Orthopedic Surgery Salary (2026): What Orthopedic Surgeons Actually Earn — and the ASC Ownership Gap Nobody Talks About

According to a 2019 review in the Journal of Spine Surgery, 90 percent of ASCs in the U.S. have at least some physician ownership, and 65 percent are solely owned by physicians. The orthopedic surgeons at the top of the pay range (SalaryDr's 90th percentile is $1,000,000) are usually physicians who own a piece of the facility where they operate, not just the professional fee component of their surgeries.

This guide covers what orthopedic surgeons actually earn in 2026 by setting, subspecialty, and career stage — with ASC ownership income explained, because orthopedic surgery compensation without understanding the facility revenue dimension is an incomplete picture.

What the Data Shows: Orthopedic Surgery Salary in 2026

The physician compensation surveys all put orthopedic surgery at or near the top, though the figures differ with each survey's method and who responds. Federal wage data, which counts employees only, comes in far lower:

The gap between the BLS figure and the physician surveys is not a measurement error — it is largely a question of who gets counted. BLS wage estimates come from employers, and the survey does not cover the self-employed or owners and partners in unincorporated firms. Orthopedic surgeons who own equity in ASCs receive facility distributions that flow through business ownership, not W-2 employment income. Those distributions simply do not appear in federal employment wage statistics.

In SalaryDr's 122 reports, the 25th percentile sits at $653,750 and the 75th percentile at $850,000. The 90th percentile is $1,000,000, and 80 percent of the reports (97 of 122) include bonus or incentive pay, with a median bonus of $130,000.

A seven-figure income is possible in orthopedic surgery, but it sits at the top tenth of SalaryDr's reports, not in the typical case. The surgeons who get there usually pair high surgical volume with the right practice structure.

The ASC Ownership Engine: Why Salary Surveys Tell Half the Story

To understand orthopedic surgery compensation fully, you need to understand how surgical revenue flows — because the professional fee that appears in salary data is only part of what a surgery generates.

When an orthopedic surgeon performs a total knee replacement:

• •The professional fee — what the surgeon bills for their work — is collected by the surgeon or their group and is what flows into salary and wRVU-based compensation models.
• •The facility fee — what the hospital or ASC charges for the use of its operating room, nursing staff, equipment, supplies, and implants — is collected by whoever owns the facility. At a hospital, this goes to the hospital. At a physician-owned ASC, the profit left after the center's costs flows to the physician owners proportional to their ownership stake. Because it covers the implant and the operating room, the facility fee on a joint replacement is several times the surgeon's professional fee.

An orthopedic surgeon who performs 300 total knee replacements per year at a hospital earns the professional fee on all 300 cases. An orthopedic surgeon who performs the same 300 cases at their own ASC — where they hold a 20 percent ownership stake — earns the professional fee on all 300 cases plus a 20 percent share of the center's profit. As a round hypothetical (real facility payments vary widely by payer and market), at a $20,000 average facility fee, 300 cases bring in $6 million of facility revenue. Once the center pays for implants, staff, supplies, and overhead, what remains is split among the owners, and the surgeon's 20 percent share arrives as ASC distributions on top of their clinical salary.

Those distributions are investment income from an ownership interest, not pay for clinical work. They never appear in employer wage data like the BLS figures above, and whether they show up in a salary survey depends on how each surgeon reports their income, one reason the survey figures differ.

The regulatory framework: Physician ownership in ASCs is explicitly legal under the Anti-Kickback Statute safe harbor for ASC investments when structured correctly. Physicians must meet volume and investment structure requirements, but the basic model — surgeons owning equity in the facilities where they operate — is well-established, federally sanctioned, and financially dominant in orthopedic surgery.

Orthopedic Surgery Salary by Practice Setting

The setting averages below come from SalaryDr's breakdown of its orthopedic surgery reports by practice type, as of September 2026.

Private Practice: $995,038 Average

Private practice is the highest-compensation model in orthopedic surgery: these surgeons report an average of $995,038 on SalaryDr (65 reports), the highest of any practice type. Combined with ASC ownership, it is also the structure that produces the top-percentile earners that salary surveys struggle to capture. A high-volume joint replacement or spine surgeon with meaningful equity in a well-run orthopedic ASC earns clinical compensation from professional fees plus facility distributions from ASC ownership — a combination that can reach seven figures for surgeons with significant case volume.

