Navigating Corporate Relationships: The Dos and Don’ts for Entering a Contract
Khoi D. Than, MD
Ali A. Baaj, MD
According to the Centers for Medicare & Medicaid Services1, in 2019 the average neurosurgeon received $18,149.19 in general payments from industry. General payments consist of consulting fees, speaking honoraria, travel, lodging, food, and beverage. This amount is nearly five times higher than the average value received across all medical specialties of $3,742.28. Relationships between medicine and industry are essential to clinical practice, research, and medical education. Due to the high revenue generation and technological reliance of our field, neurosurgeons are particularly likely to be approached by industry to engage in consulting opportunities. In fact, 95% of American neurosurgeons receive some payment from industry.2 The goal of this article is to discuss best practices for entering a corporate contract and navigating issues with bias and conflicts of interest.
1. Read the contract.
A consulting contract can be long and downright boring to read. Nonetheless, it is important to do so. The onus is on you, the recipient, to correct any mistakes and omissions. If the monetary value of the agreement seems low, it is perfectly reasonable to negotiate for better terms. In addition, seeking professional legal advice may be worthwhile, especially if there are clauses pertaining to intellectual property and/or a potential patent is at play. If stock options are involved, be certain to consult with a tax adviser, as there are nuances with nonqualified stock options that could cost you a lot of money if you are not careful to file certain elections. At the very least, discussion of a given opportunity with a colleague with significant consulting experience might prove beneficial before signing on the dotted line.
2. Check your primary employer’s policy
Institutions vary widely on rules regarding involvement with industry. Some centers may forbid it, while others may have no restrictions whatsoever. There may be limitations on the use of your or your institution’s name in corporate promotional materials. Some employers stake claim on a certain percentage of money made from consulting and/or royalties. Almost all will require that you disclose such relationships. Clarifying your employer’s policies on this is imperative prior to entering a contract. Most institutions have compliance officers that can help navigate these waters.
3. Acknowledge bias to your patients, in your research, and in presentations.
Informing patients of conflicts of interest prior to neurosurgical intervention likely builds trust,3 and may even be mandated by institutions and/or government. When it comes to research, previous studies have shown that research supported by industry is 3.6 times more likely to report positive results. Even if a study is not funded by industry, personal conflicts of interest by authors have also been shown to influence results. As such, it is important for appropriate disclosures to be made and for consumers of the literature and meeting audiences to be aware of bias.4
4. Keep the relationship dynamic.
It is important to keep these consulting relationships dynamic; otherwise, you risk partaking in a “symbolic consultancy.” Meet with your contacts routinely to discuss and assess the engagement; ensure you are optimizing your time, energy and skillset; and never hesitate to offer suggestions for improvement. After all, industry sought your expertise to enhance a given product or educational initiative.
5. Diversify your relationships.
It is expected that one may work more closely, as a consultant, with one or two industry partners. This is understandable given time constraints and the neurosurgeon’s clinical and technical interests. Keeping an open mind, however, to exploring other potential relationships is important as technology and interests do change. Ensure that your contract with one entity does not preclude you from offering services to another.
1. Let financial conflicts of interest affect your decision-making.
We work in a field where good evidence is not available across all situations. For example, in spine surgery there is great uncertainty as to which surface technologies and osteobiologics result in the best rate of fusion. It is important to be aware that all gifts and financial interests have the potential to affect judgment.5 Continuously being aware of this will allow each individual surgeon to put these conflicts of interest aside in making the best decision for patients.
2. Request or expect remuneration for using products.
It is both illegal and unethical to receive remuneration in exchange for prescribing, implanting or using medical equipment and products. Avoid circumstances or situations that directly or indirectly suggest this. If unsure regarding the nature of the contract or proposal, discuss this with your Chair or business manager/compliance officer.
3. Accept gifts of any kind.
Accepting gifts from industry and vendors, especially if you are a consultant, can be problematic. It is important to keep the relationship professional and related to the work as delineated in the consultant agreement. Accepting gifts, whether small or large in value, not only violates most institutional rules, but it can also undermine the expected professional relationship. It is tempting to accept an invitation for a sporting or entertainment event, but such offers should be declined.
4. Conceal consultancy agreements from your employer.
One of the most common reasons for employment termination is concealing outside engagements from an employer. These activities must be declared and disclosed to avoid potential conflicts with patient care and equipment procurement. Most, if not all, institutions allow for surgeon-industry partnerships, but all require disclosures.
In summary, advancing our field depends on neurosurgeon-industry partnerships and relationships. These interactions are vital and necessary. Abiding by simple rules, however, ensures a professional relationship that enhances the experience for the consultant surgeon, consulting entity, and ultimately the care delivered to our patients.
- “Open Payments.” cms.gov. Centers for Medicare and Medicaid Services, revised 09/21/2020. Accessed 12.12.2020.
- Motiwala M, Herr, MJ, Jampana Raju SS, et al. Dissecting the Financial Relationship Between Industry and Academic Neurosurgery, Neurosurgery, 2020; 87( 6):1111–1118
- Edwards D, Ballantyne A. 2009. Patient awareness and concern regarding pharmaceutical manufacturer interactions with doctors. Intern Med J. 39(3):191-96
- Bekelman JE, Li Y, Gross CP. 2003. Scope and impact of financial conflicts of interest in biomedical research: a systematic review. JAMA 289(4):454-65
- Brennan TA, Rothman DJ, Blank L, et al. 2006. Health industry practices that create conflicts of interest: a policy proposal for academic medical centers. JAMA 295(4):429-33