William N. Levine, MD, FAAOS
October 13, 2025
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One of the most common questions I get from mentees is: “How and when should I get involved with Industry?” It’s not unusual for young orthopedic surgeons to wonder about this. Many are surrounded by mentors or faculty with established industry relationships and want to know if—and how—they should follow a similar path.
Start by Asking: Do I Even Want an Industry Relationship?
Before anything else, ask yourself if you want to have a relationship with industry at all. For much of my career, I intentionally avoided these partnerships. I was hyperaware of the “asterisk stigma”—the way your conflicts of interest are flagged in every presentation, paper, or podium talk. That said, many of my friends and colleagues chose to engage much earlier than I did. There’s no single correct path; it’s a personal decision that depends on your goals, values, and comfort level.
Be Patient: You Need to Bring Something to the Table
My first and most important piece of advice is: be patient. Industry relationships work best when you bring something valuable—clinical expertise, a strong reputation, thought leadership. These things take time to develop.
As you build your career and emerge as a key opinion leader (KOL) in your subspecialty, opportunities will begin to come your way. Trying to force these relationships too early can backfire. Companies can be put off if it feels like you’re trying to jump the line, and that could limit your chances both now and down the road.
Choosing the Right Company
If and when the time is right, how do you choose the right company to partner with?
In some cases, it’s easy—there may be a unique technology or product with no real competitors. But more often, you’ll find yourself approached by multiple companies with similar offerings. In those situations, the decision becomes more nuanced.
Consider:
- Interpersonal relationships – Do you trust and respect the people at the company?
- Corporate culture and values – Does the company operate with integrity?
- Reputation and public perception – Will you be proud to have your name publicly linked to them?
- The “gut check” – What’s your overall impression of working with them?
Remember, this is a very public relationship. You want to feel confident about the company whose name will be next to yours—that infamous asterisk next to your slide deck should feel like a badge of alignment, not compromise.
Get Legal Support—and Know the Rules
Most contracts these days are fairly standard, especially after the Department of Justice crackdown in 2007. But it’s still smart to have legal counsel review any agreement before you sign. You’re not just signing a consulting deal—you’re entering a long-term professional alignment.
If you work in an academic institution, you must understand your employer’s policies on innovation and industry relationships. Some institutions have strict guidelines; others may be more flexible. Either way, transparency and compliance are critical.
Types of Industry Involvement: Understanding the Options
Once you’re ready to explore industry relationships, it’s important to understand that “industry involvement” isn’t one-size-fits-all. There are several different ways to engage with companies, each with its own expectations, benefits, and potential conflicts of interest.
Here are some of the most common types:
1Consulting
This is one of the most common entry points. As a consultant, you may:
- Provide feedback on new technologies or products
- Advise on product development or marketing strategy
- Participate in surgeon advisory boards
This role typically involves hourly compensation, often outlined in a formal contract. Be clear on deliverables and time commitments. Consulting work should be grounded in your clinical expertise—not just your title or affiliations.
2Teaching & Speaking Engagements
Surgeons are often invited to:
- Teach courses or labs
- Speak at educational symposia
- Serve as faculty at company-sponsored events
This type of engagement is ideal if you enjoy educating peers and sharing your techniques or insights. Just be mindful of how this could be perceived in terms of bias—particularly if you’re also involved in research or publishing.
3Product Development / Innovation
If you have an interest in engineering, design, or problem-solving, you may want to get involved in the development of new surgical tools or implants.
This can include:
- Inventorship or co-designing new devices
- Collaborating with engineers and product teams
- Receiving royalties for your intellectual contributions
These relationships often require more legal oversight, especially around intellectual property and royalty structures. If you’re at an academic institution, there may also be IP sharing policies you need to follow.
4Research Support
Industry may fund clinical trials, outcomes studies, or basic science research. These partnerships can be incredibly valuable—but they must be fully transparent.
If you pursue this path:
- Make sure study design remains scientifically sound and ethically appropriate
- Disclose funding sources in all publications and presentations
- Follow all institutional and regulatory requirements
5Equity & Startups
Surgeons sometimes get involved with early-stage companies in exchange for equity rather than traditional consulting fees. This can happen if:
- You help found a company or incubate an idea
- You advise a startup in its early growth stages
- You contribute clinical insight critical to product-market fit
This type of relationship carries higher financial upside—but also more risk and scrutiny. It’s critical to document everything, maintain clear conflict-of-interest disclosures, and consult legal counsel early.
Final Thoughts
There’s no “right” way to engage with industry—only the way that aligns best with your values, expertise, and professional goals. Take your time, understand your options, and most importantly, preserve your integrity along the way.
An industry relationship should feel like a partnership, not a transaction. When done right, it can be an incredibly rewarding way to contribute to innovation in orthopedics and improve patient care on a broader scale.
DISCLOSURES: Dr. Levine is on the Columbia faculty. Dr. Levine serves as a paid consultant and surgeon designer for Zimmer Biomet. International Board of Shoulder and Elbow Surgery – Treasurer : Type: Board of Directors or committee member: Self
Read the AAOS Code of Conduct for Discussion Group Terms, Conditions and Disclaimers HERE.
Reference
Parisi, Thomas J. MD, JD; Ferre, Isabella M. BA; Rubash, Harry E. MD. The Basics of the Sunshine Act: How It Pertains to the Practicing Orthopaedic Surgeon. Journal of the American Academy of Orthopaedic Surgeons 23(8):p 455-467, August 2015. | DOI: 10.5435/JAAOS-D-14-00426
Disclaimer
AAOS does not provide advice related to legal matters, insurance, financial planning—including investments—or any practice management or business decisions. The information presented in this blog is intended solely for educational and informational purposes and should not be construed as professional advice. Individuals are strongly encouraged to consult with qualified legal, financial, insurance, or investment professionals regarding their specific circumstances. AAOS disclaims any liability for actions taken based on the content of this blog.
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