Taking Ortho to the Bank

[bakedbeans18]

I have only ever really followed IM and the IM subspecialties, but have recently taken an interest in orthopaedic surgery and am wondering about the timeline to a 'proper' (see: not PGY-# determined) salary in orthopaedic surgery. Does one need to subspecialize and do a fellowship before becoming an attending? Is there such a thing as a general orthopaedic surgeon? Anyone have any info on what ortho salary is like? For sub-specialists and non-specialists in ortho?

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[Elevencents]

No. Yes. Google.

Lazy reply, on my phone. But all easily attained information.

 

[bakedbeans18]

No. Yes. Google.

Lazy reply, on my phone. But all easily attained information.

The thing is I haven't really considered the salary of medical specialties until fairly recently, 3 months before I will begin medical school, but as I understand it there is some controversy around what sites are reliable or give a decent representation of the field, as opposed to a self-selected survey targeting mostly top-earning physicians, which is why I asked instead of just googling.

 

[woltej1]

Talking to other docs it seems around $400k. I was looking things like that up with a doc I was scribing for and one site listed $350k as the average and he said that's a bit low, probably being dragged down by academic orthos vs actively practicing and performing surgeries. The way the insurance reimbursement is set up, ortho procedures get paid like crazy. ED docs get reimbursed 6 times more by setting a broken wrist vs placing an emergency intubation.

 

[bakedbeans18]

Talking to other docs it seems around $400k. I was looking things like that up with a doc I was scribing for and one site listed $350k as the average and he said that's a bit low, probably being dragged down by academic orthos vs actively practicing and performing surgeries. The way the insurance reimbursement is set up, ortho procedures get paid like crazy. ED docs get reimbursed 6 times more by setting a broken wrist vs placing an emergency intubation.

Thanks for taking the time to reply. Any idea of those figures are starting or midpoint (5-10 years of practice)? I am also curious what newly minted, freshly board certified orthos are raking in.

Before I get flamed by half of SDN for asking about earnings - $$ was not my motivation for becoming a doctor, but given how much I am going to owe once I graduate, $$ may influence the field of medicine I pursue.

 

[pDeluxe]

Maybe try here: http://forums.studentdoctor.net/threads/orthopaedic-spine-surgeon-ask-me-anything.1059247/

 

[ace12345]

Ortho and IM are so different. I know you have premeditated the ensuing negativity you will receive, but I do not think this argument makes much sense, nor does trying to figure out the difference between 350K or 400K. Get a feel for both, you can succeed and make a lot of money in either.

 

[woltej1]

Once you're practicing you're practicing. Obviously you can expect small bumps in pay through the years, but it's not like you're going to start at $150 and work your way up. you should be making at least 300.

 

[Optimus-Prime]

http://www.orthopedicjobs.net

Jobs available seems to be the best way, I feel like you can only take polls with a grain of salt

 

[bakedbeans18]

Ortho and IM are so different. I know you have premeditated the ensuing negativity you will receive, but I do not think this argument makes much sense, nor does trying to figure out the difference between 350K or 400K. Get a feel for both, you can succeed and make a lot of money in either.

I feel like your sentiment may be more philosophical than practical - for example, Cardio and GI are extremely competitive subspecialties of IM, the former of which is increasingly more competitive and happens to be the subspecialty I am interested in. That being said, if I am an 'average' IM resident, or just an 'adequate' doctor, that may not be enough to lock into a cardiology fellowship, and I am not interested in working the IM service as a hospitalist or as a GP. Contrarily, from what I have learned (have done basic science research with an Ortho mentor) I like Ortho - I probably know more about IM/Cardio at this point than I do clinical Ortho, but so-far, so good. Here's the catch - if I'm an average Ortho resident, I'm still going to become an Orthopaedic surgeon. If I'm an average IM resident, I might not get to where I want to be. I'm not saying that I don't want to work hard - I'm just saying that the reality of how competitive all of this is has humbled me, and I'm looking to options where not being a top candidate won't hinder where I can take myself.

