Does Industry Sponsorship Influence Research Productivity Among Foot and Ankle Surgeons?
Authors: Matai Prashant , Frane Nicholas , Piniella Nick , Katsigiorgis Michael , Scelzi Nick , Katsigiorgis Gus , Bitterman Adam D. 
Published: January 2022

Category: Ankle; Basic Sciences/Biologics; Other Introduction/Purpose: Research productivity and success drive academic promotions in surgeons' careers. While previous studies have shown a strong relationship between research funding and academic productivity, few have analyzed that relationship in Foot and Ankle surgery. Furthermore, they have primarily used bibliometric data, such as the Hirsch index (h-index), which although is representative of an author's impact, heavily favors physicians who have been in practice longer. There is a need for more pragmatic variables that take into account career longevity. Because there is deficient literature in the analysis of the association between industry sponsorship and research productivity among foot and ankle surgeons, we sought to narrow the gap. Methods: A retrospective review of all articles from the 2018 issues of Foot and Ankle International Journal, Journal of Foot and Ankle Surgery and Clinical Research on Foot and Ankle Journal were queried for authors. 303 unique United States-based non trainee Foot and Ankle authors were identified, and ultimately included in the study. They were analyzed for demographic data including sex, academic title, years in practice, and specialty. We also collected bibliometric data from Scopus, including total publications, Hirsch index (h-index), m-index, and publications-to-years in practice ratio. The Center for Medicare & Medicaid Services Open Payments Database was reviewed, and total payments were collected for each author. Authors were divided into quartiles based on payment data (i.e., Quartile 1: 0-25%, etc.) for analysis. Kruskal Wallis and Mann-Whitney U tests were performed to identify significant differences between groups. A Multivariate logistic regression was performed to identify independent predictors of high research productivity. Results: A total of 253 (83.5%) of authors had received at least one payment. The payments received by the authors were broken down in the following quartiles.: Quartile 1, (n=77) who had payments of 0 to $171.41; Quartile 2: (n=76) $171.42 to $2515.15; Quartile 3: (n=76): $2515.16 to $34,577.36; and Quartile 4: (n=74) $34,577.37 to $8,530,326.50. Total Publication Count, H- index, M-index and publications to years in practice ratio all were significantly different and increasing between quartiles (p<0.001 for all). Multivariate logistic regressions identified both Academic status (p<0.001) and Total payments (p<0.05) as contributing factors to total number of publications, publications per year ratio, h-index and m-index, while Author order also contributed to higher h-index. Physician Sex or Level of Evidence were not significant independent contributors to the total number of publications, H-Index, M-Index or publications per year ratio in our study. Conclusion: We identified that both industry payments and academic status are significantly correlated with higher research productivity among Foot and Ankle authors. Being the last author on a research also correlated with increased productivity. While h-index and total publications measure the research output, they fail to account for time as a confounding variable, where an individual who has been active longer in research can potentially have a higher research output. The m-index, (which is H-index divided by number of years that an author has been active) and publications-per-year ratio takes that into account, and yet our findings remained significant.