What Are Graduating Surgeons Looking For? A Guide for Employers and Practice Leaders

As the healthcare landscape continues to evolve, the priorities and expectations of graduating surgeons are shifting. For employers and practice leaders aiming to attract top surgical talent, understanding what these new surgeons seek in their careers is essential. The competition for skilled surgeons is fierce, and offering the right mix of opportunities, support, and incentives can make all the difference.

How Many Graduating Orthopedic and Spine Surgeons Are There in the US?

Each year, the United States trains a limited number of orthopedic and spine surgeons through its residency and fellowship programs. According to data from the Accreditation Council for Graduate Medical Education (ACGME), approximately 700 to 800 orthopedic surgery residents complete their training annually -source-. Additionally, around 150 to 200 spine surgery fellows, who often come from orthopedic or neurosurgery backgrounds, finish their specialized training each year. This results in roughly 850 to 1,000 new orthopedic and spine surgeons entering the workforce annually. These figures reflect a critical but constrained influx of specialists, challenged by the increasing demand for musculoskeletal and spinal care driven by an aging population and rising rates of conditions like osteoarthritis and degenerative spine diseases.

How Many Orthopedic and Spine Surgery Job Positions Are Available?

The demand for orthopedic and spine surgeons in the US remains high, driven by demographic trends and advancements in surgical techniques. Based on projections from the Bureau of Labor Statistics (BLS) and workforce analyses, there are approximately 10,000 to 12,000 active job openings for orthopedic surgeons and an additional 1,500 to 2,000 for spine surgeons, totaling around 11,500 to 14,000 positions currently available. The BLS projects a 7% growth in physician and surgeon jobs from 2018 to 2028, which could translate to an additional 3,000 to 4,000 orthopedic and spine surgery positions over the decade (source). However, a 2019 report prepared for the Association of American Medical Colleges (AAMC) highlights a projected shortage of 4,000 to 7,000 surgical specialists in orthopedics and related fields by 2032, particularly in rural and underserved areas (source). This gap underscores the challenge of matching the supply of graduating orthopedic and spine surgeons with the growing number of available positions, requiring strategic recruitment efforts by healthcare employers.

A Guide for Employers and Practice Leaders

This guide explores the key factors that graduating surgeons are prioritizing as they embark on their professional journeys, alongside insights into their numbers, job availability, tenure, and common challenges.

1. Competitive Compensation (Very often the priority)

While passion for patient care drives many surgeons, financial considerations remain a significant factor. Graduating surgeons often carry substantial student debt and are looking for competitive salaries or compensation. Transparent compensation structures and opportunities for performance-based incentives can also sway their decision. Employers should be prepared to discuss financial packages early in the recruitment process to address this critical concern.

Feedback from recent applicants discussed that employers often are not upfront about compensation until late in the process, which can be frustrating. Fair compensation is at the top of the list for many applicants and is often used as a screening tool in which to decide whether to proceed into more in-depth discussions about the position.

Often candidates are aware of what their peers are making in similar markets and some have access to MGMA data. Waiting until final contract negotiations to discuss compensation ranges comparing senior and junior partners could turn away talent. We recommend being upfront with compensation ranges, RVU amounts, any ancillary compensation. These numbers not only tell whether a practice or employed job is competitive, they tell the candidate how efficiently things are run. If a private practice is hitting >60-65% overhead, then this could be a red flag that if discovered later on in the process, versus being upfront about it and showing a trend downward or explaining a recent capital purchase that would explain a transiently higher overhead amount to partners.

2. A Stable, High Functioning Environment

New job applicants want to know the stance of where practices are at with in regards to private equity sell-offs, hospital co-ownership partnerships, or how the departments are run within large health systems. For example, is there stable leadership of the department? Or is the department chief unhinged power hungry specialist that is not even the same subspecialty as the department that they are leading.

How has the leadership performed in the last 5-10 years? Where is the group heading? Where have challenges been addressed or not addressed? What are the partner’s goals? Are the senior partners padding their retirements on the backs of the juniors? Are the variable expenses shared evenly? Did the senior partners just sell a significant portion of the practice and saddle the juniors with a private equity group running the show?

How efficiently run are the assets of the practice? Are certain ares of the practice losing money? What is the average ancillary income for senior versus junior partners? For employed jobs, is the RVU structure actually competitive?

These are the types of questions that new applicants want to know. Are they about to join a department or practice in turmoil? Or one that aligns with their professional goals and ideals?

3. Mentorship and Professional Growth. Aka: Excellent Partners

Graduating surgeons recognize that the people and partners they will be working with are extremely important. Sometimes even more so than compensation. Applicants want to know the personalities, experience levels, and how the group overall interacts. Is everyone cohesive and aligned? Or are there a few in the group that are high risk to the rest of the group in regards to poor indications, higher malpractice risks or toxic personalities. Are they on their way out of the group or are they in control based on hierarchy? Access to experienced surgeons who can guide them through complex cases, as well as funding for conferences, certifications, and advanced training, is highly appealing. Practices that invest in their surgeons’ growth signal a commitment to long-term success, fostering loyalty and satisfaction.

Probably most important for junior partners, is how is the practice or department structured, is it in a way that values junior partners, or are juniors just being taken advantage of for the sake of the seniors in regards to compensation, call, or even new patient referral sources. Do senior partners cherry pick all of the good insurances and just leave the medicaid and call cases for the junior partner? This set up is doomed to fail and is a significant red flag that should be highlighted early in discussions.

