Shoulder surgeon perspective of surgical device representatives: a multinational survey

BACKGROUND: This study aimed to determine the working relationships of shoulder surgeons and surgical device representatives, and benefits or detractors to the operating environment. METHODS: An electronic survey was distributed to all members of the Codman Shoulder Society, an international group of fellowship-trained shoulder surgeons. RESULTS: The response rate was 44% (59 of 134). Mean yearly case volume was estimated as 253.3 ± 126.7, with 205.7 ± 119.6 cases having a surgical device representative present (81.2%). Among respondents, 41.1% (23 of 56) expressed wishes for the increased presence of device representatives during cases. A majority, 78.6% (44 of 56), felt that the presence of a device representative improved the efficiency of the operating room, with 7.3% (4 of 55) identifying an inability to use certain equipment without instruction. Valued qualities of device representatives were identified as attentiveness, organized, knowledgeable, honest, and available, whereas qualities not valued were pushiness/salesmanship, unpreparedness, disengagement, and disorganized. Median working time with the same representative was 5 years (0.5-20 years) with 94.4% (53 of 56) of respondents identifying desire for familiarity. A large proportion, 42.9% (24 of 56), identified changing their implants based on qualities of device representatives. Only 26.8% (15 of 56) felt that the presence of a device representative should be disclosed to a patient. CONCLUSIONS: High-volume shoulder surgeons partially dictate the use of surgically implanted devices and make decisions based on valued or disvalued surgical device representative traits. Working relationships between the shoulder surgeon and device representatives proceed longitudinally and are significant in establishing long-term company relationships.