 

[ace12345]

I feel like your sentiment may be more philosophical than practical - for example, Cardio and GI are extremely competitive subspecialties of IM, the former of which is increasingly more competitive and happens to be the subspecialty I am interested in. That being said, if I am an 'average' IM resident, or just an 'adequate' doctor, that may not be enough to lock into a cardiology fellowship, and I am not interested in working the IM service as a hospitalist or as a GP. Contrarily, from what I have learned (have done basic science research with an Ortho mentor) I like Ortho - I probably know more about IM/Cardio at this point than I do clinical Ortho, but so-far, so good. Here's the catch - if I'm an average Ortho resident, I'm still going to become an Orthopaedic surgeon. If I'm an average IM resident, I might not get to where I want to be. I'm not saying that I don't want to work hard - I'm just saying that the reality of how competitive all of this is has humbled me, and I'm looking to options where not being a top candidate won't hinder where I can take myself.

True, but you may be discrediting how competitive ortho is as well. If you do well enough to garner an ortho residency spot, that means you also did well enough to garner a top IM spot. If that is the case, you will be well situated to subspecialize. I get the average resident comment, but I guess I would hope you work hard in either (Top IM vs. ortho).

 

[KinesiologyNerd]

Thanks for taking the time to reply. Any idea of those figures are starting or midpoint (5-10 years of practice)? I am also curious what newly minted, freshly board certified orthos are raking in.

Before I get flamed by half of SDN for asking about earnings - $$ was not my motivation for becoming a doctor, but given how much I am going to owe once I graduate, $$ may influence the field of medicine I pursue.

There are lots of ways to help people and/or do some pretty cool science. Medicine pays the best. Nothing wrong with admitting that.

 

[Mad Jack]

Keep in mind that compensation can vary greatly over time. Rads, cards, and anesthesia are good examples of this. Ortho may be paying extremely well today, but if certain major procedures take serious cuts, you could be looking at a huge pay cut. The point is, do what you think you'll love, because the money might not be there at the end.

 

[Xenoblade]

Medicine pays the best. Nothing wrong with admitting that.

this is funny. Hilarious actually!

 

[WestCoastNative]

Speaking of, I always wondered how salaries work if you decide to move to another practice, hospital, etc.. If I get hired at one place and work for 5 years, when I decide to get hired at another place or however that works, will my pay start out at the bottom or will it depend on experience?

 

[TheWeeIceMan]

Once you're practicing you're practicing. Obviously you can expect small bumps in pay through the years, but it's not like you're going to start at $150 and work your way up. you should be making at least 300.

Definitely not an obvious assumpion.

 

[Aerus]

this is funny. Hilarious actually!

I don't think you read that sentence in the proper context.

 

[armybound]

Once you're practicing you're practicing. Obviously you can expect small bumps in pay through the years, but it's not like you're going to start at $150 and work your way up. you should be making at least 300.

I've heard from a chair of a colorectal department that he'll start new people at 250-300 and after 3-4 years they'll bump up to 400 with the rest of the crew, with few raises after that except as decided by productivity.

 

[DermViser]

I feel like your sentiment may be more philosophical than practical - for example, Cardio and GI are extremely competitive subspecialties of IM, the former of which is increasingly more competitive and happens to be the subspecialty I am interested in. That being said, if I am an 'average' IM resident, or just an 'adequate' doctor, that may not be enough to lock into a cardiology fellowship, and I am not interested in working the IM service as a hospitalist or as a GP. Contrarily, from what I have learned (have done basic science research with an Ortho mentor) I like Ortho - I probably know more about IM/Cardio at this point than I do clinical Ortho, but so-far, so good. Here's the catch - if I'm an average Ortho resident, I'm still going to become an Orthopaedic surgeon. If I'm an average IM resident, I might not get to where I want to be. I'm not saying that I don't want to work hard - I'm just saying that the reality of how competitive all of this is has humbled me, and I'm looking to options where not being a top candidate won't hinder where I can take myself.

