Laura Dydra and Max Green also contributed to this article.
Orthopedic spine surgeon compensation and salary statistics
1. The median salary of an orthopedic spine surgeon is $736,710, according to MGMA's 2015 Provider Compensation and Production Survey Report.
2. Orthopedic spine surgeon salary based on type of practice, according to the report.
- Physician owned — $669,170
- Hospital/IDS owned — $847,825
3. Orthopedic spine surgeon salary based on region, according to the report.
- Eastern — $656,392
- Midwest — $755,907
- Southern — $732,328
- Western — $752,980
4. Orthopedic spinesurgeon salary based on experience, according to the report.
- 3 to 7 years in specialty — $751,051
- 8 to 12 years in specialty — $834,679
- 23 or more years in specialty — $631,768
5. General orthopedic surgeons make an average of $421,000, according to the Medscape Orthopedist Compensation Report 2015.
6. Orthopedic compensation based on subspecialties, according to OrthoBuzz.
- Spine — $749,445
- Oncology — $569,353
- Joint Replacement — $563,89
- Sports Medicine — $549,048
- Trauma — $540,197
- Pediatrics — $516,544
- Hand — $513,864
- Foot and Ankle — $505,606
7. Orthopedic surgeon signing bonuses, according to the Orthopedic Recruiting Group's 2011 Orthopedic Recruiting Trends and Salary Overview.
- Spine — $40,000
- General orthopedic — $35,000
8. Orthopedic surgeon net worth, according to Medscape's Physician Debt and Net Worth Report 2015.
- Under $500,000 — 21 percent
- $500,000 to $999,999 — 16 percent
- $1 million to $1.9 million — 26 percent
- $2 million to $5 million — 27 percent
- Over $5 million — 10 percent
Neurosurgeon compensation and salary statistics
9. The average salary of a neurosurgeon is $605,000, according to Merritt Hawkins' annual compensation survey, which reports real world starting salaries.
- The range of average salaries is between $400,000 and $790,000.
10. The following annual and hourly compensation statistics are based on 2012 data from Jackson & Coker's physician salary calculator.
Average annual compensation of full-time neurosurgeons
- Salary: $690,548
- Benefits: $138,110
- Total Compensation: $828,658
- National average gross revenue per neurosurgeon: $2,632,463
Average hourly compensation of full-time neurosurgeons
- Salary: $332
- Benefits: $66
- Total Compensation: $398
- National average gross revenue per neurosurgeon: $1,266
11. Neurosurgeon percentages by practice setting for 2011, according to AANS Neurosurgical Procedural Statistics 2012:
Type of practice
- Private: 48 percent
- Private (academic affiliation or appointment): 19 percent
- Full-time academic: 30 percent
- Military: 1 percent
- Other (federal government): 2 percent
- Practice employed by hospital: 28 percent
- Individual neurosurgeon employed by hospital: 11 percent
- N/A: 61 percent
12. Neurosurgery generates $1.68 million in revenue for hospitals on average, while the average 2012 hospital compensation for neurosurgeons was $669,000. The revenue-to-compensation ratio was 2.52:1, according to a report from Merritt Hawkins.
Surgeons focused on spine
13. Neurosurgeons performed 2,296,331 total procedures in 2011, 1,448,400 of which were spine surgeries, according to AANS National Neurosurgical Procedural Statistics.
Where surgeons are practicing
14. Wyoming, Montana, New Hampshire, Vermont and South Dakota boast the highest density of orthopedic surgeons, with more than 11 per 100,000 people. Mississippi, Texas, Arkansas, West Virginia and Michigan have the lowest density, with seven or fewer per 100,000 people, according to the AmericanAcademy of Orthopaedic Surgeons released its 2014 Orthopaedic Surgeon Census.
