The Orthopedic Surgery Rate & Negotiation Toolkit

What's Inside

Not "a PDF." Six specific tools:

1. Rate Benchmark Database

   Orthopedic Surgery rates by state and setting — urban hospital and rural/critical access — at the 25th, 50th, 75th, and 90th percentile. Fifty states. The number you need before you call the recruiter back.

2. Recruiter Call Scripts

   Word-for-word. The exact sentences:

   • The opening anchor when you've received a below-market offer
   • The counter when they say "this is our standard rate"
   • The leverage script for 24-hour trauma call and weekend OR coverage
   • The subspecialty differentiation script (spine, joint, trauma)
   • The renewal script when they try to roll your old rate forward
3. Orthopedic Surgery Leverage Points

   The specific credentials and coverage capabilities that justify a higher rate:

   • Spine fellowship training commands $500+/hr at tertiary centers — state it explicitly on the first call
   • ATLS certification and trauma panel eligibility expands rural CAH assignment options into Level III/IV trauma coverage
   • 24-hour trauma call ($3,600–5,000/day) is the most underpriced line item in most orthopedic locum contracts — negotiate it as a separate line item from the hourly rate
   • Joint reconstruction capability (hip and knee arthroplasty) opens elective surgical volume assignments at higher daily rates
4. Contract Red Flag Checklist

   Daily minimum guarantee, trauma call compensation, malpractice tail scope, non-compete language, and OR case-mix expectations. One page, annotated. Open it while reviewing any contract.

5. Agency Markup Framework

   The math behind what the hospital actually pays for your shift. For orthopedic surgery, agency bill rates run $580–720/hr. When you know the approximate bill rate, "that's our maximum" means something different.

6. Locum Tax Framework

   The 1099 math most surgeons undercount: the S-corp threshold, the Solo 401(k) gap, and the minimum premium required to break even against a W-2 employed rate.

What It Looks Like on the Call

When a recruiter quotes $390/hr for a rural CAH orthopedic trauma assignment, this is the sentence from Section 2:

"The market median for rural critical access orthopedic surgery in the South is $420/hr. Given my ATLS certification and trauma panel experience, I'd expect to be in the $440–460 range. Is there flexibility to get there before we discuss scheduling?"

You change the numbers to match your state. You say it. That is the product.

Who Built This

For years I took every rate I was offered without pushing back. Not because I was naive. I didn't have the data to know whether I should. Neither did anyone I trained with. I built this because the information existed in federal wage surveys, peer-reviewed research, and 50 years of negotiation science, and it wasn't assembled anywhere a physician could use it before calling a recruiter back.

I started with surgery. Then I built the same data model and negotiation framework for the 22 specialties with the highest locum demand. The leverage points in each toolkit come from specialty-specific research. The scripts and the data are the same framework I use myself.

The agency has this organized. Now you do too.

— General Surgery MD

Verify the Premise Before You Buy

Call three locum agencies and ask what their bill rate is for orthopedic surgery. Write down how many give you a number.

That is the problem this PDF solves.

The Research Behind It

The economic analysis in this toolkit is grounded in Nobel Prize-winning research:

• Akerlof (1970, Nobel 2001): In markets where one side has better information, the uninformed party is systematically underpriced, not because they're naive, but because the market is structured that way.
• Spence (1973, Nobel 2001): Credentials only move your rate when the agency prices them. This toolkit shows you how to make that happen.
• Nash (1950, Nobel 1994): The fair split in any negotiation assumes equal information and equal skill. Neither assumption holds on a recruiter call.

The negotiation psychology section cites 17 peer-reviewed sources. This is not a blog post formatted as a PDF.

What It Costs in Context

• Consulting an attorney to review your locum contract: $350–$500/hr.
• Hiring a negotiation consultant: $3,000–$5,000.
• This toolkit: $99. One successful negotiation adds $13,000+ annually.

One Honest Limitation

This will not help you if you are already negotiating above the 75th percentile for your specialty and state. If you don't know what percentile your current rate is, that is the problem this solves.

About the Data

Sourced from BLS OEWS public data and CMS geographic adjustment factors, processed through a locum-adjusted model. Not derived from agency-reported data.