Robotic surgery is expanding alongside industry payments—but the most striking pattern is not simply that companies pay surgeons. It is where the money goes, where the operations happen, and what remains uncertain. Considerable evidence links pharmaceutical industry payments to health providers’ over-prescribing behavior, and public policies were enacted to mitigate this effect.

However, limited evidence examines surgical device industry payments and surgeons’ utilization of robot-assisted surgeries, or RAS. The study therefore assessed the relationship between industry payments to healthcare providers and the usage of RAS. The study examined reported industry payments from general surgery robotics companies and their allocation toward different payment categories.

It also examined the relationship between industry payments to individual surgeons and hospitals and the use of robotic surgery in urology, gynecology, and general, including gastrointestinal, surgery. Finally, trends over time and variation by surgeon specialty and geographic regions were examined to elucidate mechanisms behind these relationships.

The New York State analysis used 2015 through 2019 data from SPARCS, an all-payer data reporting system that includes patient characteristics, diagnoses, and treatments. Data from 2020 were not included because of the unexpected disruption in surgical volume during the peak of the SARS CoV two pandemic.

Approval was not sought for the Open Payments Database because it is publicly available. The Open Payments Database quantified industry-funded payments from general surgery robotics companies made to hospitals and physicians from 2015 to 2020.

Reported payments were recategorized into five groups, including Education and training, Travel and food, Direct payments, Space rental and facility fee, and Research. Space rental and facility fee and Research applied to teaching hospitals only, while current or prospective ownership or investment interests payments were excluded because that category was added only in 2019.

In New York State, annual trends tracked payments to surgeons performing abdomen and pelvic RAS, including gastrointestinal, gynecological, and genitourinary RAS. The same analysis tracked the corresponding volume of RAS performed in those categories during the study period.

Table 1 breaks down industry payments to surgeons and teaching hospitals across five categories, reporting recipient counts, total payments, mean payments, and standard deviations. Across all categories, the total was two hundred thirty-six million, four hundred eleven thousand, nine hundred seventy-five US dollars, including one hundred fifty-seven million, five hundred eight thousand, sixty-five dollars for education and training.

This matters because it shows how the overall payments were distributed and distinguishes physician payments from payments to teaching hospitals. Physicians received one hundred eighty-six million, one hundred thirty-nine thousand, six hundred ten dollars, or seventy-nine percent, while six hundred fifty-nine teaching hospitals received fifty million, two hundred seventy-two thousand, three hundred seventy-four dollars, or twenty-one percent.

For physicians, most payments were in Education and training, at one hundred thirty-five million, six hundred fifty-eight thousand, four hundred ninety-four dollars, or seventy-three percent, and Travel and food, at forty-eight million, five hundred ninety-nine thousand, four hundred fifty-two dollars, or twenty-six percent.

For teaching hospitals, most payments were in Education and training, at twenty-one million, eight hundred forty-nine thousand, five hundred seventy-one dollars, or forty-three percent, and Space rental and facility fee, at thirteen million, four hundred ninety-three thousand, eight hundred eighty-six dollars, or twenty-seven percent.

Figure one breaks down Open Payments reported between twenty-fifteen and twenty-twenty across five categories, separating payments to physicians from those to teaching hospitals. The table reports recipient counts, totals, means, and standard deviations, with percentages indicating each category’s share of overall payments.

This matters because it shows how industry payments were distributed across payment types and recipient groups, providing the descriptive foundation for the authors’ analysis of surgeon-related payments. Payments to physicians performing RAS and the number of abdomen and pelvic RAS performed between 2015 and 2019 are presented for gastrointestinal, genitourinary, gynecological, and total trunk procedures.

General surgeon payments did not significantly increase between 2015 and 2019, while the volume of gastrointestinal RAS increased steadily. Payments to genitourinary and gynecological surgeons remained stable, but surgical volume in both categories showed an upward trend. Figure three tracks physician payments and robot-assisted surgery volume in New York from 2015 through 2019, separating gastrointestinal, genitourinary, gynecological, and combined procedures.

Panel A shows that general surgeon payments did not significantly increase, while payments to genitourinary and gynecological surgeons remained stable. Panel B shows steadily increasing gastrointestinal volume, alongside upward trends in genitourinary and gynecological volume, highlighting that procedure growth was not uniformly accompanied by changes in physician payments.

The results demonstrated a significant positive correlation between industry payments and volumes of RAS performed. Three quarters of overall industry funding supported education activities and surgeons’ travel to training and conferences, while less than one percent supported research initiatives.

Spatial analysis showed that industry payments were concentrated in large academic health centers. From 2015 through 2020, most industry payments went to individual physicians, at seventy-eight point seven percent, rather than teaching hospitals, at twenty-one point three percent.

Because industry payments were reported annually as a total amount, the study could not examine the causal relationship between these payments and surgeon behavior. Industry-sponsored training often covers surgical skills, safety, and technology use for surgeons, other healthcare providers, and hospital staff, rather than for surgeons alone.

Hospital mergers and acquisitions mean that many surgical training programs serve multiple hospitals and provide training to a wider pool of providers, including surgeons in rural areas. With substantial industry payments continuously allocated to surgical education and training of physicians, the use of RAS will certainly continue to rise in the long term.

Despite significant investment in surgeon RAS education and training, only one point four percent of industry payments had been allocated to comparative research on RAS outcomes. That limited allocation undermines quality improvement efforts and the ability to track patient safety and provider preferences.

The study finds a positive association between industry payments and robot-assisted surgery volumes, while most funding supports education and training and very little supports comparative outcomes research. That makes independent safety evidence especially important.