15. Medscape conducted a study to discover the best places physicians practice in 2015. Low taxes, low malpractice costs and low cost of living all factor into determining where physicians might want to consider practicing. The study found these five states to be the most desirable:
- Tennessee: Low cost of living, progressive communities, good pay, music
- Mississippi: Low taxes, low malpractice payouts, cultural activities
- Oklahoma: High physician income, arts and culture scene
- Texas: No state income tax, fewer malpractice lawsuits, medical community
- Wyoming: Scenery, no state income tax, need for physicians
16. California, Texas, New York, Florida and Pennsylvania boast the highest levels of employment for surgeons as of May 2014, according to the Bureau of Labor Statistics.
17. According to Medicus Firm's 2015 Physician Practice Preference & Relocation Survey, 30.3 percent of 2,685 physicians polled prefer single-specialty group practice. As for location, 33.1 percent preferred a suburban community setting about 30 minutes from downtown.
US spine market
18. The North American spine surgery devices market is expected to grow at a 7.5 percent compound annual growth rate by 2019, according to a Research and Markets study. The United States is predicted to have the largest market share. Spinal fusion devices have the biggest grasp on the market, with spinal fixation devices experiencing the fastest growth.
19. The U.S. spinal implant market is currently valued around $5 billion and is expected to grow for the next 10 years at a compound annual growth rate of 2.4 percent, according to a Q2 Metrics report. It is expected to reach $6.4 billion by 2024.
20. Although the U.S. spine surgery market is $12 billion, payer reimbursement will face some obstacles. Certain spinal procedures are causing payer pushback, the spine surgery market returned low, single-digit growth, and many payers haven't loosened polices on utilization. Increasing cost transparency, high deductible plays, hospital-employed physicians, ACA, accountable care organizations and new reimbursement pilots are giving rise to the potential for incentive disruption.
Global spine market
21. Here are the top five companies leading the global spinal implant market:
- DePuy Spine
- Medtronic Spinal and Biologics
- Stryker Spine
- Synthes Spine
- Zimmer Spine
While these companies lead the nonfusion segment of the market, a greater breadth of product availability and choice will change the competition in the future. Smaller companies will see a rise in their shares as the options expand for surgeons.
22. Although spinal fusions still hold the largest market share, disc replacements are pushing forward in popularity as they become more available among spine practices. The Millennium Research Group reported that the global spinal non-fusion market would surpass $1.6 billion by 2022, nearly tripling in size from just a few years ago. By 2020, cervical disc replacement is expected to have 10 percent of the global spine surgery market, according to a MedMarket Diligence report. Patients are seeking alternatives because fusion limits mobility and may result in adjacent segment disease.
23. The 2D X-Ray market is expected to grow from $5 billion in 2014 to $16.9 billion by 2021, as MRI and CT scans become less profitable due to insurers claiming they are overused, according to a study by WinterGreen Research. Growth correlates with an increasing aging population, as areas like China build improved healthcare facilities and as improved 2D X-Ray diagnostics and therapeutics equipment increase demand.
Large global spine societies and their presidents and chairpersons
24. Notable, large spine surgeon groups around the world include:
- North American Spine Society: William C Watters, III, MD
- International Society for the Advancement of Spine Surgery: Gunnar B.J. Andersson, MD, PhD and Hee Kit Wong, MD, PhD
- AO Spine: Global Spine Conference: Jeffrey Wang, MD
- Society for Minimally Invasive Spine Surgery: Greg Anderson, MD
- Scoliosis Research Society: John P. Dormans, MD
- Cervical Spine Research Society: Alan S. Hilibrand, MD
- The International Society for the Study of the Lumbar Spine: James Kang, MD
- International Spine Intervention Society: Jeffrey Summers, MD
Spine device company acquisitions
25. Here are four recent spine device company acquisitions:
- Medtronic's acquisition of Covidien: The final acquisition was for $23.9 billion and the new Ireland-headquartered company is called Medtronic Plc.
