What Surgeons Get Paid, and What Patients Think Surgeons Get Paid

(Photo: kcxd)

Jared Foran, an orthopedic surgeon in Denver, is a co-author of a new study called “Patient Perception of Physician Reimbursement in Elective Total Hip and Knee Arthroplasty” (PDF here). The authors surveyed 1,200 patients to see how much they thought orthopedic surgeons should make and what Medicare actually pays for a hip or knee replacement.

In an e-mail, Foran describes their results:

On average, patients thought that surgeons should receive $18,501 for total hip replacements,  and $16,822 for total knee replacements. Patients estimated actual Medicare reimbursement to be $11,151 for total hip replacements and $8,902 for total knee replacements.  Seventy per cent of patients stated that Medicare reimbursement was “much lower” than what it should be, and only 1% felt that it was higher than it should be.

In reality, surgeons get paid on average $1,378 for a total hip and $1,430 for a total knee.  Thus patients were off by an order of magnitude in their estimates!  The disconnect in public knowledge seems extreme.

In short, patients — the most important part of all of health care policy decisions — have absolutely no clue how much doctors get paid.  They think we get paid (or, at least, deserve to) about 10 times more than we actually do!

Foran tells us that similar studies have been done for spine surgery and sports medicine, with similar findings.  


If the average person thinks doctors get paid 10 times what they actually get paid, then any public opinion that Medicare underpays is pretty worthless. That being said, to what extent do patients pay attention to the break out of costs. Between the cost of the device, the hospital fees, the nursing, radiology and anesthesiology what is the cost of a replacement?


I wonder if there is a disconnect in perception. There is a clear difference here in how much is paid for the surgery, and how much the doctor or surgeon actually receives. My thoughts are that many of those questioned may be answering how much they think these surgeries cost, rather than how much a doctor or surgeon receives for the actual procedure. It has been my experience that a great deal of population is unaware of the disparity between the cost of items, and the profit or compensation received for selling those items.


My brother's knee replacement was over $22,000 by the time all was said and done. I'm sure the surgeon only received a portion of that.

I also suspect the question's responses are being skewed by what the respondents have in mind for the total cost.


I've got some nice vinyl siding I'd like to sell to those old folks


This is about as useful as a survey of parents of what they think a public school teacher should be paid per student per hour of instruction.


Of course patient estimates are high. It's asking the guy who just had his knee replaced how much of someone else's money he would give to the doctor who just made his life much better. I'm surprised the dollars weren't measured in gajillions.


That is just what the surgeon actually pockets...the total cost of surgery is much closer to the 18k


If you seek a likely source for the misperception, look no farther than that physician's bill. It bears no relation to what Medicare or an insurer will pay -- in fact it is probably off by the "order of magnitude" of which you speak.


The respondents are probably thinking of the total cost of the procedure (hospital, anesthesia, etc.) rather than the surgeon's personal share.

Some Random Economist

Why would these patients know how much doctors do (or should) get paid? The patients aren't paying the doctors.


Well, this gets back to the whole "there are few true market prices in health care" because of third party payors, etc.

Charles Lohrstorfer

Please provide some empirical evidence of this rate of compensation. What is the mean compensation per year for an orth surgeon? Dare you to show that figure

Gary K.

Medicaid payment is still lower.

Mike B

The doctor isn't the expensive part of medicine. It's the team of trained professionals assisting him/her, the expensive equipment, the one-time-use medical devices, the hospital buildings, the malpractice insurance and related lawyers, the complex medical records system, the massive team of people that put together the bill and finally the people who get the treatment , but wind up being unable to pay.


People might be confusing the total cost of care with the portion that goes to the doctor.


I bet if when you asked people how much the doctor should receive ... if you also told them how many hours the doctor worked for it, their estimates would be much lower.


Kind of meaningless unless you also ask them how much time the surgeon spends on the job as well. If they are off by an order of magnitude on that it would even out. Likewise if you ask them how much a surgeon should make in a year.

Even then I don't see what it has to do with value, it's like asking an Indian how many beaver skins he would give you for your magical death-stick. The answer would be a lot if he's never seen a musket before, not so many if there is an established market with cost expectations.

Thomas Brambor

I am not sure why patients should be expected to have a good sense of how much a hip replacement surgery costs. If instead the questions were about total income of surgeons / what surgeons should earn, the answers may be closer to reality. I doubt that most patients would argue that surgeons should earn 10 times the $300,000 (median) salary they are earning today.


How many study subjects would know the litany of line-item charges for a typical hip replacement well enough to single out a surgeon's reimbursement?

According to NIAMS, a traditional hip replacement surgery "lasts from 1 to 2 hours"

How many of those patients thought they were suggesting the price of the surgeon's time alone should be $9250.50 to $18,501.00 an hour?

Lucas Reis

That's incredible! Would it be better if all prices paid in these transactions were public? Like, an annual publication or something?