Many orthopedic trauma surgeons may see some significant ethical concerns if a drug company representative wanted to be present during all of their procedures. In contrast, most feel they need device sales representatives in the OR, found a recent survey.1

“As an orthopedic surgeon, I found it very interesting that orthopedic device sales representatives, who have sales goals similar to pharmaceutical representatives, seem to be viewed in a different way by orthopedic surgeons, as well as our governing bodies,” says Berton R. Moed, MD, FAOA, FACS, FRCS(I), the study’s lead author.

As a Bander fellow in medical business ethics at Saint Louis University’s Albert Gnaegi Center for Health Care Ethics, Moed studied the ways in which pharmaceutical sales representatives gain access to physicians, and how these individuals can influence prescribing habits.

“Over the years, I have noticed a transition from a time when device sales representatives were hardly ever in the operating room, at least in my personal experience, to now, where they are a ubiquitous operating room presence,” says Moed. Some key findings of the study, which surveyed 127 orthopaedic trauma surgeons, include the following:

  • Overall, respondents viewed device sales representatives favorably.
  • Generation X responders felt device sales reps should be in the OR for all cases. In contrast, baby boomers felt there was a place for device reps, but that they should not be in the OR routinely for all cases.
  • Most respondents believed that they personally were not at risk for a conflict of interest, but believed their colleagues might be.

“They feel they are not subject to the conflict of interest from the salesman contact that affects their peers,” says Moed.

These findings are similar to studies of the pharmaceutical industry, notes Moed: “There are both financial and ethical implications.”

The surgeons surveyed clearly believed that orthopedic device sales representatives are needed in the operating room, whether only for new or complicated procedures, or for all procedures. “The sales representatives fill a void in operating room support, most likely created by progressive cutbacks and reorganizations of hospital personnel,” says Moed.

The functional importance of device representatives in the operating room is well-known, and has even been recognized by the Orthopaedic Institute of Medicine.2

“Unfortunately, their service comes at a price,” says Moed. “That price is the potential conflict of interest from the salesman contact affecting implant selection.”


  1. Moed BR, Israel HA. Device sales representatives in the operating room: Do we really need or want them? A survey of orthopaedic trauma Surgeons. J Orthop Trauma 2017 Apr 28. doi: 10.1097/BOT.0000000000000880. [Epub ahead of print]
  2. American Orthopaedic Association Orthopaedic Institute of Medicine. Report from the task force on surgeon-industry relationships in the discipline of orthopaedic surgery. Journal of Bone & Joint Surgery 2012: 94(12):e89.


  • Berton R. Moed, MD, FAOA, FACS, FRCS(I), Professor, Department of Orthopaedic Surgery, Saint Louis (MO) University School of Medicine. Phone: (314) 577-8850. Fax: (314) 268-5121. Email: