Explore orthopedic surgery NP and PA salary ranges, hourly rates, and how surgical first-assist responsibilities and locum work shape earning potential in 2026.
Orthopedic surgery NPs and PAs operate at the intersection of musculoskeletal medicine and surgical care. The combination of clinic-based fracture management, post-operative care, and surgical first-assist responsibilities creates a scope of practice that commands competitive compensation. Most earn between $135,000 and $140,000 annually, with surgical volume, procedural responsibility, and rural versus academic setting driving variation above the median.
| Source | What it Measures | NP Compensation | PA Compensation |
|---|---|---|---|
| AANP/AAPA Compensation Reports (2025) | Median annual compensation | ~$140,000 | ~$140,000 |
| Medscape APRN Compensation Report (2025) | Average total NP/PA compensation | ~$135,000 | ~$138,000 |
| Bureau of Labor Statistics, OEWS (2025) | Mean annual wage (all-specialty proxy) | $133,646 | ~$130K–$135K |
Orthopedic surgery APPs who take on surgical first-assist responsibilities and manage high-volume fracture clinics consistently earn at the top of the compensation range.
| Compensation Type | Hourly Rate |
|---|---|
| W-2 employed NP (BLS mean, ~2,080 hrs) | $64.25 /hr |
| W-2 employed PA (BLS mean, ~2,080 hrs) | $64.25 /hr |
| Locum tenens NP — typical range | $70–$95 /hr |
| Locum tenens PA — typical range | $70–$135 /hr |
Sources: BLS OEWS 2025; Barton Associates market data 2025–2026.
PA locum rates in orthopedic surgery can reach $135/hr for surgical first-assist roles at high-volume centers, reflecting the specialized procedural skills required.
Orthopedic surgery APP compensation peaks in markets with high surgical volume and limited APP supply. Rural trauma centers, high-volume joint replacement programs, and sports medicine practices in underserved markets pay the highest locum premiums. Surgical first-assist certification significantly expands both assignment availability and rate potential.
Orthopedic surgery APPs with surgical first-assist certification and trauma experience access the widest range of high-paying locum assignments across both urban and rural markets.
A full-time orthopedic surgery APP typically sees 20 to 30 patients per day in a clinic setting, managing fracture care, post-operative follow-up, and musculoskeletal injections. APPs with surgical first-assist certification spend a portion of their time in the operating room assisting with joint replacements, arthroscopic procedures, and trauma cases. The combination of clinic and OR responsibilities creates one of the most varied APP roles in surgical medicine.
Locum rates range from $90 to $120 per hour. The four scenarios below use representative rates from within that band.
To exceed $250,000: target surgical first-assist roles at high-volume centers, trauma assignments, and rural orthopedic markets at the top of the PA rate band ($135/hr).
Orthopedic surgery APPs with surgical first-assist certification and trauma experience access the widest range of high-paying locum assignments and the highest rate ceilings in the APP market.
A $100/hr locum rate versus a $64/hr W-2 equivalent is a meaningful structural advantage. 1099 orthopedic surgery APPs unlock business deductions across licensing, CME, travel, and equipment; higher retirement contributions through a SEP-IRA or Solo 401(k); the Qualified Business Income deduction of up to 20%; and S-corp structuring at higher income levels. Barton partners with Earned to help locum APPs navigate these decisions.
Barton coordinates your job search from start to finish!
We’ll schedule a phone consultation to discuss your interests, goals, and work history to find the right opportunities.
Your Barton rep will submit your information to the facility you want to take an assignment at and work on next steps.
Barton handles licensing, credentialing, and travel arrangements before you arrive so you’re ready on day one.
Most earn between $135,000 (Medscape NP) and $140,000 (AANP/AAPA). Surgical first-assist responsibilities, procedural volume, and rural versus academic setting drive variation above the median.
W-2 employed NPs and PAs average approximately $64.25 per hour based on BLS data. Locum tenens NP rates range from $70 to $95 per hour; PA rates range from $70 to $135 per hour for surgical first-assist roles.
Hybrid models combining employed income with regular locum shifts can push total compensation above $188,000. Full-time locum at $120/hr working 15 shifts per month yields approximately $216,000 annually.
Rural trauma centers, high-volume joint replacement programs, and sports medicine practices in underserved markets pay the highest locum premiums. Surgical first-assist certification significantly expands both assignment availability and rate potential.
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