Most surgeons track collections, not what they actually keep per clinical hour. In this article, I walk through a real‑world style example of a 2.4M orthopedic practice and show how overhead, tax structure, retirement plan design, and debt service combine to create a much lower effective hourly rate than most surgeons expect—and how targeted structural changes can raise that rate without adding a single additional case.

Medicare’s 2.5% efficiency adjustment feels like a small cut with big consequences for orthopedic surgeons. This article walks through why “doing more cases” is often the least efficient response, and how tightening overhead, rethinking income flows, and coordinating tax and entity structure can help protect your practice’s profitability without adding more OR time.