Between 2013 and 2025, medical-device and pharma companies routed nearly $9.7 billion to 38,104 U.S. orthopedic surgeons through CMS Open Payments — but the money is among the most concentrated in all of medicine. This brief shows where it pools, which subspecialties and surgeons it reaches, and how field and medical-liaison teams can turn that signal into smarter targeting. The full extract names every surgeon.
If you ranked every orthopedic surgeon by the industry money they've received, the curve barely lifts off the floor until the very top. The top 0.1% (38 surgeons) account for nearly a third of all dollars. The top 1% account for two-thirds. By the time you reach the top 5%, almost nothing is left for everyone else.
The mean payment ($253,530) over 2013–2025 sits 46× above the median ($5,504) — the signature of a market dominated by a few enormous recipients rather than broad-based engagement. A Gini coefficient of 0.96 (where 1.0 is total inequality) puts orthopedic payments well beyond the inequality of any national income distribution.
"Open Payments leader" lists are dominated by a tiny set of inventors and royalty-holders whose totals reflect IP economics, not prescribing or referral influence. Filtering them out is essential before using payment volume as an engagement signal.
The single largest recipient — a Florida spine surgeon who also founded his own implant company — accounts for $700M alone, or 7.2% of the entire specialty's total. Almost all of that figure is ownership and investment value in his own device company, not consulting fees or meals; this type of surgeon-founder has been a recurring focus of federal anti-kickback enforcement and investigative reporting (see Sources & further reading). Most names below follow the same pattern: surgeon-inventors whose totals are royalty and equity, not promotional spend.
| # | Surgeon (initials) | Subspecialty | Location | Payments 2013–2025 |
|---|
Surgeons are shown by initials only — names withheld in this public brief. All are identifiable by NPI in the CMS Open Payments database. Subspecialty per CMS taxonomy; totals span 2013–2025 across every Open Payments category (ownership, royalty/license, consulting, research, food & travel).
Orthopedics is not one market for industry money — it's several, separated by an order of magnitude. A spine surgeon receives, on average, 13× what a hand surgeon does. The gap tracks the implant-and-royalty intensity of each subspecialty: spine and joint reconstruction run on high-value hardware and surgeon-designed instrumentation; hand and pediatrics far less so.
The median tells the quieter, more representative story: even in spine, the typical surgeon's 2013–2025 total is ~$20,600. The towering means are pulled up by inventors. But the ordering is stable across both measures — spine, adult reconstruction, and foot & ankle consistently sit above sports medicine, trauma, and hand.
Subspecialty is a strong proxy for how much a surgeon's practice revolves around branded implants. For device and ortho-biologics commercial teams, it's a cleaner first-pass segmentation than payment volume alone.
Subspecialties with at least 100 surgeons shown.
Sort surgeons by graduation decade and a clear arc appears. Average payments peak for surgeons who graduated in the 1980s–90s — the cohort now senior enough to hold royalty agreements, board seats, and KOL roles — then fall sharply for newer graduates who haven't accumulated them. But the median moves the opposite way.
The mean is an elite-capture signal: it rewards the few who became inventors and consultants, and those take a full career to build. The median is an engagement signal: it actually rises from older to mid cohorts, because recent graduates receive small, broad-based payments (meals, education) almost universally, while many older surgeons have wound down.
The 1980s–90s cohort is where to look for established KOLs and royalty relationships. The 2000s–10s cohort, with the highest median, is the broad, reachable, still-growing base — the right target for awareness and adoption programs.
By total dollars, the map looks predictable: big states win. Florida tops the list at $1.61B, ahead of California ($1.20B) and New York ($684M). But normalize by dollars per surgeon and a stranger map emerges — tiny municipalities outrank every major metro because a single mega-recipient currently practices there.
A note on geography: locations reflect each surgeon's current primary practice address in the CMS/NPI record — not necessarily where they live, nor where the payments were originally earned over 2013–2025.
These are not centers of orthopedic density — they're the current practice locations of a few surgeon-inventors, often near the device companies they founded. The signal is concentration around individuals, not regional strength.
| City | $ / surgeon | Surgeons |
|---|
Cities with ≥3 surgeons, ranked by average payment (2013–2025).
Florida's lead is driven heavily by Hollywood, FL ($702M — almost entirely one surgeon). A state- or city-level "where the money is" heat map will mislead unless single-recipient outliers are stripped out first. Per-surgeon medians give a far more faithful picture of regional industry engagement.
CMS Open Payments doesn't report a single number — it records the nature of every transfer of value. Two surgeons with identical totals can sit at opposite ends of the influence spectrum depending on which categories make up that total. Reading the mix, not just the sum, is what turns Open Payments from a compliance feed into a key-opinion-leader (KOL) signal.
A true KOL profile is dominated by the middle tier — consulting, speaking, honoraria, research — ideally spread across multiple manufacturers. That breadth signals the field values their expertise, not that one company has bought a captive advocate.
A profile dominated by royalty/ownership from a single company is a different animal: highly influential within that product line, but conflicted and not a neutral voice. And a profile that is almost entirely food & travel indicates reach, not authority.
To find genuine KOLs in this dataset, you'd strip out ownership/royalty-dominated profiles (the inventors atop our table), then rank the remainder by consulting + speaking + research breadth and manufacturer diversity. Alpha Sophia lets you filter Open Payments by nature of payment, manufacturer, and product to do exactly this — see the KOL-mapping guide below.
Payment categories reflect CMS Open Payments "nature of payment" classifications. This dataset contains 2013–2025 totals; a category-level breakdown per surgeon is available in the full Open Payments record.
For a medical science liaison or field sales liaison, Open Payments is a map of who already has a relationship with industry — and with whom. Used well, it tells you who to engage, who's already locked up by a competitor, and where the genuinely uncommitted opportunity sits. Here's how to read it in the field.
Quick answers on using CMS Open Payments for targeting, KOL identification and competitive intelligence.
This brief shows the shape of the market. The full Alpha Sophia extract gives your commercial and field teams the surgeon-by-surgeon detail to build territories and target the right accounts.
All 38,104 orthopedic surgeons — name, NPI, primary practice address, and Alpha Sophia profile link.
Per-surgeon split across royalty, ownership, consulting, speaking, research, and food & travel.
Which companies and devices each surgeon is paid by — the key to spotting competitor loyalty.
CMS taxonomy plus top sites of care and primary affiliation for account planning.
Cross Open Payments with procedure-code volume to find surgeons who are both paid and billing your codes.
Filter by manufacturer, payment type, subspecialty, or geography and export to Excel / CRM, with a usage license.
Open Payments totals are just the headline. In Alpha Sophia you can break the same data down to the questions your team actually asks — by device, payment type, manufacturer, subspecialty or geography.
Book an extract scoping call →Primary sources, methodology references and investigative reporting behind this brief.
Figures derive from an Alpha Sophia export of CMS Open Payments totals for 38,104 U.S. orthopedic surgeons covering 2013–2025 (the full span of the program to date).
This brief presents aggregated CMS Open Payments totals for U.S. orthopedic surgeons, 2013–2025, for illustration and market context. Figures are directional. Source: CMS Open Payments via Alpha Sophia.