Physician Salary by Specialty in Orthopedic Surgery: A Complete Guide

Orthopedic surgery is consistently listed among the highest paid specialties in medicine, but the story is more nuanced than a single number. Within orthopedics, subspecialty, practice setting, geography, call burden, and your path from residency to attending all dramatically influence your earning potential.

If you’re a medical student or resident targeting an orthopedic surgery residency—or already planning your fellowship—understanding physician salary by specialty within ortho will help you make better long-term career decisions.

This guide breaks down how orthopedic salary works, what to expect at each training stage, and how different subspecialties and practice models affect compensation.

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Understanding Orthopedic Surgery in the Context of Physician Salaries

Orthopedic surgery sits at the top tier of physician salary by specialty in almost every major compensation survey. When people talk about the “highest paid specialties,” orthopedic surgery is nearly always on that list.

To put things in context:

• Orthopedic surgery is typically:
  • Top 3–5 among all highest paid specialties
  • Frequently compared with neurosurgery, cardiology, plastic surgery, and interventional radiology
• In contrast:
  • Primary care fields (e.g., family medicine, pediatrics) usually earn less than half to two-thirds of what many orthopedic surgeons earn
  • Even many “procedural” specialties (e.g., GI, pulmonary/critical care) often trail orthopedics by a substantial margin

Across recent surveys (e.g., Medscape, MGMA, Doximity), average attending orthopedic surgeon compensation often ranges from approximately $550,000 to $700,000+ per year, with significant variation based on:

• Subspecialty (e.g., spine vs. pediatrics)
• Geographic region (Midwest and South often pay more than coastal metros)
• Type of practice (private group, hospital-employed, academic)
• Productivity (RVU-based or production bonuses, call pay, ancillary income)

However, these “average” figures can disguise big differences within the field. A sports medicine–focused ortho surgeon in a major academic center, a spine surgeon in a high-volume private group, and a hand surgeon in a rural hospital-employed role can have very different income profiles—even though they all fall under “orthopedic surgery.”

For residency applicants, the key is to understand that:

• Orthopedic surgery as a specialty offers very strong earning potential relative to most fields.
• Within orthopedics, there is a wide salary spectrum driven by subspecialty, market demand, and lifestyle trade-offs.

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Training Pathway and Salary Milestones in Orthopedic Surgery

Before comparing doctor salary by specialty and subspecialty within orthopedics, it’s helpful to map the training timeline—because your income changes in distinct stages.

1. Medical School (Debt Accumulation Phase)

• Income: $0 or very limited; possibly small stipends or part-time work
• Reality: Tuition plus living expenses often lead to significant debt—commonly $200,000+ for U.S. graduates

During this phase, your “orthopedic salary” is theoretical, but your loan burden is real. The prospect of a high eventual income in orthopedics is one reason many students tolerate substantial debt—but it’s important to be realistic about timelines.

2. Orthopedic Surgery Residency Salary

Most orthopedic surgery residency programs offer similar baseline salaries to other surgical residencies at the same institution:

• PGY-1: Roughly $60,000–$70,000 per year (varies by region and institution)
• PGY-2 to PGY-5: Gradual increases to $70,000–$85,000+ by chief year

Key points:

• These are fixed institutional salaries, generally not specialty-specific.
• Orthopedic residents often work long hours (60–80+ hours/week), making the effective hourly rate relatively modest.
• Some programs offer small extras:
  • Housing stipends
  • Meal stipends
  • Call pay (less common at the resident level)
  • Moonlighting (if your program allows and you’re licensed)

From an ortho match perspective, you’re competing heavily now for positions, but financially, your income during residency will be similar to other residents in your hospital—regardless of your future earnings potential.

3. Fellowship(s) (Optional but Common in Ortho)

Most modern orthopedic surgeons complete at least one fellowship, and some do two. Common fellowships include:

• Sports Medicine
• Spine
• Hand & Upper Extremity
• Trauma
• Adult Reconstruction (Joints)
• Foot & Ankle
• Pediatric Orthopedics
• Oncology

Fellow salary is typically:

• Comparable to a PGY-6 or PGY-7 resident salary, often $75,000–$95,000/year
• May include some opportunities for moonlighting or limited attending-level work, depending on the institution and state licensing rules

Financial trade-off:

• You delay attending-level physician salary for 1–2+ years
• In return, you may:
  • Increase long-term earning potential (e.g., spine, sports, joints)
  • Gain a more competitive position in specific markets or academic centers
  • Align your clinical practice with your preferred cases and lifestyle

4. Early Attending Years (First 3–5 Years)

Your first job after training is a critical determinant of your income trajectory:

• Starting total compensation for orthopedic attendings can vary dramatically:
  • Academic roles: $300,000–$500,000+
  • Hospital-employed community positions: $450,000–$700,000+
  • Private practice (especially high-volume subspecialties): $500,000–$900,000+ with growth potential

You might see a lower base salary your first 1–2 years with the promise of productivity-based increases (RVU bonuses or collections percentages) as your practice builds.

Also consider:

• Sign-on bonuses: $20,000–$100,000+ in some markets
• Relocation assistance
• Loan repayment incentives in rural/underserved areas
• Partnership tracks in private practice (with a step up in income when you become partner)

Within several years of practice, many orthopedic surgeons surpass the typical national averages if they are in high-demand subspecialties and high-productivity environments.

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Physician Salary by Subspecialty Within Orthopedic Surgery

When people ask about “doctor salary by specialty,” they often overlook that subspecialty choice within orthopedics can significantly alter your income. While exact numbers vary by region and survey, certain trends are consistent.

Below is a high-level comparison of common orthopedic subspecialties and typical earning patterns. (All ranges are approximate and can vary widely; many experienced surgeons earn above the upper bounds listed.)

1. Spine Surgery

• General pay level: Among the highest paid specialties within orthopedics and across all of medicine
• Typical ranges: Frequently $750,000–$1,200,000+ for high-volume private practice; academic roles may be lower but still strong
• Drivers of income:
  • Complex procedures with high RVU values
  • Significant case volumes in degenerative spine, deformity, and trauma
  • High demand, especially in regions with aging populations
• Trade-offs:
  • Long, complex cases
  • Potentially higher medicolegal exposure
  • Intense call and clinic schedules in some settings

2. Adult Reconstruction (Joints)

• General pay level: High; often among top earners in ortho but slightly below spine on average
• Typical ranges: Commonly $600,000–$900,000+ in private practice; somewhat less in academia
• Drivers of income:
  • High volume of hip and knee arthroplasty
  • Strong procedural reimbursement
  • Consistent demand with aging population and active older adults
• Trade-offs:
  • High case volume expectations in many practices
  • Revision and complex arthroplasty can be demanding and time-consuming

3. Sports Medicine (Orthopedic)

• General pay level: Upper-middle to high within orthopedics; variable based on practice and market
• Typical ranges: Approximately $500,000–$800,000+, with some high-volume private practices exceeding this
• Drivers of income:
  • Arthroscopic procedures (shoulder, knee, hip, etc.)
  • Mix of surgical and clinic-based care
  • Potential for branding with teams, schools, and community sports programs
• Trade-offs:
  • Highly competitive markets in attractive metro areas
  • Some practices rely heavily on clinic volume and long days of patients to sustain income
  • Team coverage obligations (nights/weekends) may not always be separately compensated

4. Trauma

• General pay level: Often strong, especially in busy trauma centers with call stipends
• Typical ranges: Roughly $500,000–$800,000+, highly dependent on call structures and contracts
• Drivers of income:
  • High RVU cases from emergent and urgent surgeries
  • Frequent after-hours and weekend work
  • Many hospital-employed or academic hybrid models with extra trauma call pay
• Trade-offs:
  • Intense workload and unpredictable hours
  • Higher burnout risk for some surgeons
  • May have less elective clinic control compared with joints or sports

5. Hand and Upper Extremity

• General pay level: Middle to upper-middle among orthopedists; can be very strong in efficient, high-volume practices
• Typical ranges: About $450,000–$750,000+
• Drivers of income:
  • High-volume outpatient procedures (carpal tunnel, trigger fingers, fractures, tendon repairs)
  • Mix of elective and trauma-related cases
• Trade-offs:
  • Many short cases; efficiency and OR access strongly influence productivity
  • Split competition in some markets with plastic surgeons

6. Foot & Ankle

• General pay level: Middle tier, though high-volume practices can do very well
• Typical ranges: Approximately $450,000–$750,000+
• Drivers of income:
  • Chronic deformity corrections, arthritis, sports-related injuries
  • Steady demand, often with a mix of complex and routine cases
• Trade-offs:
  • Market competition from podiatric surgeons
  • Variable payer mixes depending on region and referral patterns

