Are Orthos making this much?

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ER BlueBlood

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Was having a discussion with a buddy of mine who deals with hospital admin at a senior level. We were kicking around what some specialties make, ER included of course. Started talking about Ortho. Guy says Orthos can make $4 mil a year as partners, he sees it all the time! Is this true? I thought they start closer to $450k and top out around $800-1mil usually. I was shocked.

I’m already burning out here after the last 5 years and this convo made me want to pretty much quit. Call me what you will, I felt like I’m on a treadmill headed nowhere with my comp.

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Was having a discussion with a buddy of mine who deals with hospital admin at a senior level. We were kicking around what some specialties make, ER included of course. Started talking about Ortho. Guy says Orthos can make $4 mil a year as partners, he sees it all the time! Is this true? I thought they start closer to $450k and top out around $800-1mil usually. I was shocked.

I’m already burning out here after the last 5 years and this convo made me want to pretty much quit. Call me what you will, I felt like I’m on a treadmill headed nowhere with my comp.

Ortho checking in. Median is around 600k if you average everyone. Busy guys (and you work hard) usually make $800k-$1.2 mill ( depending on the area and comp structure). I personally don’t know any guys making 4 mil other than guys collecting royalties from product development, or exceptionally busy nationally renowned guys who own everything in their practices (Midwest at Rush/Lombardi/Berend, etc) The top 1 percent of private practice guys are usually around 1.5-2 mil, that’s after owning everything. 90th percentile is usually around 1 mil. I would say $4 mil is likely 0.001 percent. I know many many orthos, and only one of them makes 2 mil. Does 800 joints a year and owns everything ( works very very hard).
 
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Many thanks for your candid feedback. You guys deserve that pay, that range makes more sense. I’m barely pulling 350k and probably need to step away for awhile to recharge bc these last 5 years have me upside down with my thinking. It’s silly to compare at this stage and rather philistine, but I guess I just have buyers remorse.
 
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Many thanks for your candid feedback. You guys deserve that pay, that range makes more sense. I’m barely pulling 350k and probably need to step away for awhile to recharge bc these last 5 years have me upside down with my thinking. It’s silly to compare at this stage and rather philistine, but I guess I just have buyers remorse.

Sorry to hear that. I think it may be time to look for another gig as I understand that is below average for EM. My brother is an ED physician, and while he works pretty hard, he’s usually around 500k (he says it’s around 85th percentile). Works in a midsized town in the Midwest however.
 
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Median is smaller than that according to medscape et.al.
This is why i was surprised by the comment. This is a person with access to all the data etc. guess some folks like to pump numbers for shock value. Or course, EM not pumped up lol
 
Yeah, that sounds off. My last hospital system acquired a NSGY interventional guy to do all the thrombectomies and coils and I think he made around 1.5-2mill(incentives). I remember he was jealous of some of his friends who were trying to get him to join their practice in TX who were making 3-4 million. I somehow doubt a simple orthopod would be able to command the same salary unless he had a really nice setup and owned everything including the surgicenter.
 
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Was having a discussion with a buddy of mine who deals with hospital admin at a senior level. We were kicking around what some specialties make, ER included of course. Started talking about Ortho. Guy says Orthos can make $4 mil a year as partners, he sees it all the time! Is this true? I thought they start closer to $450k and top out around $800-1mil usually. I was shocked.

I’m already burning out here after the last 5 years and this convo made me want to pretty much quit. Call me what you will, I felt like I’m on a treadmill headed nowhere with my comp.
I wonder if your friend confused billing and income. It wouldn't be that unusual for an orthopod to bill $3-4 M/year, but income as others have said is closer to $600k range. But a typical emergency physician also bills way more than they take home in income, like $1-2 M/year in billing, with the typical income being closer to $300k.

While all of these numbers will vary widely based on geography, specifics of the practice, etc there are very few docs who will make several times the median in income for their clinical work without committing serious insurance fraud. The times when you see physicians generate that much more legally is typically for a combination of industry related consulting/honoraria, patents, research stipends (non-NIH or similar because those come with a salary cap too), etc. For department chairs who are also big names in the field it's not unheard of to bring in an additional $1-2 M/year for that kind of stuff.
 
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A recent appellate opinion out of Indiana about a contract dispute between a senior orthopedic surgeon and a hospital in Indianapolis. This is as real salary information as you will get.

Opinion
 
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A recent appellate opinion out of Indiana about a contract dispute between a senior orthopedic surgeon and a hospital in Indianapolis. This is as real salary information as you will get.

Opinion

This was from 2009.
 
So, what are you going to do, @ER BlueBlood - do an Ortho residency? EM is perilously underpaid. That won't change, except for the worse. Never go into a field where you don't own.
 
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This was from 2009.
No. He started working for them in 2009. The contract in question was from 2017-2019.

The opinion itself is from earlier this week.
 
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No. He started working for them in 2009. The contract in question was from 2017-2019.

