Despite the unprecedented challenges that the COVID-19 pandemic caused medical practices in 2020, orthopedists continued to be among the top-earning specialists, with average reported incomes remaining unchanged from 2019, according to the Medscape Orthopedist Compensation Report 2021.

In the survey of nearly 18,000 physicians in more than 29 specialties, orthopedists reported average annual earnings of $511,000 — the same as in 2019. And while 56% of orthopedists said they did have some decline in compensation, the lack of an overall change in earnings was reflective of patterns seen in physicians across specialties in 2020.

Among orthopedists who did experience a decline in compensation, 41% report that they expect a return to pre-COVID-19 income levels within the next year, but 43% expect a recovery to take 2 to 3 years.

And12% said they did not expect ever to return to prepandemic income levels.

Overall, 45% of physicians report that they experienced no financial or practice-related harm related to the pandemic.

While the average of $511,000 annual earnings place orthopedists behind only plastic surgeons (annual reported earnings $526,000), as the top earners, orthopedists did land at the top of the list in terms of average incentive bonuses, reporting an average bonus of 23% of their total salary, or $116,000 — an increase over the 19% rate in 2019.

Not all achieve that, however. While 65% of orthopedists wound up earning more than 75% of the potential bonus, the average earned bonus in 2020 was 70% of the full potential bonus, which is consistent with physicians across specialties.

Self-employment proved to be a bit more lucrative for orthopedists, with those specialists reporting average earnings of $526,000 in 2020 versus $497,000 among the employed.

The gap appears much wider among physicians overall, however, with average earnings among the self-employed averaging at $352,000 versus $300,000 among those employed.

The survey responses were received between October 6, 2020, and February 11, 2021.

Workload Decline Amid COVID-19

In terms of workload in 2020, orthopedists saw about a 15% drop in patients per week, down from an average of 93 in 2019 to 79 in 2020, as COVID-19 restrictions significantly reduced physician visits overall.

About 45% of orthopedists feel that 1% to 25% of the decline in patient volume is permanent, while 13% said that 26% to 50% of the volume is likely permanently reduced.

Meanwhile, the average hours worked per week by orthopedists declined slightly, from 56 in 2019 to 53 in 2020.

As could be expected during the pandemic, specialties including intensivists, infectious disease physicians, and public health and preventive medicine physicians report heavier workloads of 6 to 7 hours more per week in 2020.

In terms of time spent on paperwork and administration, orthopedists report only 13.9 hours per week, which is on the lower end of the spectrum. The least amount of time spent is reported by anesthesiologists, with just 10.1 hours per week. Specialists in infectious disease top the list, at an average of 24.2 hours of paperwork and administration per week, followed by public health and preventive medicine (20.7 hours).The average of all specialties is 16.3 hours per week on those tasks.

Despite Higher Earnings, Lower Feelings of Fair Compensation

Interestingly, despite having nearly the highest compensation of all specialties, orthopedists are fourth from the bottom of the list in terms of feeling fairly compensated, with only 53% reporting that they felt fairly compensated, a drop from 60% in 2019.

Below them on the list are internal medicine (52%), diabetes and endocrinology (50%), and, ranking last, infectious diseases (44%). In comparison, oncologists, at the top of the list, have a rate of 79% reporting that they feel fairly compensated.

Orthopedists reported that the most rewarding aspects of their job were gratitude and relationships with patients (26%), closely followed by “knowing that I’m making the world a better place” (eg, helping others, 25%).

The most challenging factors, meanwhile, include “having so many rules and regulations” (25%) and “difficulties getting fair reimbursement from or dealing with Medicare and/or other insurers” (22%).

If given the choice, 81% of orthopedists say they would choose medicine again, similar to that reported by 78% of physicians overall.

But orthopedists were at the very top of the list — tied with dermatology and oncology — among those reporting that they would indeed choose the same specialty if given the chance, each with 96%

Those least likely to choose the same specialty included internal medicine (68%) and public health and preventive medicine (67%).

Medscape Orthopedist Compensation Report 2021. Published online May 14, 2021.

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