- Bacterin's acquisition of X-spine: Bacterin purchased X-Spine's outstanding common stock in exchange for around 4.24 million shares of Bacterin common stock and around $60 million in cash. The new company is called Xtant Medical Holdings.
- Amendia's acquisition of Custom Spine: The acquisition will add SpineSelect's unique minimally invasive transforaminal lumbar interbody fusion system to Amendia's product portfolios.
- ChoiceSpine acquiring Baxano systems: Baxano Surgical filed for Chapter 11 bankruptcy in late 2014. The technology acquisition expands ChoiceSpine's efforts to grow the company's Western footprint.
26. A substantial difference in the postoperative utility between two groups of patients who received disc replacement versus spinal fusion surgeries existed at every point from six months to sixty months, according to a study published by Spine. The study compared evidence from a previous controlled trial to compare disc replacement to spinal fusion for quality of life. The researchers concluded that this data could be used as baselines for future cost-utility analyses in similar populations.
27. Cervical disc arthroplasty reduced monthly costs of care compared with anterior cervical discectomy and fusion, according to a study published in Spine, Researchers looked at the outcomes for patients ranging from 18 years olds to 60 year olds who had surgery for single-level cervical disc disease between 2008 and 2009. The study found total insurer payments for the disc replacement patients were lower than the fusion patients, at $34,979 versus $39,820.
28. Both neurosurgeons and orthopedic spine surgeons have similar 30-day readmission and surgical site infection following spinal fusion surgeries, according to a study published in Spine.
29. Patients who are younger, less educated, and smoke seem to be less satisfied with clinical visits, according to a recent study in Spine.
30. St. Jude's Invisible Trial System is the first SCS trial system to use Bluetooth and Apple technology. The wireless system is designed to limit distractions caused by bulky cables and complex controllers, so chronic pain patients can more accurately assess the impact of the therapy.The iPad mini allows physicians to view, print and email EPG data in PDF format and the iPod touch provides patients with a simple platform to adjust their therapy.
31. A Spine study investigated whether anterior or posterior cervical fusion produced better results. While the anterior approach resulted in a lower 30-day complication rate, that approach also resulted in more dysphasia. The anterior group also had less hospital payments and lower 30-day readmission rates.
32. Injured workers will most likely undergo back surgery in certain parts of the country, according to a Workers Compensation Research Institute study. Of the workers comp patients surveyed in 13 states, 20 percent of those in Oklahoma and Tennessee underwent back surgery. Comparatively, less than 10 percent of works in California and Florida with similar diagnoses had surgery. The study contributed the disparities to surgery-intensive local practice norms, higher reimbursement rates and availability of more surgeons.
33. The highest severe screw malposition rates were between T3 and T8, according to a study published in Spinal Deformity, the Scoliosis Research Society journal. The study investigated postoperative CTs for 85 patients who received 605 screws.
34. "The use of a cage with or without plate constructs in two-level ACDF provides similar clinical results and fusion rates," according to an article published in The Journal of Spinal Disorders & Techniques. Researchers also concluded that "ACDF-CPC showed higher incidence of ASD than ACDF-CA over the two-year follow-up." Researchers examined adjacent segment degeneration for two-level anterior cervical discectomy, comparing fusion with standalone cages and fusion with cage and plate constructs. The study looked at 42 consecutive patients who underwent two-level ACDF with standalone cages or with cages and plate constructs.
35. Gender-specific spines were found in newborns at the Children's Hospital Los Angeles. Researchers found that gender-differing spines in men and women develop at birth rather than over time, based on a study published in the Journal of Pediatrics, according to Softpedia. The new study builds on the scientifically accepted fact that male spines have bigger cross-sections than female spines. Researchers at the Children's Hospital Los Angeles found that the difference between male and female spines is already existent at birth.