The private practice trajectory follows a predictable pattern:

• •Associate track (years 1–3): A salary with productivity bonuses, typically without ASC ownership. Building surgical volume, referral relationships, and proving case performance before partnership is offered.
• •Partnership buy-in: The financial commitment that unlocks ASC distributions. Buy-in amounts vary widely depending on group size, ASC valuation, and ownership percentage offered. Some groups structure buy-ins over 3 to 5 years; others require immediate payment.
• •Partner status: Clinical salary plus ASC distributions. The income jump at partnership is often the largest single financial event in an orthopedic surgeon's career.

The private equity consolidation factor: Private equity firms have been actively acquiring orthopedic surgery practices in recent years. When a private equity firm acquires an orthopedic group, physicians typically receive a significant cash payment for their practice equity, followed by a transition to employment arrangements with the PE-backed entity. The ongoing compensation in PE-backed employed arrangements is typically lower than true partnership income — but the upfront liquidity event can be substantial for founding partners.

Hospital Employment: $772,919 Average

Hospital employment is a common arrangement for early-career orthopedic surgeons and for those who prefer income predictability over the business risk of private practice. Hospital-employed orthopedic surgeons report an average of $772,919 on SalaryDr (31 reports), typically structured as a base salary with a wRVU productivity bonus.

The wRVU model is the standard compensation structure in employed orthopedic surgery. In SalaryDr's orthopedic reports that include a rate, the median is $70 per wRVU (66 reports, data as of August 29, 2026), and the middle half falls between $68 and $72. Hospital-employed surgeons report a $68 median (15 reports). At $70 per wRVU, every 1,000 wRVUs is worth $70,000 in productivity pay.

The hospital employment income ceiling is real. Without a share of facility revenue, employed pay rises only with wRVU volume. The roughly $222,000 gap between SalaryDr's private practice and hospital-employed averages is one measure of what practice ownership, including ASC equity, can add.

Academic Medical Centers: $605,000 Average

Academic orthopedic surgery pays meaningfully below private practice and employed community settings — SalaryDr's academic orthopedic surgeons average $605,000 (20 reports) — in exchange for protected research time, complex revision surgery case exposure, resident and fellow education, and the academic prestige that opens doors to speaking, consulting, and editorial opportunities.

For orthopedic surgeons at qualifying nonprofit academic medical centers, PSLF eligibility provides real financial value that partially offsets the salary gap. Use our PSLF Calculator to model what loan forgiveness adds to your total career compensation.

The academic orthopedic surgery environment also offers unique exposure to industry relationships — implant companies actively engage with academic surgeons for product development, clinical trials, and teaching — that can add meaningful speaking and consulting income for prominent academic orthopedists.

Orthopedic Surgery Salary by Subspecialty

Fellowship training in orthopedic surgery does not universally increase income — and some fellowship choices trade income potential for lifestyle or academic opportunity.

The subspecialty averages below are from SalaryDr's orthopedic surgery reports as of September 2026. Each rests on 5 to 18 reports and is rounded by SalaryDr, so treat them as a direction rather than a benchmark.

Spine Surgery: $1,000,000 Average

Spine surgery has the highest average of any orthopedic subspecialty in SalaryDr's reports, at $1,000,000 from 15 reports — ahead of joint replacement.

The income drivers in spine are similar to joint replacement — high procedure wRVUs, high implant-driven facility fees, and ASC ownership creating a facility revenue stream on top of professional fee income. A high-volume spine surgeon performing cervical and lumbar decompressions, fusions, and increasingly complex spinal reconstructions at an ASC generates facility revenue that can reach seven figures annually at significant surgical volume.

Total Joint Replacement (Arthroplasty): $905,000 Average

Joint replacement is one of the highest-volume and highest-revenue subspecialties in orthopedic surgery — and the one most directly enabled by ASC ownership economics. SalaryDr's joint replacement surgeons average $905,000 (12 reports). Sports medicine trades some of that surgical volume for team physician work, and its average is lower, at $785,000.

Total hip and total knee replacements are high-acuity, high-revenue procedures with standardized implant systems and relatively efficient operating room times for experienced surgeons. A joint replacement surgeon doing 400 to 500 cases annually at an ASC generates facility revenue that dwarfs their professional fee income.

Trauma Surgery: $855,000 Average

Orthopedic trauma surgery treats acute fractures and musculoskeletal injuries, typically in hospital settings where emergency on-call coverage is required. The income profile is strong: trauma generates high wRVUs per case, and SalaryDr's trauma surgeons average $855,000 (from only 5 reports). But the ASC ownership advantage that drives the highest orthopedic incomes is largely unavailable because trauma patients are treated in hospital emergency settings rather than elective ASC scheduling.