The opinion itself is from earlier this week.
So $705k base, couldn’t find bonus but guess that was the problem
 
So, what are you going to do, @ER BlueBlood - do an Ortho residency? EM is perilously underpaid. That won't change, except for the worse. Never go into a field where you don't own.
Oh how I wish I could go back. I think I may go into stem cell/hair transplants. Buddy is doing it (used to practice neurology) and is doing really well with it.
 
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I know a gang of Orthos making $1m+. Key is own the asc, use midlevels, work hard, etc.

$4m seems insane but private practice guys who work are often $1.2-1.7m

Keep in mind avg em is upper 300s. I think last one I saw was $384k that’s salary and benefits. I’ve had residents sign upper 4s-to mid 5s. Imo em is tough to compare. Some people are part time. I know people working 60 hours a month and they are considered full time. Their income counts as much as the guy who works 2500 hours. I know of 4 em docs in various practices and settings who hit $1m in a year working just em. One of them worked almost 3000 hours. Another one worked more like 1500. I also know of a dude who made 180k a month.

Note I’m none of the people mentioned. I say this simply to point out the variety in em which makes it hard to compare apples to apples.

Ortho you pretty much have to be full time. Yes there is variability in how hard you work but the delta is not huge and they have multiple sources of income related to their practice.
 
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I may just tell Kaiser or similar that I identify as an Ortho and as such deserve higher pay.
 
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I know a gang of Orthos making $1m+. Key is own the asc, use midlevels, work hard, etc.

$4m seems insane but private practice guys who work are often $1.2-1.7m

Keep in mind avg em is upper 300s. I think last one I saw was $384k that’s salary and benefits. I’ve had residents sign upper 4s-to mid 5s. Imo em is tough to compare. Some people are part time. I know people working 60 hours a month and they are considered full time. Their income counts as much as the guy who works 2500 hours. I know of 4 em docs in various practices and settings who hit $1m in a year working just em. One of them worked almost 3000 hours. Another one worked more like 1500. I also know of a dude who made 180k a month.

Note I’m none of the people mentioned. I say this simply to point out the variety in em which makes it hard to compare apples to apples.

Ortho you pretty much have to be full time. Yes there is variability in how hard you work but the delta is not huge and they have multiple sources of income related to their practice.

For every private guy making a million plus, there are probably 5 trying and never getting there. Private practice varies a lot depending on the region and your senior partners. Some practices are legit and never advertise their jobs, and rarely hire anyone. Others are constantly turning over younger associates in guise of making partners. But I agree, ceiling is much higher in Ortho private practice than employed position.

I’m currently employed, easier to get to 75th percentile ($800k-$900k) if you work hard, but they actually put barriers so it’s difficult to cross 90th percentile ($1+ mil). Whereas in PP, harder to get busy (no in house referrals) but much more control, hence less hurdles once busy, and actual ownership of ancillaries and real estate.
 
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Ortho has so much going for it the ancillary income, imaging, procedures. They are the darlings of the hospital .Plus unlike EM. They aren’t opening up residencies like crazy relative to demand likely due to barriers inherent to surgical training in general.
 
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Our orthos make in the 650-700 range. In terms of billing, we bill 3-5 million per year per EM doc, which I imagine is pretty average
 
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Sorry to hear that. I think it may be time to look for another gig as I understand that is below average for EM. My brother is an ED physician, and while he works pretty hard, he’s usually around 500k (he says it’s around 85th percentile). Works in a midsized town in the Midwest however.
Midwest tends to pay pretty well. Wages have been falling for 5+ years.
 
Ok so.

Yearly gross income doesnt mean squat.

The only thing that matters is the hourly rate.

Even in 50th percentile markets, the hourly EM rate approaches the highest in medicine.

I'm not saying EM doesn't suck. It does. But id rather take my 300k and limit my exposure to medicine.

One of our guys "works hard" too. He makes over 600k. Who cares? He doesn't have time to spend it on anything meaningful except a bigger and bigger house. He never sees his kids.

What's the point?
 
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Ok so.

Yearly gross income doesnt mean squat.

The only thing that matters is the hourly rate.

Even in 50th percentile markets, the hourly EM rate approaches the highest in medicine.

I'm not saying EM doesn't suck. It does. But id rather take my 300k and limit my exposure to medicine.

One of our guys "works hard" too. He makes over 600k. Who cares? He doesn't have time to spend it on anything meaningful except a bigger and bigger house. He never sees his kids.

What's the point?

Yeah, this.
My ten "12s" a month leave a lot of time for me to adventure.
 
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Ok so.

Yearly gross income doesnt mean squat.

The only thing that matters is the hourly rate.

Even in 50th percentile markets, the hourly EM rate approaches the highest in medicine.

I'm not saying EM doesn't suck. It does. But id rather take my 300k and limit my exposure to medicine.

One of our guys "works hard" too. He makes over 600k. Who cares? He doesn't have time to spend it on anything meaningful except a bigger and bigger house. He never sees his kids.