36. Graduating from a top-20 medical school proves to be the top deciding factor in whether spine surgeons will choose to practice in the academic field after completing a fellowship program, according to a study in Spine. The other top factors include:
- Graduation from a top-20 medical school
- Indication of a desire to enter the academic field-
- Five or more national presentations
- Research Fellowship completion
- Letters of reference stating likelihood of pursuing academics on hiring the applicant
37. This year, ProPublica released the "Surgeon Scorecard," which is a database of complication rates for more than 17,000 U.S. surgeons, including spine surgeons. Former North American Spine Society president, Charles Mick, MD, hopes the database will better inform patients about required surgeries.
38. The CMS Physician Quality Reporting System for 2015 approved the National Neurosurgery Quality Outcomes Database as a Qualified Clinical Data Registry. Neurosurgeons now have access to specialty-specific measures for use in public quality reporting programs. It's expected that neurosurgeons will use the register to fulfill PQRS requirements, thus bolstering the database with extensive information.
Trends impacting spine
39. The International Journal of Spine Surgery published an article about seven trends in endoscopic spinal surgery techniques. A few of the following are:
- There are improved endoscopic optics and instrumentations leading to better spinal anatomy visualization with ultra-minimally invasive approaches.
- The circumferential spinal stenosis resulting from concomitant congenital and acquired stenosis may have better outcomes with open decompressive techniques, especially if it's present at multiple levels.
- Endoscopic techniques can treat the central, paracentral, foraminal and far lateral lumbar disc herniations. New endoscopic systems permit posterior inter laminar lumbar decompression, anterior and posterior cervical and posterior lateral thoracic decompression.
40. The in-office ancillary services exemption is threatened again, according to a Mondaq report. In February, the Department of Health and Human Services implied the limitation of in-office ancillary services exemption might appear in the fiscal year 2016 proposed budget. The fallout of this could drastically hurt private practice, causing a rise in hospital employment. Spine surgeons may be affected by this change because they offer MRI and physical therapy services, among others, or are considering adding those extra services to provide a more comprehensive healthcare experience.
The HHS claimed that in-office services are being overused and not used in the intended manner, resulting in money makers instead of convenient options for patients. In other words, the HHS proposed the elimination of self-referrals for therapy, advanced imaging, radiation therapy and anatomic pathology services unless they are "clinically integrated" practices for cost containment. If implemented, these changes could save $6 billion over a decade.
41. Physicians rank shifting reimbursement, financial management, time with patients, and the Affordable Care Act as the top four challenges they deal with in their practices, according to the Wolters Kluwer Health's 2013 Physician Outlook Survey. Healthcare IT, more legislation and uninsured patients cause the most stress about costs. Above all, physicians want to increase their practice's efficiency in the next five years.
Spine in ASCs
42. Although the amount of spine surgeries continues to grow in ASCs, surgery centers face difficulties with payment from payers. The Centers for Medicare and Medicaid Services approved codes for spine surgeries in ASCs, which went into affect in 2015:
- Neck spine fusion
- Lumbar spine fusion
- Spine fusion extra segment
- Neck spine disc surgery
- Laminectomy single lumbar
- Removal of spinal lamina (code 63045)
- Removal of spinal lamina (code 63047)
- Decompression spinal cord
43. The Mayo Clinic in Rochester, Minn., ranked first in U.S. News & World Report's best hospitals for adult neurology and neurosurgery. The New York-Presbyterian University Hospital of Columbia and Cornell followed at second and JohnHopkinsHospital came in third.
44. The Hospital for Special Surgery in New York topped the U.S. News & World Report for best hospitals for adult orthopedics. Mayo Clinic and Cleveland Clinic followed.
Bundled spine surgery statistics
45. Pacific Business Group on Health expanded its Employers Centers of Excellence Network to provide bundled spine surgery for Walmart and Lowe's employees.
The initiative started April 1. Within the network, large employers collaborate with three hospital providers to send employees for healthcare. The hospitals are GeisingerMedicalCenter in Danville, Pa., MercyHospital in Springfield, Mo., and VirginiaMasonMedicalCenter in Seattle. If employees choose to have surgery done at a center of excellence, they receive surgery at no cost and do not pay for their travel and related expenses.
