Your actual income is also going to be affected by several factors related to geography, medical climate, etc. Malpractice insurance will vary a lot depending on where you live. In Philadelphia, rates have risen to $150K - $250K per year for most docs and are higher for the busiest ones. Insurance in the South is substantially less, so even though you may make $75K less, your insurance may be more than $100K less. Certain areas have maybe? too many docs, including New York. I have heard several stories of how it is not uncommon for people in NYC to seek 3rd+ opinions, so one has to see as many pts as possible to be able to fill up the OR schedule. Some areas of the country, including parts of the South and Midwest, are recruiting orthos to practice in their area, and starting income in practices may be substantially higher. There are a hundred more arguments for pros and cons for each situation, but the bottom line is that a higher salary does not necessarily translate into higher net income, let also piece of mind.