Yes, there is a LOT of risk taking when you enter IM (with the intent of specializing) vs. Ortho.

 

[Mt Kilimanjaro]

I have only ever really followed IM and the IM subspecialties, but have recently taken an interest in orthopaedic surgery and am wondering about the timeline to a 'proper' (see: not PGY-# determined) salary in orthopaedic surgery. Does one need to subspecialize and do a fellowship before becoming an attending? Is there such a thing as a general orthopaedic surgeon? Anyone have any info on what ortho salary is like? For sub-specialists and non-specialists in ortho?

This resource aggregates compensation data from ~12 different sources for each specialty, so it's a better source than a single poll. Go find it at your local medical school library or interlibrary loan

https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod1230073&navAction=push

 

[The Buff OP]

Keep in mind that compensation can vary greatly over time. Rads, cards, and anesthesia are good examples of this. Ortho may be paying extremely well today, but if certain major procedures take serious cuts, you could be looking at a huge pay cut. The point is, do what you think you'll love, because the money might not be there at the end.

TBH I don't see another specialty taking over orthopedics. There is always going to be people with musculoskeletal problems (elderly people, athletes, etc) and the price for procedures shouldn't change.

 

[bakedbeans18]

TBH I don't see another specialty taking over orthopedics. There is always going to be people with musculoskeletal problems (elderly people, athletes, etc) and the price for procedures shouldn't change.

The same exact thing could be said about cardiology, considering an ever fattened America - yet as has been discussed elsewhere on SDN, cardio has seen it's ups and downs - so I don't think Ortho is necessarily immune to that.

 

[bakedbeans18]

Yes, there is a LOT of risk taking when you enter IM (with the intent of specializing) vs. Ortho.

However, if one is a strong enough candidate to match into Ortho, someone here has suggested that they would also be a strong enough contender to match at a top IM residency - wouldn't that offset the risks that are the source of my trepidations? I'm not being interrogative, I'm really trying to wrap my mind around this....thanks!

 

[DermViser]

However, if one is a strong enough candidate to match into Ortho, someone here has suggested that they would also be a strong enough contender to match at a top IM residency - wouldn't that offset the risks that are the source of my trepidations? I'm not being interrogative, I'm really trying to wrap my mind around this....thanks!

No, I know you're not being interrogative. That's very much correct. If you have the scores/class rank to get Ortho, you would also be a strong contender to enter a good IM residency (the top IM programs tend to also look at pedigree a lot). That being said, getting a fellowship in IM residency is more dependent on your in-training exam scores, evaluations from faculty, where you rank in your specific residency class, research & networking (When you hit Ortho, a fellowship is icing on the cake vs. IM where getting fellowship is the cake itself, so you're almost starting all over in residency).

 

[The Buff OP]

The same exact thing could be said about cardiology, considering an ever fattened America - yet as has been discussed elsewhere on SDN, cardio has seen it's ups and downs - so I don't think Ortho is necessarily immune to that.

Which cardio are you talking about? Cardiothoracic's? They are kind of losing to interventional cardiology is what I have heard.
There is no other specialty that focuses primarily on operating on the musculoskeletal system.

 

[bakedbeans18]

Which cardio are you talking about? Cardiothoracic's? They are kind of losing to interventional cardiology is what I have heard.
There is no other specialty that focuses on primarily operating on the musculoskeletal system.

I was talking about IM-Cardiology, not Surgical.

 

[The Buff OP]

I was talking about IM-Cardiology, not Surgical.

Okay. Whats wrong with their market? Inform me, please. I don't know much about it at the moment.

 

[circulus vitios]

The thing is I haven't really considered the salary of medical specialties until fairly recently, 3 months before I will begin medical school, but as I understand it there is some controversy around what sites are reliable or give a decent representation of the field, as opposed to a self-selected survey targeting mostly top-earning physicians, which is why I asked instead of just googling.