Sports Medicine: $785,000 Average

Sports medicine fellowship produces the clearest trade-off between income and lifestyle in orthopedic surgery. Arthroscopic knee and shoulder procedures — ACL reconstruction, rotator cuff repair, meniscus surgery — generate lower per-case revenue than joint replacement or spine, operate at higher volumes than complex revision surgery, and attract a younger, more physically active patient population.

SalaryDr's sports medicine orthopedists average $785,000 (18 reports), below the spine, joint replacement and trauma averages.

Foot and Ankle: $765,000 Average

Foot and ankle surgery is a growing subspecialty with strong procedure volume driven by diabetic foot complications, sports injuries, and degenerative joint disease. Like hand surgery, foot and ankle procedures are highly compatible with ASC environments — improving income for surgeons with ownership access. SalaryDr's foot and ankle surgeons average $765,000 (12 reports).

Hand Surgery: $705,000 Average

Hand surgery — which can be pursued through either orthopedic or plastic surgery residency — produces strong compensation at higher volume levels. Hand and upper extremity procedures are well-suited for ASC environments, and hand surgery groups with ASC ownership produce total compensation at the higher end of the specialty's range. Even so, SalaryDr's orthopedic hand surgeons average $705,000 (13 reports), the lowest of the subspecialties it lists.

Orthopedic Oncology

Orthopedic oncology manages primary bone and soft tissue tumors — a lower-volume subspecialty concentrated in academic medical centers and major cancer programs. SalaryDr does not publish a separate figure for it. The primarily hospital-based practice settings leave little access to the ASC income that lifts other subspecialties.

The Robotic Surgery Factor: Technology, Training, and Income

Robotic-assisted total joint replacement has become one of the fastest-growing trends in orthopedic surgery — and its income implications are more nuanced than they appear.

The major robotic platforms — Stryker's Mako, Zimmer Biomet's ROSA, and Johnson & Johnson's Velys — offer image-guided, robot-assisted accuracy for hip and knee replacement. Adoption has been rapid: hospitals and ASCs offering robotic orthopedic capability market it as a competitive differentiator, patients specifically request robotic procedures, and surgeons with robotic training have a distinct marketing advantage in competitive markets.

The income effect is indirect but real. Robotic systems do not increase the professional fee for the procedure — CMS and commercial insurers reimburse robotic joint replacement at the same rate as conventional surgery. The income advantage comes through patient volume — patients who specifically seek robotic surgery increase a surgeon's case volume and referral base, which directly increases both professional fee income and ASC facility revenue distributions.

Orthopedic Surgery Salary by Career Stage

Related reading: See where orthopedic surgery ranks in physician wealth in our Physician Net Worth by Specialty rankings.

Orthopedic surgery has a steeper early-career income curve than most specialties — driven by the transition from residency to attending practice and the subsequent transition from associate to partner.

• •Residency (PGY-1 through PGY-5): Orthopedic surgery is one of the most competitive residencies in medicine. Resident stipends are set by each program and rise with each training year, and a fellowship adds one more year of training-level pay.
• •New attending (years 0–2): SalaryDr's orthopedic surgeons with zero to two years of experience average $720,000 (19 reports), a figure that pools all practice settings. Signing bonuses are common in competitive markets.
• •Early to mid-career (years 3–10): SalaryDr's averages rise from $720,000 at zero to two years to $920,000 at three to five years of experience (24 reports), then $927,889 at six to ten years (27 reports). Those averages also pool every practice setting, so they don't isolate partnership, but the move from associate to partner in private practice is one likely driver of the rise.
• •Senior physician (11+ years): SalaryDr's average holds at $900,186 for surgeons with 11 to 15 years of experience (35 reports), then falls to $785,000 at 16 years and beyond (17 reports). Private practice partners with established ASC ownership and high case volumes sit at the top of the range.

These experience averages are from SalaryDr's orthopedic surgery reports through September 24, 2026.

Orthopedic Surgeon Starting Salary

Starting figures for orthopedic surgery vary more by source than most. AMN Healthcare's 2025 recruiting review, based on the physician searches it ran from April 2024 to March 2025, found an average starting salary of $576,000 for orthopedic surgeons. SalaryDr's 2026 Physician Pay Report shows a median of $515,000 for orthopedic surgeons with 0 to 2 years of experience, drawn from 3,832 physician salary reports collected from March 2025 to July 2026, well below the $720,000 average from SalaryDr's 19 orthopedic reports for that group above; in a small group, a few very high reports can pull an average far above the median.

