The first is lowest normal, middle is the mean, and the top is, well, the top. (And don't take this for religion or anything, just a search engine)
Orthopedic Surgery $256,000 $289,000 $450,000
Foot & Ankle $220,000 $282,000 $411,000
Hand & Upper Extremities $258,000 $325,000 $370,000
Hip & Joint Replacement $330,000 $391,000 $475,000
Spine Surgery $327,000 $400,000 $785,000
Sports Medicine $321,000 $322,000 $511,000

OSB )

as far as private practice goes, it depends on 1)the billing/reimbursement model of your practice 2)how good you/your people are at coding (i mean maximizing your LEGAL billing, not fraud) 3) your volume. Where some of the differences in specialty comes in in the dollars billed:time procedure takes ratio. Also, spine guys have the art of "unbundling" down, where you can bill per level fused/decompressed/instrumented, etc. Those 10 level scoli cases start adding up.

I have been told that one of the reasons spine guys can "bill so well" is because there was a spine surgeon on the IDC coding committee... don't know if it is true but interesting if it is.

bottom line: any field of orthopaedics will earn you plenty of money to be able to send your kids to college. People who choose a certain sub-subspecialty over another for the difference in reimbursement are probably not likely to be the happiest campers.

That said, I would think that the top-top numbers listed above for Spine may be on the low end. As a resident, I regularly get offers in the mail for starting salaries in that top-top range. . . . Maybe they are bogus, but I think that there are those out there earning even more than the already ridiculously high reimbursements received by any orthopod.

Regarding the fascination with Sports Medicine, I cannot claim to be an authority on it, because I have no interest in it myself, but I think that one of the attractions is that Sports Medicine is the "sexiest" part of orthopaedics right now. You take care of younger, otherwise healthy people to get them re-tuned and back to their active lives. They tend to be highly motivated to work hard on recuperation. That can add up to satisfying work. You can dispense with some of the old school rules of doctoring like white coats and ties. Just the fact that your patients are not sick makes an enormous difference in your lifestyle as you care for them. The surgeon who pins a fractured hip is mostly paid to pin the fractured hip, but he or she must also take care of the little old lady with a failing heart and diabetes who has the fractured hip. The 35 year old with a torn ACL has a torn ACL and may even go home the day of surgery. This is very desirable for some.

One thing to keep in mind as you consider the different reimbursement patterns of varied sub-specialties of orthopaedics is that while in any you will make plenty, you cannot necessarily predict which ones will pay the best ten years from now. While spine is far and away the most highly paid currently, that honor when to adult reconstruction 15 to 20 year ago. Reimbursement for total joints has continued to decline in recent years. While its still pays well, as all ortho fields do, it is no longer the gold mine that it was thought to be in the 80s. It can almost be guaranteed that the same decline in reimbursements for spine surgery are not too far off in the future. For both Spine and Sports, many procedures have gray-zone indications that many still argue about. Likewise, there are gray-zone outcomes from many of these. In a world of medicine that is becoming increasingly evidence-based, reimbursements will necessarily follow the evidence-based benefits of a given procedure. As this takes place, spine surgeons will not be making as much as they are now. Nonetheless, they will still be able to send their kids to college.

Just make certain you choose the field you want to practice rather than the salary you want to bring home. Lynn T. Staheli, the editor or Journal of Pediatric Orthopaedics stated in address he gave at POSNA last year that he learned and lived the advice of one of his mentors to "live where you want to live, practice the part of orthopaedics you want to practice, and live within the means that practice can provide you in that area." It is pretty simple, but fairly sound advice.

if you ask me; and i know you didn't
1) could it be that competitiveness is directly correlated to salary (i.e. surgical subspecialties in general) i don't see many peolpe fighting over pediatirc onc. (60-90k)
2) as far as "ridiculously high reimbursement" go ask an attending in the northeast in a univ. hosp., how much they bill and what their take home is. financial reimbursement is pitiful for doctors these days relative to other professions esp considering what it was 10-20 years ago
3) no orthopod i've ever seen is managing non-ortho medical problems. i'll admit i've only been in teaching hosp's
4)lastly , i'm willing to bet that someone other than a spine guy, is out there pulling in 7 digits.
if a neurosurg in priv practice can pull 3mil+
why can't a bone head in a suitable setting )