MGMA or AAMC's Careers in Medicine page, which I think pulls from MGMA data.

Ortho is ~$500k/year. Here's an excerpt from MGMA: http://murdockconsultingmd.com/blog/view/mgma-2012-primary-care-comp-survey

 

[TheWeeIceMan]

Okay. Whats wrong with their market? Inform me, please. I don't know much about it at the moment.

I think his point was that using the "demand for ___ specialty will only go up" argument for high pay didn't work for cards. They got hit hard recently. Ortho could go the same route in the future.

 

[The Buff OP]

I think his point was that using the "demand for ___ specialty will only go up" argument for high pay didn't work for cards. They got hit hard recently. Ortho could go the same route in the future.

 

[gyngyn]

No, I know you're not being interrogative. That's very much correct. If you have the scores/class rank to get Ortho, you would also be a strong contender to enter a good IM residency (the top IM programs tend to also look at pedigree a lot). That being said, getting a fellowship in IM residency is more dependent on your in-training exam scores, evaluations from faculty, where you rank in your specific residency class, research & networking (When you hit Ortho, a fellowship is icing on the cake vs. IM where getting fellowship is the cake itself, so you're almost starting all over in residency).

Another difference is that about a hundred over-qualified US Seniors trying to match into Ortho failed to get a position in each of the last three years. Failing to match can put a serious deflection on one's career trajectory.

 

[DermViser]

Another difference is that about a hundred over-qualified US Seniors trying to match into Ortho failed to get a position in each of the last three years. Failing to match can put a serious deflection on one's career trajectory.

I agree. The difference is where the risk is located, when it comes to getting Cards (at the residency level) vs. Ortho (at the MS-4 level). Very scary time for medical students matching these days.

 

[bakedbeans18]

I agree. The difference is where the risk is located, when it comes to getting Cards (at the residency level) vs. Ortho (at the MS-4 level). Very scary time for medical students matching these days.

This is exactly what I am getting at.

 

[DermViser]

This is exactly what I am getting at.

Yes, but unlike Ortho, in IM there is a strong possibility that if you don't match to Cards (a competitive specialty) you will be stuck being a generalist: doing primary care IM or Hospitalist.

 

[bakedbeans18]

Yes, but unlike Ortho, in IM there is a strong possibility that if you don't match to Cards (a competitive specialty) you will be stuck being a generalist: doing primary care IM or Hospitalist.

Again, exactly what I am driving at.

 

[gyngyn]

Yes, but unlike Ortho, in IM there is a strong possibility that if you don't match to Cards (a competitive specialty) you will be stuck being a generalist: doing primary care IM or Hospitalist.

There are plenty of good fellowships in IM besides cardiology.

 

[The Buff OP]

There are plenty of good fellowships in IM besides cardiology.

Yeah, like geriatrics. 👍

 

[DermViser]

There are plenty of good fellowships in IM besides cardiology.

Yes, I agree, but the OP wants a competitive subspecialty in IM.

 

[bakedbeans18]

There are plenty of good fellowships in IM besides cardiology.

@DermViser was citing cardiology because that is what I mentioned. I'm interested in Ortho or Cards. I would be pursuing IM so I could hopefully become a cardiologist - not an endocrinologist of a gastroenterologist or nephrologist. 🙂

 

[BestDoctorEver]

There was one ortho doc who told me that he has been making over 500k/year for the past 4 years. I thought he was exaggerating IMO because in that same conversation , he told me his mortgage payment is almost 6k/month. There were two REALLY hot nurses who were close by... 6k/month mortgage payment! Really!

 

[gyngyn]

@DermViser was citing cardiology because that is what I mentioned. I'm interested in Ortho or Cards. I would be pursuing IM so I could hopefully become a cardiologist - not an endocrinologist of a gastroenterologist or nephrologist. 🙂

An informed decision regarding life's work will best be made after OP has identified personal strengths in the various specialties (and has a Step 1 score!). I have every confidence that he will have access to the best career counseling at the school lucky enough to matriculate him. These threads are for exploration and entertainment only. For that reason, I have not restricted my comments to tight confines.

