Surgeon Compensation Models: A Systematic Review

Surgeon compensation models influence physician productivity, care quality, and engagement in nonclinical activities. Information on compensation plans across surgical specialties and settings is often difficult to obtain.

To describe surgeon compensation models in the US, differentiate models by practice setting, and evaluate their association with clinical productivity and nonclinical contributions.

A systematic review was conducted following PRISMA guidelines. PubMed and Embase were queried for articles published between January 1, 2014, and August 20, 2024, reporting on surgeon compensation models. Two reviewers independently screened and abstracted data on study characteristics, practice settings, compensation structures, and outcomes. Risk of bias was assessed, and studies were synthesized by compensation model. Qualitative analysis was performed to determine themes across the literature.

Of 3268 screened records, 39 studies met inclusion criteria, encompassing 13 surgical specialties. Articles reported on compensation models, including salary (n = 8), work relative value unit (wRVU)-based (n = 8), hybrid (n = 7), fee-for-service (n = 5), and value-based models (n = 3). Hybrid models include a blend of financial incentives and base salary. Salary-based models provided financial stability, promoted team-based care and were associated with lower clinical volume. wRVU and fee-for-service models strongly incentivized productivity and often failed to account for case complexity, patient outcomes, or nonclinical work. Hybrid models offered flexibility by combining base salaries with incentives for volume, quality, and academic contributions despite greater administrative complexity. Value-based models, rarely used, may have unintentional consequences. Across models, there was wide variability in financial compensation for teaching, research, and administrative duties.

Surgeon compensation models in the US remain heterogeneous. While productivity-based systems dominate, emerging hybrid and value-based approaches aim to support broader professional obligations. Transparent, adaptable frameworks that balance clinical output with quality and nonclinical contributions are needed to sustain surgeon engagement and align compensation across the totality of surgical practice.