Spine surgeons often work with medical device representatives when leveraging the latest technologies and implants. For two spine surgeons those relationships have evolved, along with professional boundaries.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
Next question: If you could redesign spine surgery training from scratch, what clinical experience or business competency would you make non-negotiable that programs currently treat as optional?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, May 26.
Question: How has your relationship with medical device reps evolved, and where do you draw the line between useful collaboration and influence you’re uncomfortable with?
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: It has evolved considerably, and I think the evolution reflects something important about how I understand my own decision-making.
Early in training, device reps were ubiquitous and genuinely useful in a narrow sense: they knew the implants better than most residents did, they were present in the OR, they troubleshooted in real time. That relationship felt straightforward. It became more complicated as I started to notice how subtly it shaped preferences — not through explicit pressure, but through familiarity, through meals, through the sense that a particular company was invested in your success.
I now draw the line at anything that creates a financial entanglement between my implant choices and my income. Consulting relationships that are structured around volume, royalty arrangements tied to procedures, educational events that are thinly veiled product promotion. I’ve declined all of these. It isn’t because I think everyone who accepts them is compromised, but because I don’t trust my own objectivity to hold under those conditions. Most of us don’t. That’s not a character failing; it’s a well-documented feature of how human cognition responds to reciprocity.
Where I find genuine value: reps who provide honest in-service support, who flag technique updates, who are present for complex cases with specific implant systems I’ve chosen on clinical grounds. The collaboration that’s useful is purely technical. The moment it becomes relational in a way that could influence selection, I want distance.
The question I ask myself: if this patient’s family could see every interaction I’ve had with this company, would I be comfortable? That’s the line.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Historically throughout one’s career and observing many physicians’ behaviors and interactions with the medical sales have been dually entertaining and alarming. Granted, the ‘golden years’ of lavish European trips punctuated with sultry establishments of opprobrium have been vacated to antiquity by an act of sunshine; there still remains observed levels of contemptuous interaction and fawning by some representatives. The allowance of device representative into one’s private life and friendships (built solely on business dealings), supersedes reasonability and certainly borders the limitations of inurnment. Reliance on timely product delivery and the use of implantation devices is the job description; overstepping as a consultant or even an influencer is financially biased and reflects poorly on physician decision making and character. Limiting testimonial/social interactions to large group education forums is by far and away the established practice method to avoid any perceived improprieties.
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