What's the point?
Also, how much "overhead" time (meetings, etc.). EM can have minimal. EM can suck. 24s, night shifts, crazy patients, lack of control or influence in the workplace. But it's not that bad compared to most careers, medical or otherwise.
 
EM you can also add more shifts or do tele health.

I complain about EM but what else would I do other than rads?

Ortho is so competitive and I hated my IM rotation so much doing 7 days on as a hospitalist gives me dread

I couldn’t work a cush 9-5 clinic no way
 
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I can pick up extra shifts for 250/hr at an ER where I can get away with seeing 1.4 pph. I don't even wanna do that, especially in the summertime.
 
A recent appellate opinion out of Indiana about a contract dispute between a senior orthopedic surgeon and a hospital in Indianapolis. This is as real salary information as you will get.

Opinion
What was the ultimate ruling here? It seems like they are arguing for his performance pay above base, but that seems very small compared to the legal fees themselves?

47A6D4A7-A136-4BD2-A48F-61FC674BFDFD.gif
 
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What was the ultimate ruling here? It seems like they are arguing for his performance pay above base, but that seems very small compared to the legal fees themselves?
The quick version is that he won some claims and lost some claims, but since wage statutes have a fee-shifting provision, he was able to recover attorney fees. Otherwise, his "win" would have cost him several hundred thousand dollars "net".

The performance pay - really patient satisfaction pay - said that he had to average over a certain level each quarter. The hospital refused to pay this bonus because he was slightly below that stipulated level in one quarter. He argued that if you average the quarters together, he was above the required level. The hospital argued - and the courts held - that the way the contract was written was that it required the average score each quarter had to be above the negotiated level. Not the scores averaged over a year, or the length of the contract.

He also served as a medical director at a fixed hourly rate. The hospital refused to pay for certain hours because he did not provide documentation, and for other hours since they believed to have done so would have violated federal anti-kickback laws. The court held that the hospital was justified in not paying for the hours without documentation, but was required to pay him for the other set of hours. The trial judge and the appellate panel held that while the hospital's decision not to pay for the second set of hours was wrong, the decision was made in "good faith." This means the physician did not get double the amount of damages on this claim.

The key issue was "unpaid leave." The contract had a fixed base salary. It also said the physician was able to take eight days "unpaid leave" each year. The hospital calculated the daily rate of base pay, and then deducted eight days worth from his base salary since he took eight days of "unpaid leave." Both courts found that these provisions were in conflict with each other. However, a fundamental rule of contact law is that "ambiguities are resolved against the party that drafted the contract." In this case, the hospital. So the physician was entitled to be paid the eight days salary the hospital deducted from his base salary.

The most important issue was that the "Indiana Wage Payment Statute", like similar rules in other states, allows a prevailing party to recover attorney fees from the losing party. Without this, the physician would have received less than $100K in damages, but would have had a net loss of over $100K once his attorney fees were factored in.

The primary legal issue the appellate court - this opinion - faced was what to do in a case where each party wins on some claims and loses on others. The appellate court held that it was not an "abuse of discretion" for the trial court to award the physician his full fees and to not require him to pay any to the hospital. The court held that it wouldn't have been wrong for the trial court to have determined otherwise, but the decision it reached also wasn't wrong.

I would not at all be surprised if the Indiana Supreme Court did take up this case to clarify this legal issue. The odds are against it ... but I would not be surprised. (And what do I know?)

This is why you get an attorney to review a contract. Not that they will be able to change anything, but to tell you what it actually means. Or more specifically, how a court will determine what it actually means.
 
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Ok so.

Yearly gross income doesnt mean squat.

The only thing that matters is the hourly rate.

Even in 50th percentile markets, the hourly EM rate approaches the highest in medicine.

I'm not saying EM doesn't suck. It does. But id rather take my 300k and limit my exposure to medicine.

One of our guys "works hard" too. He makes over 600k. Who cares? He doesn't have time to spend it on anything meaningful except a bigger and bigger house. He never sees his kids.

What's the point?
Em hours aren’t equal to Ortho hours. An orthopedic doc can do a surgery that takes and hour or 2 and not be bothered or interrupted. In em interruptions are constant and you’ll get your 2pph no matter. Angry patients due to waits etc.

Ortho and other surgeons often spend a lot of time waiting for the or etc.
 
EM have bunch of issues but I don't think pay/her is one of them. 5 yrs ago when I was moonlighting, some guys were working 20x12 shifts/mo @325/hr which along with some big bonus shifts were right at $1M.

I am not sure if 325/hr is still available but I am sure its close b/c its a crap show.

20 shifts/mo is miserable, never would recommend it.

If you want to make 1M+ without working crazy hours, you have to own something. I know some ER docs who Own, do not work any more clinical shifts, and just sit back make in 2 months what most EM make in a yr. Same goes to Optho, ENT, etc...
 
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