Orthopedic and spine surgeons remain among the highest-paid physicians in the U.S., but the forces behind their compensation are pulling in opposite directions heading into 2027.
Surgical pay climbed in 2025 even as overall physician pay rose just 2%, the slowest growth in several years, according to Doximity’s 2026 Physician Compensation Report. Starting Jan. 1, Medicare will pay less per unit of work.
Here are five factors shaping orthopedic and spine surgeon pay:
- Surgical pay keeps outpacing medicine overall. Neurosurgeons averaged $829,161 in 2025, the highest of any specialty, after a 10.7% increase, according to Doximity, which surveyed nearly 23,000 full-time physicians. Orthopedic surgeons ranked third at $696,852 per year. Surgical specialists earned 90.1% more per year than primary care physicians, up from 87.3% in 2024. Medscape’s 2026 report estimated average orthopedic pay at $611,000 per year, the highest of any specialty it surveyed, after an 8% increase. Pay across all specialties rose 3% per year.
- Productivity drives the paycheck. Orthopedic surgeon compensation relies mostly on productivity, according to an American Medical Association Policy Research Perspectives report. That ties pay closely to case volume and the work RVUs assigned to each procedure.
- Medicare’s conversion factor is falling. CMS’ final 2027 physician fee schedule, released Nov. 4, cuts the conversion factor 2.31% to $32.63 for clinicians outside qualifying alternative payment models. Qualifying APM participants take a 1.83% cut to $32.95.
- Global surgery changes came in softer than proposed. CMS had proposed a 50% cut to evaluation and management services billed the same day as a procedure in the office setting. The final rule instead applies a 20% reduction only to procedures with a zero-day global period.
- ASC economics remain under pressure. CMS finalized a 2.3% increase to ASC payment rates for 2027. The Ambulatory Surgery Center Association said other policies, including the ASC weight scalar, continue to suppress reimbursement. In August, spine surgeons warned that proposed facility cuts to common spine pain procedures could push cases out of surgery centers. “The numbers just won’t work for an ASC anymore,” Issada Thongtrangan, MD, an endoscopic and minimally invasive spine surgeon at MicroSpine in Scottsdale, Ariz.
Surgeons say the averages mask eroding economics. Paul Vessa, MD, an orthopedic spine surgeon and medical director at New Jersey Spine Institute in Bedminster, told Becker’s in September that CMS reimbursement has fallen more than 30% since 2000, and his practice no longer participates in Medicare. A standard lumbar laminotomy or discectomy in Medicare “pays less than what I presently pay my landscaper,” Dr. Vessa said.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