46. Total bundle costs were relatively flat when the researchers increased bundle length, according to a study published in Spine. The total average cost of the 30-day bundle was $33,522 compared to the average 90-day bundle cost of $35,165. This could indicate the bulk of charges happen within the first 30 days of surgery. The study looked at the variation in spine surgery costs and the implications that variation could have on evidenced-based bundled payments. The largest portion of the bundled costs was associated with hospital payments, with 76 percent of the bundle going towards hospital payments on average.
Paul Slosar, MD, said in a Becker's Spine Review report, that "spine practices will need business partners to represent their groups in order to negotiate and generate profits from bundled payment strategies…[spine practices] have neither the experience nor capacity to negotiate favorable bundled payment terms from payers."
Settlements and lawsuits
47. Two federal cases and other lawsuits were brought against South Dakota-based spine surgeon Allen Sossan, MD, for unnecessary surgeries and fraudulent billing. The federal government has also brought suits against the physicians on the committees that credentialed Dr. Sossan. He previously lost his privileges in Norfolk, Neb., where he practiced before moving to South Dakota. In Nebraska, Dr. Sossan allegedly falsified patient charts and radiological results to perform unnecessary surgery. Dr. Sossan received many patient complaints after he moved to South Dakota to practice in 2010. He did not renew his South Dakota license when it expired in March 2014.
48. Former neurosurgeon Cully White, MD, is center stage in a whistle-blower lawsuit involving kickbacks and counterfeit implants. The case involves Spinal Solutions, a now defunct California-based company. The lawsuit alleges that Dr. White implanted Spinal Solutions' "counterfeit" parts in patients in order to receive kickbacks. Aurora St. Luke's MedicalCenter and Wheaton Franciscan Healthcare's St.FrancisHospital were also named in the lawsuit for not vetting Dr. White properly. Fifty insurance companied filed the suit and Dr. White relinquished his medical license as part of a plea deal. This suit sparked nationwide allegations about healthcare fraud.
49. Aria Sabit, MD, a neurosurgeon formerly practicing in Michigan, pled guilty to performing unnecessary spine surgery and billing insurance companies and the government unlawfully. The U.S. Attorney's Office reported Dr. Sabit billed insurance companies and the government $11 million unlawfully. Since 2011, Dr. Sabit has pled guilty to four counts of healthcare fraud. He faces at least nine to 11 years in prison under the plea agreement.
50. Medtronic PLC agreed to pay $2.8 million to the United States Justice Department to settle false claims alleging illegal payment to physicians. Medtronic was accused of making illegal payments to physicians in exchange for recommending procedures that were not safe. The Justice Department alleges Medtronic wanted physicians to use a neurostimulation device off-label in order to create an expanding market for their devices. Medtronic denied any wrongdoing.
Spine surgeons making the news
51. Albert Telfeian, MD, performed the first endoscopic extraction of a spinal tumor for a patient while the patient was awake.
52. Sanjay Khurana, MD, a spine surgeon at DISCSports & SpineCenter in Marina Del Ray, Calif., helped save actor Harrison Ford's life in March. He pulled him out of the crashed air plane. Playing a round of golf nearby, Dr. Khurana quickly responded to the plane crash by stabilizing Mr. Ford and minimizing damage at the scene while waiting for emergency responders. Dr. Khurana focuses on minimally invasive and microscopic spine surgery.
53. Five spine specialists are ranked #1 on Google for their articles on spine conditions and treatments. Combined, these articles are read by more than 13 million back pain patients every year:
- John Sherman, MD: Dr. Sherman has contributed his expertise in spine fusion by authoring three top-ranked articles on lumbar spine fusion surgery. These articles are read by nearly a half-million patients every year, indicating that just about every person having a lumbar fusion in this country reads Dr. Sherman's articles.
