Laird Harrison

February 15, 2012

February 15, 2012 (San Francisco, California) — Orthopedic surgeons are well paid, but the profession is less lucrative than some other career choices, making orthopedics training a "poor financial investment," researchers reported here at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.

"If this continues over time, we may lose qualified individuals in our field, and this may reduce access to good quality orthopedic care, orthopedic research, and orthopedic management," warned Suneel B. Bhat, MD, an orthopedic surgery resident at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania.

To see how orthopedic surgery stacks up as a career, Dr. Bhat and his colleagues compared orthopedic surgeons to dentists, lawyers, certified registered nurse anesthetists, and nurse practitioners.

"We simulate an individual entering a profession at age 18 or 19, taking on loans, going through school, emerging, starting a salary, paying back their loans, and then saving some every year once they have a stable income," said Dr. Bhat.

Using various surveys from professional organizations, the team estimated after-tax income, savings and interest, and liabilities such as student loans. The medical profession income data were from 2008 and 2009, but the law profession data were from 1997.

They assumed that educational loans would be deferred until the annual liability was less than 25% of earnings, and that interest on the loans was 8.25%.

They also assumed that the individual would save 0.15% of earnings after achieving a stable income, and that investments paid an interest rate of 0.5%.

Looking at lifetime cumulative earnings, they found that orthopedic surgeons do better than the other 4 professions, reaching $10,756,190 by age 65.

In comparison, lawyers earned a cumulative $8,381,250, certified registered nurse anesthetists $7,338,412, dentists $6,866,796, and nurse practitioners $3,867,504.

But orthopedic surgeons, it seems, work longer hours. When the researchers calculated hourly income for the 5 professions, lawyers came out on top, at $130; dentists were next at $99, followed by nurse anesthetists at $93. Orthopedic surgeons came in fourth, with a relatively modest $88, although still well ahead of nurse practitioners, who made $49.

"In absolute terms, orthopedic surgeons do well," said Dr. Bhat. "However, when you adjust for hours of work, orthopedics is not a very good financial investment. In fact, you would almost be better to go into another field and work as hard."

He identified several trends that might be eroding orthopedic surgeons' incomes. Since 1984, medical school tuition in public institutions has risen 165% and in private schools has risen 312%.

In the past 5 years, the mean debts of orthopedic surgery students have increased from $86,000 to more than $120,000 in public schools and from $120,000 to more than $160,000 in private schools.

Meanwhile, decreases in Medicare fee schedules and the increased market penetration of managed care has caused orthopedic surgeons' salaries to stagnate.

Asked during a panel discussion whether he would choose a different profession if he had the decision to make over again, Dr. Bhat acknowledged that he would still choose orthopedic surgery. "But I can't help but look at my buddies in college," he said; "they had the same offers, and they went the other way."

Session moderator Joseph Dias, MD, professor of orthopedic surgery at the University of Leicester, United Kingdom, and president of the British Orthopaedic Association, speculated that most orthopedic surgeons would say the same. "I think people go into medicine mainly because they have seen how much doctors enjoy being doctors," he told Medscape Medical News.

"Often they have a glorified view, but after they start, they see that most of the time we are relieving people of their pain. We help people.... So we get engaged in what we do."

Dr. Bhat and Dr. Dias have disclosed no relevant financial relationships.

American Academy of Orthopaedic Surgeons (AAOS) 2012 Annual Meeting: Abstract 746. Presented February 10, 2012.

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