Orthopaedic Practice Setting Opinions: Heat Maps for a Hot Topic.

Background: Selecting an orthopaedic surgery practice setting is a career-altering decision, yet guidance is often anecdotal. Despite existing resources, no consolidated data compare surgeon experiences across practice models. This study surveys orthopaedic surgeons across Texas and California, to quantify perceived strengths and weaknesses of academic, private, hospital-employed, and privademic practice environments. Methods: An anonymous survey was distributed through professional networks and organizations between May 2024 and May 2025. Respondents identified their current and prior practice settings, subspecialties, and employment ZIP codes. They rated each practice setting in categories including autonomy, salary, ancillary income opportunities, education, research, administrative burden, reputation, community respect, and work-life balance. Responses were aggregated into a heatmap, with subgroup analysis conducted based on employment history and location. Results: A total of 100 orthopaedic surgeons responded 45% academic, 30% private, 16% hospital-employed, and 8% privademic. Subspecialty distribution was balanced. Academic surgeons rated research opportunities, professional reputation, and continued education highly (p < 0.001), and ancillary income was rated poorly (p < 0.001). Private practitioners valued autonomy, salary, and ancillary income (p < 0.001), but rated research opportunities and continued education poorly (p < 0.001). Hospital-employed surgeons had no categories rated highly. Privademic surgeons had favorable views on autonomy, salary, and income opportunities (p < 0.001), and no categories were rated poorly. Regional comparison showed California surgeons perceived lower academic autonomy (p = 0.048) and work-life balance (p = 0.037), along with less favorable views on salary and income (p = 0.007). Conclusions: This survey highlights distinct tradeoffs across orthopaedic practice models and locations. Academic models offer professional and educational benefits but are limited in financial upside, whereas private and privademic settings offer enhanced autonomy and compensation. California surgeons reported less favorable perceptions, especially with compensation, highlighting potential regional influences on employment satisfaction. These findings may inform future decisions in orthopaedic career planning and workforce policy. Level of Evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.