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Surgeon Compensation Models: A Systematic Review.

J Walker Rosenthal1, Drew Goldberg1, Elliott R Haut2,3,4

  • 1Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

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|February 25, 2026
PubMed
Summary
This summary is machine-generated.

Surgeon compensation models in the US vary widely. Hybrid and value-based approaches are emerging to balance productivity with quality and nonclinical duties, requiring adaptable frameworks.

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Area of Science:

  • Health Policy
  • Surgical Practice Management
  • Medical Economics

Background:

  • Surgeon compensation models significantly impact physician productivity, patient care quality, and engagement in nonclinical responsibilities.
  • Obtaining comprehensive information on compensation plans across diverse surgical specialties and practice settings presents a significant challenge.

Purpose of the Study:

  • To systematically describe surgeon compensation models prevalent in the United States.
  • To differentiate these models based on practice settings.
  • To evaluate their association with clinical productivity and nonclinical contributions.

Main Methods:

  • A systematic review adhering to PRISMA guidelines was performed, querying PubMed and Embase for relevant studies.
  • Data from 39 included studies, covering 13 surgical specialties, were independently screened and abstracted by two reviewers.
  • Syntheses were conducted by compensation model, including qualitative analysis to identify overarching themes.

Main Results:

  • Salary-based models offered stability but were linked to lower clinical volume.
  • Work relative value unit (wRVU)-based and fee-for-service models strongly incentivized productivity, often neglecting case complexity and nonclinical work.
  • Hybrid models balanced base salary with incentives for volume, quality, and academic contributions, despite administrative complexity; value-based models were rarely implemented.

Conclusions:

  • Surgeon compensation in the US is characterized by heterogeneity, with productivity-based systems being dominant.
  • Emerging hybrid and value-based models attempt to incorporate broader professional obligations.
  • There is a need for transparent, adaptable compensation frameworks that equitably balance clinical output, quality, and nonclinical contributions to sustain surgeon engagement.