How Should Orthopaedic Surgeons Be Paid?

In this episode of the AAOS Now Podcast, host Stuart J. Fischer, MD, FAAOS, is joined by David Jevsevar, MD, MBA, FAAOS, CEO of OrthoVirginia, and Ronald Navarro, MD, FAAOS, Regional Chief of Orthopaedic Surgery, Southern California region, at Kaiser Permanente.

Together, they examine the payment models for orthopaedic surgeons in 2026 and what each means for surgeons, practices, and patients. Both guests bring extensive experience in physician payment and administration across independent, employed, and academic settings.

The conversation moves through RVU-based pay, straight salary, salary plus incentive, multispecialty groups, and fee for service. Drs. Jevsevar and Navarro discuss the tension between rewarding clinical productivity and valuing leadership, research, and community service. They also explore how ancillary income, bundled payments, and patient-reported outcomes are changing the landscape.

The group then looks at how the ideal payment model shifts across a surgeon’s career, from early career stability to mid-career autonomy to planning a graceful exit. They close by describing what a better payment system might look like, while acknowledging that there is no perfect solution.

Key topics covered in this episode:

• How RVU-based models work and why the RUC process is considered a zero sum game

• Pros and cons of employment and salary models, including concerns about productivity over time

• The role of salary plus incentive pay and the challenge of rewarding surgeons for providing appropriate, high-quality care

• How academic productivity, research time, and leadership fit into compensation

• Why equity and “fence time” comparisons can create friction within groups

• Whether fee for service is still viable, including OrthoVirginia data showing a 25.2 percent decline in the value of a work RVU between 2019 and 2024

• The growing importance of ancillary income and how it can be distributed

• Which payment models are optimal for early-career, mid-career, and late-career surgeons

• The value of equity shares, pensions, and phased retirement options

• Strengths and flaws of bundled payments, including the lack of an appropriateness measure, and how bundled payment income can be divided within a group

• The promise and limits of patient-reported outcomes, including the effects of mental health and social determinants of health

• Why one payment model cannot fit every orthopaedic subspecialty

As Dr. Jevsevar notes, this is not a one-answer question. A fair and balanced payment system has to reflect the different ways orthopaedic surgeons create value over the course of a career.

Host: Stuart J. Fischer, MD, FAAOS, member, AAOS Now Editorial Board

Guests: David Jevsevar, MD, MBA, FAAOS, sports medicine surgeon and CEO of OrthoVirginia

Ronald Navarro, MD, FAAOS, sports medicine surgeon and Regional Chief of Orthopaedic Surgery, Southern California region, at Kaiser Permanente