I'm not sure what to make of those published surveys. They never really tell you exactly what those salaries include like fringe benefits, paid malpractice, etc. I don't know if that is actual take-home pay or what. I've heard of guys just out of training getting starting offers of 300k with the chance to get bigger once a stake in the practice is earned, which seems a touch higher than those surveys usually post. I've heard of more than one spine guy who makes seven digits, so I think that is certainly possible. Also, how much vacation do pods take? The radiology weenies brag about their 10-12 weeks off per year.

I wish the IRS would publish what pods are reporting on tax forms, that would be more accurate (one would hope). Overall it looks like we are going to be compensated fairly well for doing something we love. Let's just hope that salaries start to drift up with inflation rather than the yearly cuts that medicare has been dictating of late.

If the cuts continue, I wonder where the breaking point on the curve where people start deciding that there are easier ways to make a few hundred grand a year than working 60-90 hours a week and worrying about huge malpractice claims and premiums? Apparently in some states docs are already at that point.

I suppose it depends on your background, but i get pretty p@#$ed when i hear orthopods complaining about their salaries. I mean c'mon peple, even if you "only" make 250,000 a year that puts you ahead of 90-95 percent people. Yes, i think that we deserve to get paid well for all the hours, delayed gratification (I try not to think of my friend with the MBA who already has a Porsche) and stress. My goal is to go in the area i find interesting, with some consideration to what is in demand/ability to get a job where i want, and if that happens to be one of the higher paying subspecialties thats a bonus. My starting salary will be what my mom used to make in 10 years, so I feel very fortunate that i am able to earn such a good living in a field as cool as ortho...

Bonedoc,

Stop Crying. I believe it is perfectly OK for future Orthopods to ponder on their future earnings.

Being an orthopedic resident, a big payday makes staying up all night worth the wait. I love my job. There is no better job in the world. There is nothing like enjoying what your doing and getting paid to do it.

Granted orthopods make plenty of money. However, with the price of malpractice, decreasing physcian re-imbursement, and rising cost of college tuition ( i have kids) making big bucks is a plus.

Bonedoc, if you try an tell me that you never used money as ONE of ther reasons why you chose medicine as a career, I would say you're full of S*@t! Well got to go, I received a paged from the ED.

ORTHODOG

I'm not an ortho resident...yet, but I must admit I think about making a better than average living doing what I feel like I will love to do--ortho.

I've noticed that there's a lot of hangup among med students/residents/attendings concerning the personal economics of medicine. Almost as if it's taboo that we would make any money while in the service of treating mankind's ailments. It's weird and I haven't figured it out yet. The way I see it, we're no different than anyone else who provides a service and expects to be compensated properly for it.

Anyway, I believe that docs should be paid what they're worth and for the value of the service they provide. And I think the fact that we spend so long in training is a factor that alone merits commensurate pay. Just my $.02

Well orthodog,
i am a resident also. I never said pondering our future income is a bad thing. What i said was that while i agree that society is seriously messing with doctors compensation, we still need to step back and look at the big picture of how lucky we are to make WELL above average $$$$ for doing something so cool as ortho.
As far as telling me i am full of @$%&, your wrong. I did not use money as a REASON for going into medicine. Is making a good living a nice benefit? You bet. If money were one of my reasons then there are easier (though not as cool as ortho) routes to take. I suppose it is just an argument of semantics.

We should all be thankful we're not general surgeons. Ortho is a great field, but the lawyers and insurance folks are trying to take it all away (jealous, I guess). Hard to keep from being cynical, but feeling lucky to be doing it nonetheless. out.