7. Pediatric Orthopedics

• General pay level: Typically lower than adult orthopedic subspecialties, but still above many non-surgical fields
• Typical ranges: Often $350,000–$600,000+, depending on academic vs community setting
• Drivers of income:
  • Highly specialized skill set but lower reimbursement for many pediatric procedures
  • Often concentrated in academic and children’s hospital settings
• Trade-offs:
  • More academic and mission-driven practice patterns
  • Greater emphasis on congenital and developmental conditions vs high-RVU adult recon or spine

8. Orthopedic Oncology

• General pay level: Often similar to or somewhat higher than pediatrics; usually on the lower end for orthopedics as a whole
• Typical ranges: Roughly $350,000–$600,000+
• Drivers of income:
  • High complexity cases, but relatively low volumes
  • Frequently academic or tertiary referral center based
• Trade-offs:
  • High intellectual and technical demand
  • Deeply meaningful but emotionally intense patient population
  • May have fewer private practice options

The key pattern: within orthopedic surgery, spine, adult reconstruction, and (in many markets) sports medicine often trend toward the upper end of the income spectrum, while pediatric orthopedics and oncology trend toward lower ranges—though still competitive compared with many other medical specialties.

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Factors That Drive Salary Variation in Orthopedic Surgery

Subspecialty choice is only one axis of variation. For anyone targeting the ortho match with an eye on long-term compensation, you should understand the levers that actually move income in practice.

1. Practice Setting

Private Practice / Group Practice

• Often offers the highest long-term earning potential, especially after partnership
• Income structure may include:
  • Base salary plus collections percentage
  • Partnership track with profit sharing
  • Ancillary income from imaging centers, surgery centers (ASCs), PT, etc.
• Risk:
  • Income may be more volatile
  • Business responsibilities, overhead, and buy-in costs
  • Greater exposure to payer mix fluctuations

Hospital-Employed / Health System

• Typically offers:
  • Stable base salary plus RVU-based production bonuses
  • Solid benefits, retirement matching, and malpractice coverage
• May include:
  • Generous sign-on bonuses
  • Loan repayment packages in some areas
• Trade-offs:
  • Less autonomy in scheduling and practice management
  • Limitations on ancillary income streams
  • Caps or target ranges on total compensation

Academic Medicine

• Generally the lowest paying among practice settings, though still substantial
• Structure:
  • Fixed academic salary tiers
  • RVU or incentive compensation layered on top
  • Possible supplemental income from consulting, speaking, or side work (within institution policies)
• Upsides:
  • Teaching, research, and leadership opportunities
  • Academic prestige and mission-driven practice
  • Access to complex, high-acuity cases

2. Geographic Location

Location is one of the strongest determinants of orthopedic surgeon compensation:

• Rural and semi-rural regions, Midwest, and parts of the South:
  • Often offer higher base salaries, larger sign-on bonuses, and loan repayment
  • Competition may be lower; demand for orthopedists is high
• Large coastal cities and highly desirable metro areas:
  • Typically offer lower base salaries relative to cost of living
  • Greater competition from other orthopedic surgeons and large groups
  • Compensation can still be strong, but your purchasing power may be constrained by housing and taxes

When you see surveys listing “average orthopedic surgery residency graduate salary,” remember that your first job offers will look very different if you’re considering Manhattan vs mid-sized Midwestern cities.

3. Call Burden and Trauma Coverage

Orthopedic call can be lucrative—or simply exhausting—depending on how it’s structured:

• Some hospitals pay generous call stipends to ensure coverage
• Busy trauma centers may offer:
  • Ortho trauma surgeons dedicated trauma lines
  • Extra pay for additional call days
  • Opportunity for high RVU from emergent cases
• In contrast, some groups require a certain number of call shifts with minimal or no extra compensation, with the justification that call generates downstream referrals and cases

When evaluating job offers, clarify:

• Is call shared equitably?
• Is there separate pay for extra call or trauma line coverage?
• How frequently are you in the OR overnight vs handling consults?