Orthopedic Surgery Salary by Geography

Geographic variation in orthopedic surgery compensation is substantial — driven by the combination of nominal salary differences, state income tax, and critically, the commercial insurance reimbursement environment that determines ASC facility revenue.

Retirement destination states drive surgical volume. Orthopedists in retirement-destination states like Florida and Arizona see steady demand from aging populations needing joint replacements. Florida in particular has high concentrations of Medicare-age patients with significant joint disease, producing consistently high surgical volumes for orthopedic surgeons in those markets. More cases mean more professional fee income and more ASC facility revenue for surgeon-owners, though volume doesn't automatically show up as higher reported pay: SalaryDr's Florida median is $750,000 from only 6 reports (through August 29, 2026), a little under its national $770,000.

State income tax compounds the geographic comparison. An orthopedic surgeon earning $900,000 in Texas pays $0 in state income tax. The same surgeon earning $1,000,000 in California pays approximately $100,000 in state income tax — meaning the California surgeon's apparent $100,000 salary advantage produces no real advantage in take-home pay.

Commercial reimbursement geography matters enormously for ASC owners. An orthopedic ASC in a market dominated by Blue Cross Blue Shield and United Healthcare commercial plans reimbursing well above Medicare rates generates dramatically more facility revenue per case than one in a market with high Medicaid utilization or aggressive managed care compression.

For the full state-by-state physician salary and tax analysis, see our Physician Salary by State guide.

The Hospital Employment Subsidy: A Financial Fact Most Orthopedists Know

This is one of the most openly discussed financial dynamics in orthopedic surgery that is almost never mentioned in general physician finance resources.

Health systems that employ orthopedic surgeons typically lose money on the clinical practice — the salary plus overhead exceeds the professional fee collections — and make money on the hospital facility fees generated when those employed surgeons do their cases at the hospital. The clinic loss on each employed orthopedic surgeon is, in effect, a subsidy of that surgeon's salary.

The hospital tolerates this because the facility fee income from surgeries — which flows to the hospital rather than the surgeon — more than compensates for the employment subsidy. A spine surgeon whose salary costs the hospital more than their professional fee collections can still generate several times that amount in hospital facility fees from their surgical cases. The hospital profits substantially from the arrangement even while the surgeon's employment contract shows as a cost center on paper.

The implication for employed orthopedists: Understanding this dynamic is leverage. An employed orthopedic surgeon who knows their case volume generates $2 million in hospital facility revenue — revenue that flows entirely to their employer rather than to themselves — has a strong factual basis for negotiating either a higher salary, an ASC equity participation offer, or both. The surgeon who negotiates without knowing this is leaving real money on the table.

Evaluating an Orthopedic Surgery Job Offer: What to Look For

Most orthopedic surgery residents evaluate job offers on salary and location. The residents who will be the highest earners five to ten years from now evaluate on an additional set of criteria that are far more financially consequential.

• •Is there a path to ASC ownership? If a private practice group does not have an ASC or does not offer physician ownership, you are permanently excluded from the largest income driver in the specialty. Ask explicitly: Does the group own an ASC? Is physician ownership offered? What is the ownership structure? What is the buy-in amount and timeline?
• •What is the commercial payer mix? If the practice serves a predominantly Medicaid or Medicare population, ASC facility revenue per case is dramatically lower than commercial payer markets.
• •Is the wRVU rate and threshold competitive? For employed positions, the per-wRVU rate and the threshold above which you earn productivity bonuses are the most important financial terms in the contract after base salary. A $10 difference in the per-wRVU rate on 9,000 annual wRVUs is a $90,000 annual income difference. For reference, the median rate in SalaryDr's orthopedic reports is $70 per wRVU (66 reports, as of August 29, 2026). Use our Contract Analyzer to model your projected income under different wRVU scenarios before signing.
• •What is the call schedule and is it compensated? Orthopedic trauma call — covering the emergency department for acute fractures — is expected at most community hospitals. Whether and how it is compensated varies enormously: some contracts pay nothing extra for the same call burden that earns a daily stipend elsewhere.
• •What are the non-compete terms? A wide non-compete radius — 25 to 50 miles — in a major metropolitan market effectively prevents you from leaving the employer without leaving the market entirely.

For a complete comparison of physician salaries across all specialties, see our Physician Salary by Specialty guide.

Use our Contract Analyzer to model total compensation under different wRVU rate, threshold, and ASC participation scenarios before signing any orthopedic surgery employment contract.

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