4. OR Availability and Case Availability

This is another red flag if a practice is hiring a new surgeon, but has no OR availability for that new surgeon. Vague promises of OR time to complete cases is concerning. Or senior partners that say, “You can have the end of my elective block time that starts at 5-7pm on a Friday evening. New surgeons want to know that the practice truly needs help with conquering the volume of cases, and that they will have the OR time to complete those cases.

5. Cutting-Edge Technology and Resources

Surgeons fresh out of residency and fellowship are trained on the latest techniques and technologies, from robotic-assisted surgery to minimally invasive procedures. They want to join practices equipped with state-of-the-art tools that allow them to perform at their best. Employers who demonstrate a willingness to invest in modern equipment and innovative approaches will attract tech-savvy graduates eager to apply their skills in a forward-thinking environment. Highlighting access to advanced operating rooms, electronic medical records, and telemedicine capabilities can set a practice apart.

Often new surgeons want to use equipment similar to what they trained with. Having a budget ready to accommodate new surgeons for when they come to town along with allowing their choice of implants could help attract talent to the area.

6. Collaborative and Supportive Team Culture

Surgery is inherently a team effort, and graduating surgeons want to work in environments where collaboration and respect are the norm. They seek practices with cohesive teams, including skilled nurses, anesthesiologists, and administrative staff, to ensure smooth operations and high-quality patient outcomes. A toxic or hierarchical culture can be a dealbreaker, so practice leaders should emphasize their commitment to fostering a positive, inclusive workplace. Highlighting team-building initiatives or testimonials from current staff can help illustrate a supportive atmosphere.

7. Location and Lifestyle Fit

Geography plays a significant role in where graduating surgeons choose to practice. Some are drawn to urban centers with vibrant cultural scenes and academic affiliations, while others prefer suburban or rural settings offering a quieter pace and tighter-knit communities. Employers should market the lifestyle benefits of their location—whether it’s proximity to outdoor recreation, excellent schools, or a bustling city life—to align with candidates’ personal preferences. Relocation assistance and housing stipends can also sweeten the deal for those considering a move.

Polling recent fellowship grads, there is a trend where recruiters will ask specifically about the spouse/partner of the surgeon and where the spouse’s family resides. This is an illegal interview question, and savvy applicants are aware that employers/recruiters will prioritize applicants with family ties to an area over other options because placement rates are likely higher and there is potentially less concern for negotiations if the priority is purely family proximity. Tread lightly in this area.

8. Autonomy and Influence

While mentorship is crucial, graduating surgeons also crave a degree of autonomy in their practice. They want to feel trusted to make clinical decisions and contribute to the direction of the practice. Employers who offer opportunities to shape protocols, participate in leadership roles, or pursue subspecialty interests will appeal to ambitious candidates. Striking a balance between guidance and independence can empower new surgeons to thrive while ensuring patient safety and practice standards.

Be ready to give examples of how surgeons can decide what is best for their patients when it comes to equipment choices, implant choices, and how continuous improvements are being made throughout the department and or practice.

9. Commitment to Patient-Centered Care

Finally, graduating surgeons are deeply motivated by the opportunity to make a meaningful impact on patients’ lives. They are drawn to employers who prioritize patient-centered care and align with their values of empathy and excellence. Practices that emphasize quality outcomes, community engagement, and equitable access to care resonate with this mission-driven cohort. Sharing success stories or data on patient satisfaction can reinforce a practice’s dedication to this shared goal.

Autonomy and leadership of the groups make a significant impact in this area. If junior partners feel like they can not make the best decisions for their patients whether it is implant choice or equipment choice for example then this could be a significant red flag. Excellent groups will prioritize patient care over everything else, where some practices will prioritize cost savings, shareholder equity value, and surgical conversion rates over everything else.

Imagine if your senior partners and admin were flagging you as a junior partner for not signing patients up at a higher rate for surgery when in fact you are making the best possible decision for your patients by being conservative when needed. This describes a toxic environment, be ready to discuss the type of culture the practice has in regards to this area.

10. Work-Life Balance: A Non-Negotiable Priority

Gone are the days when surgeons blindly accepted grueling schedules without knowing the environment and potential upside. Today’s graduating surgeons place a premium on work-life balance, but we would argue are very willing to work hard if the environment rewards that hard work fairly.

Employers who offer flexible scheduling, reasonable on-call expectations, and paid time off are more likely to stand out. Practice leaders should emphasize what their culture is like and whether it encourages surgeons to go to conferences, pursue interests outside of medicine, and whether they allow junior partners to cater their practices to their liking, or if their output is being closely tracked.

This also comes in the form of physician assistant help. Having early PA help in a junior’s career can be a significant positive when it comes to maintaining work-life balance.

Conclusion: Building a Winning Recruitment Strategy

To attract graduating surgeons, employers and practice leaders must go beyond offering a job—they must offer a vision. By addressing these key priorities, practices can position themselves as destinations for the next generation of surgical talent. Engaging with candidates early, listening to their needs, and tailoring offerings accordingly will ensure a strong match that benefits both the surgeon and the practice. In a competitive market, meeting the needs of graduating surgeons is the first step to building a thriving, future-ready team.