- Jeffrey Spivak, MD: Dr. Spivak earns a place on this list through his articles and videos on various surgical options, including a top-ranked article and video on multi-level spinal fusion and a number of articles on vertebral augmentation. Dr. Spivak's articles are read by a half-million patients every year.
- J. Talbot Sellers, DO: Dr. Sellers is a physiatrist who has written on a variety of topics, including the top-ranked "How to get an accurate back pain diagnosis" and "All about upper back pain" articles, which are read more than 2 million times per year.
- Stephen Hochschuler, MD: Dr. Hochschuler is one of the founding Medical Advisors for Spine-health.com, and has contributed a number of top-ranked articles, including an article on Sciatica that has consistently ranked #1 in both English and Spanish and gets read over 2.5 million times a year. Two animated videos have been developed to accompany the article and both have won Telly Awards.
- Peter Ullrich Jr., MD: As co-founder of Spine-health.com, Dr. Ullrich has authored and reviewed a number of original articles. His top-ranked articles on microdiscectomy, ACDF and lumbar laminectomy are read by more than 1 million patients every year.
New leadership positions
54. These six physicians are moving on to new leadership roles this year:
- Larry Lenke, MD, Daniel Riew, MD, and Ronald Lehman, MD, are leaving Barnes-Jewish Hospital/Washington University School of Medicine in St. Louis to join New York-Presbyterian Hospital to establish a multi-disciplinary spine hospital. The three surgeons will also join the Columbia University College of Physicians and Surgeons faculty.
- Nick Shamie, MD, became the first surgeon at a major U.S. hospital to use Xenco Medical's disposable devices during a spine surgery. Designed to reduce the risk of infection, these disposable plastic instruments still retain the durability and accuracy of metal instruments.
- Raj Rao, MD, is joining George Washington University School of Medicine and Health Sciences, GW Hospital and The GW Medical Faculty Associates as the department of orthopedic surgery chair. Prior to this appointment, Dr. Rao worked as vice chairman in the department of orthopedic surgery and professor of orthopedic surgery and neurosurgery at the Medical College of Wisconsin.
- Ziya Gokaslan, MD, was appointed chairman of the neurosurgery department at AlpertMedicalSchool, as well as chief of neurosurgery at Rhode IslandHospital and The Miriam Hospital. He is also the clinical director of the Norman Prince Institute. Dr. Gokaslan left his positions as the director of the NeurosurgicalSpineCenter and vice chairman of neurosurgery at the John Hopkins School of Medicine.
- Munish Gupta, MD,will join Washington University School of Medicine in St. Louis as the chief of spine surgery in the department of orthopedic surgery on Sept. 1. Dr. Gupta will leave his positions as professor, vice chair of the department of orthopedic surgery, chief of orthopedic spine surgery and co-director of the spine center at the University of California, Davis.
- Andrew Hecht, MD,joined Mount Sinai Health System and Mount SinaiHospital as chief of spine surgery. Dr. Hecht will continue his role as director of the Mount Sinai Spine Center of Mount Sinai Doctors and a surgical consultant to the NY Jets and NY Islanders. He is also a member of the NFL Brain and Spine Committee.
Spine surgeon deaths
55. The following prominent spine surgeons passed away within the last year:
- Charles Kuntz IV, MD, of Cincinnati-based Mayfield Clinic, passed away unexpectedly at the age of 50 in February. Local police said he died in his sleep of a seizure. Focusing on complex spine surgery, Dr. Kuntz started at the Mayfield Clinic in 2000. Board-certified, he was a member of the American Association of Neurological Surgeons, Congress of Neurological Surgeons and North American Spine Society.
- Andrew Parsa, MD, passed away suddenly at the age of 48 in April. He was the neurological surgery chief at the Feinberg School of Medicine in Chicago. Dr. Parsa performed about 300 surgeries per year. He was leading a trial to test surgery technology for safer rare brain tumor removal.