Academic Surgeons Confront Stagnant Pay, Persistent Gaps in Compensation

In addition to saving lives and improving patients’ quality of life, academic surgeons are responsible for training future surgeons and advancing the field through research and innovation.

Despite the critical role they play in our healthcare system, academic surgeons tend to earn significantly less than their private practice counterparts.^1,2 This difference in earning potential often factors heavily into graduating residents’ decisions about whether to pursue careers in academia or private practice.³

As the US faces a projected shortage of 10,000 to 19,000 surgeons by 2036, building and sustaining an academic surgical workforce that reflects and meets the needs of an aging, increasingly multicultural population will require not only an investment in training, but also fair and competitive compensation.^4,5

Even with this urgency, comprehensive analyses of academic surgeon compensation trends remain limited. To address this gap, the authors and collaborators at Yale University School of Medicine in New Haven, Connecticut, analyzed data from the Association of American Medical Colleges (AAMC) Faculty Salary Report from 2017 to 2023, examining trends across rank, gender, race/ethnicity, and surgical subspecialty. This article summarizes findings from the study, “Academic Surgeon Financial Compensation in the US: Trends from 2017 to 2023,” published in the June 2025 issue of the Journal of the American College of Surgeons.

Changing Economic Landscape

Our study found that from 2017 to 2023, academic surgeon salaries increased by a compounded annual rate of 2.9%. Over the same period, the US inflation rate averaged 3.69%, suggesting that compensation for academic surgeons has not kept pace with the cost of living.⁶

In parallel, prior research has shown that medical school debt has increased by 268% during the past 40 years, delaying financial stability for surgeons, who often complete longer training compared to physicians in other specialties.⁷ Broader pressures compound these challenges. Between 2013 and 2021, Medicare reimbursement for surgical procedures declined by 9.8%, while compensation for outpatient visits increased by 1.3%, further straining financial viability.⁸

Together, these findings highlight the need to reevaluate compensation models to reflect the full scope of academic surgeons’ responsibilities, not only as clinicians, but also as educators, researchers, and institutional leaders.

Disparities across Demographic Groups

Our study also highlights disparities in compensation across gender and race/ethnicity. After adjusting for rank, women earned 77 cents on the dollar compared to men in 2023. This gap widened in higher-paying surgical subspecialties. For instance, in orthopaedic surgery, women earned only 76 cents on the dollar, while in transplant surgery, the lowest-paying specialty, women earned 96 cents on the dollar compared to men. Race- and ethnicity-based disparities were similarly evident. After controlling for academic rank, Black faculty earned 91 cents, Hispanic faculty 93 cents, and Asian faculty 98 cents on the dollar compared to White peers. Among all groups, Asian women had the lowest average compensation, earning just 73 cents on the dollar compared to White men.

As the US population becomes increasingly multicultural, so must the healthcare workforce. Studies show that physicians from underrepresented backgrounds are more likely to care for underserved populations, return to their communities, and improve outcomes.^9-11

While medical student enrollment has gradually begun to reflect the racial and ethnic makeup of the general US population, there remain leaky pipelines into competitive surgical subspecialties, and pay disparities may remain barriers to long-term retention and advancement.^12-15 These inequities raise urgent questions about how compensation is structured in academic medicine and whether we are doing enough to retain a skilled, motivated, and diverse academic surgical workforce. Understanding and addressing the root causes of these gaps is essential for ensuring a fair healthcare system that reflects and serves all patients.

Limitations and Future Directions

The limitations of this study include a lack of granular data on individual productivity and institutional-level compensation variation, as well as underrepresentation of certain racial/ethnic groups in the AAMC dataset. Nevertheless, the trends are consistent with findings in other specialties and merit serious attention.

The surgical community has an opportunity and responsibility to lead in addressing these disparities. Academic institutions must take proactive steps: conduct regular pay equity audits, increase salary transparency, and reexamine promotion and compensation policies to account for the full scope of contributions academic surgeons make. Without these efforts, we risk losing the surgeons who are best positioned to drive innovation and improve care for future generations.

Disclaimer

The thoughts and opinions expressed in this column are solely those of the authors and do not necessarily reflect those of the ACS.

Paula Flores Pérez is a fourth-year medical student at Yale School of Medicine in New Haven, CT.

Dr. Michael Alperovich is an associate professor of plastic surgery and director of the Craniofacial Surgery Fellowship Program at Yale School of Medicine.

Dr. Ajay Malhotra is a professor of radiology and biomedical imaging and of neurosurgery at Yale School of Medicine.

References

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