvania. The survey identified the surgeon's preferred vendor, tenure with that vendor, use of the vendor during residency training, receipt of financial payments from the vendor, alignment of interests with both vendor and hospital stakeholders, and exposure and receptivity to hospital cost-containment efforts.
  
  
  RESULTS
  Surgeons have long-standing relationships with implant vendors, but only a small proportion receive financial payments. Surgeons align most closely with the vendor's sales representative and least closely with the hospital's purchasing manager. Paradoxically, surgeons support hospital efforts to limit the number of vendors but report that their own choice of vendor is not constrained. The major drivers of surgeons' alignment and stance toward cost containment are their tenure with and receipt of financial payments from the vendor.
  
  
  CONCLUSIONS
  Hospitals face a competitive disadvantage in capturing the attention of orthopedists, compared with implant vendors. The vendors' advantage stems from historical, financial, and service benefits offered to surgeons. Hospital executives now seek to offer comparable benefits to surgeons.
authors.affiliation: Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA. burnsL@wharton.upenn.edu
authors.forename: Lawton R
authors.initials: LR
authors.lastname: Burns
authors.forename: Michael G
authors.initials: MG
authors.lastname: Housman
authors.forename: Robert E
authors.initials: RE
authors.lastname: Booth
authors.forename: Aaron
authors.initials: A
authors.lastname: Koenig
mesh_terms: D001291:Attitude of Health Personnel; D002755:Choice Behavior; D003132:Commerce / Q000191:economics; D016265:Conflict of Interest; D003363:Cost Control; D003625:Data Collection; D004465:Economic Competition; D019981:Health Care Sector / Q000706:statistics & numerical data*; D006622:Hip Prosthesis / Q000191:economics* / Q000706:statistics & numerical data; D018578:Hospital-Physician Relations; D006801:Humans; D007720:Knee Prosthesis / Q000191:economics* / Q000706:statistics & numerical data; D008421:Materials Management, Hospital / Q000191:economics*; D008505:Medical Staff, Hospital / Q000191:economics* / Q000523:psychology; D009042:Motivation; D015999:Multivariate Analysis; D009985:Orthopedics / Q000191:economics* / Q000193:education; D010414:Pennsylvania; D010818:Practice Patterns, Physicians'; D013997:Time Factors