← 2026 Salary Report / Orthopedic Surgery
Joint replacement and spine surgeons earn the most. ASC ownership can push comp past $1M.
Training: 5-6 years post-medical school | 5-Year Change: +14%
Early career Orthopedic Surgeons (1-3 years post-training) typically earn 15-20% below the specialty average as they build patient volume and referral networks. Mid-career practitioners (8-15 years) earn at or above average, with peak earnings occurring between years 12-20. Late-career physicians may see gradual declines as they reduce operative volume or call coverage. The 25th-to-75th percentile range spans roughly $150,000-$200,000 within Orthopedic Surgery, reflecting enormous variation based on geography, practice model, and patient mix.
After adjusting for cost of living and state income tax, the highest-paying states for Orthopedic Surgeons are Texas (no state tax, moderate COL, strong tort reform), Tennessee (no state tax, low COL), Indiana (3% tax, very low COL), and Oklahoma (low COL despite moderate tax). Academic centers in Boston, New York, and San Francisco typically pay 20-35% below private practice benchmarks. Rural and semi-rural markets offer 15-25% premiums over urban areas, with signing bonuses of $25,000-$75,000 and loan repayment incentives.
Hospital-employed Orthopedic Surgeons earn a predictable salary with benefits and malpractice coverage, but typically 15-30% less than private practice colleagues. Private practice Orthopedic Surgery physicians bear business risk and overhead (typically 45-65% of revenue) but benefit from higher income ceilings, equity value in their practice, and potential ASC or ancillary service revenue. The gap is most pronounced in procedural specialties where ancillary revenue streams can add $100,000-$400,000 annually on top of professional fees.
Three highest-leverage actions for Orthopedic Surgery physicians: (1) Negotiate using specialty-specific benchmark data from this report and MGMA, targeting the 60th-75th percentile. (2) Evaluate the real purchasing power of your location using COL-adjusted comparisons. (3) Assess whether your practice setting is optimal, particularly if you are in a procedural specialty where ASC ownership or private practice can significantly increase total compensation. Use the PhysicianWealth Salary Benchmark for a personalized comparison.
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