 

[gyngyn]

Yeah, like geriatrics. 👍

Now there is a growth field!

 

[XmedBarney]

There was one ortho doc who told me that he has been making over 500k/year for the past 4 years. I thought he was exaggerating IMO because in that same conversation , he told me his mortgage payment is almost 6k/month. There were two REALLY hot nurses who were close by... 6k/month mortgage payment! Really!

Why is that so hard to believe?

 

[BestDoctorEver]

MGMA or AAMC's Careers in Medicine page, which I think pulls from MGMA data.

Ortho is ~$500k/year. Here's an excerpt from MGMA: http://murdockconsultingmd.com/blog/view/mgma-2012-primary-care-comp-survey

These salaries are crazily high...

 

[BestDoctorEver]

Why is that so hard to believe?

..........

 

[The Buff OP]

Now there is a growth field!

Cool you are from Califas, me too, but now I reside in Texas, feller.

2 questions.
Are you a gynecologist?
Is your avatar blue broccoli?

 

[The Buff OP]

http://www.orthopedicjobs.net

Jobs available seems to be the best way, I feel like you can only take polls with a grain of salt

Dude, I was looking at the starting salaries they have for spine surgeons, it's pretty low for what they offer.

 

[Mad Jack]

TBH I don't see another specialty taking over orthopedics. There is always going to be people with musculoskeletal problems (elderly people, athletes, etc) and the price for procedures shouldn't change.

Procedure prices are easy to change. Hip replacements paid nearly three times what they do now in the past, for example. Cataract surgery used to pay far more than today- many opthos could make well over a million dollars per year doing a medicare cataracts only practice. Cardiac cath rates were gutted recently, which has basically destroyed the interventional cardiology job market. Never assume a choice will be financially untouchable- for all you know, in 20 years we could all be working in a single payer system. Sure, ortho will always be well paying, but a few strategic cuts to key procedures could easily bring reimbursement down near 300k, which you can make in many other specialties. So don't make your plans based on the numbers you see today and make sure as hell that you love what you're going to be doing for damn near 60 hours a week until the end of your career.

 

[Optimus-Prime]

Dude, I was looking at the starting salaries they have for spine surgeons, it's pretty low for what they offer.

Fresh out it wasn't too far off, wasn't there one for a second year partnership/1,000,000

 

[Cyberdyne 101]

I have only ever really followed IM and the IM subspecialties, but have recently taken an interest in orthopaedic surgery and am wondering about the timeline to a 'proper' (see: not PGY-# determined) salary in orthopaedic surgery. Does one need to subspecialize and do a fellowship before becoming an attending? Is there such a thing as a general orthopaedic surgeon? Anyone have any info on what ortho salary is like? For sub-specialists and non-specialists in ortho?

If you want guaranteed $ in ortho by doing relatively short procedures (ie 1-2 hrs each) do joint reconstruction. Although, for this you will need a fellowship, but remaining in academia is not necessary. Ortho surgeons in private practice do joints (it does seem like the tougher revision cases might be sent to tertiary academic centers, but this may not always be the case). With a a growing aging population, the need for ortho surgeons that do joint reconstruction will only increase. Also, with newer procedures such as hip arthroscopy, Birmingham Hip resurfacing, OATS, etc younger patients are opting to have joint preserving surgery. In NYC, for example, a lot of ortho surgeons combine joint reconstruction with sports medicine (acl, meniscus, SLAP) in order to have more options in terms of patient load. This might not be the case everywhere though (I can speak for NY because I live here and I've spent time at HSS).

And obviously, I can't comment on the possible declining compensation for procedures but I'm guessing a fellowship trained ortho surgeon will likely make more than an IM doctor. Although I could be wrong.