4. Productivity Model (RVUs, Collections, or Straight Salary)

Many orthopedic contracts tie part of your compensation to productivity:

• RVU-based models:
  • You earn a base salary plus a set dollar-per-RVU beyond a threshold
  • Understanding your conversion rate and realistic RVU volumes is critical
• Collections-based models:
  • More common in private practice
  • You receive a percentage of what is collected for your work, after overhead
• Straight salary models:
  • Common in early guaranteed years or heavily academic settings
  • Provide stability, sometimes at the cost of upside potential

Your ability to control your schedule, optimize OR time, and build referrals will dramatically influence your income in production-based structures.

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Aligning Income Goals With Career and Lifestyle in Orthopedic Surgery

Compensation is only one piece of your career satisfaction. For orthopedic residency applicants and early trainees, it’s important to think about how your income goals intersect with your values, interests, and desired lifestyle.

1. Matching Subspecialty Interests and Income Expectations

If you are strongly drawn to complex pediatric deformities or orthopedic oncology, you may earn less than a spine surgeon—but your career satisfaction may be far higher. On the other hand, if your goal is to maximize income, subspecialties like spine or adult reconstruction in high-volume private practice settings may be more aligned.

Questions to ask yourself:

• Which types of cases and patient populations energize me?
• How comfortable am I with long, high-stakes operations vs shorter, repetitive cases?
• Am I more drawn to academic, teaching, and research missions or to entrepreneurial practice building?

2. Balancing Income With Lifestyle

High-income orthopedic roles often come with:

• More call
• More hours
• Higher stress and complexity

For some physicians, a “mid-tier” orthopedic salary in a lower-stress setting (e.g., community practice with balanced clinic/OR time and moderate call) offers the best overall quality of life.

Consider:

• Would you trade $100,000–$200,000 in annual income for:
  • Fewer nights and weekends?
  • A shorter commute?
  • Guaranteed vacation time?
  • A more predictable schedule?

3. Long-Term Financial Planning

Even though orthopedic surgery offers one of the highest doctor salaries by specialty, good financial habits still matter:

• Start retirement contributions as early as possible (401(k), 403(b), 457(b), Roth IRA, etc.).
• Have a plan to address medical school and training debt:
  • Aggressive payoff vs strategic refinancing
• Carry appropriate disability and life insurance, especially as the primary earner
• Avoid rapid “lifestyle creep” in your first few attending years:
  • Big house + new car + private school + multiple mortgages can consume a huge portion of even a high orthopedic salary

Dialing in these basics early can easily create the equivalent of an extra six-figure “raise” over the course of your career.

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FAQ: Physician Salary by Specialty in Orthopedic Surgery

1. Is orthopedic surgery really one of the highest paid specialties?

Yes. Across nearly all major compensation reports, orthopedic surgery is consistently near the top of the highest paid specialties list. It often outranks most medical and surgical fields, with only a few subspecialties (like neurosurgery or interventional cardiology) rivaling or exceeding its averages. Within orthopedics, spine and adult reconstruction tend to be among the top earners.

2. How much do orthopedic surgery residents make compared to attendings?

Orthopedic surgery residents typically earn $60,000–$85,000 per year, depending on PGY level and institution. After completing residency (and usually a fellowship), orthopedic attendings can see their income jump to $300,000–$700,000+ in academic or hospital-employed settings and $500,000–$900,000+ (or higher) in high-volume private practices. The largest differences arise from subspecialty choice, geographic location, and practice model.

3. Which orthopedic subspecialties have the highest earning potential?

In general, spine surgery and adult reconstruction (joints) are often at the top, followed by sports medicine and trauma in many markets. Hand, foot & ankle, and general orthopedics can also be very well compensated. Pediatric orthopedics and orthopedic oncology tend to earn less than some adult-focused subspecialties but remain financially strong compared with many other medical specialties.

4. How should I factor salary into my choice of orthopedic subspecialty and job?

Use physician salary data as one input—not the only one. Consider:

• Your genuine clinical interests and what cases you want to do for decades
• Lifestyle preferences (call frequency, nights/weekends, clinic vs OR balance)
• Desired practice setting (academic vs private vs hospital-employed)
• Location priorities (family, partner’s career, cost of living)

A balanced approach—combining realistic understanding of orthopedic physician salary by specialty with an honest assessment of your values—will serve you better than simply chasing the highest possible income.

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Orthopedic surgery offers some of the strongest earning potential in medicine, but the real advantage is the flexibility: within this single specialty, you can tailor your subspecialty, practice setting, and location to match not only your financial goals, but also the kind of surgeon—and person—you want to be.