Becoming an orthopedic surgeon requires 13 to 14 years of education and training after high school. That breaks down into four years of college, four years of medical school, and five years of residency. Many orthopedic surgeons add a sixth year of fellowship training on top of that, and board certification requires additional exams after residency is complete.
Four Years of College
The path starts with a bachelor’s degree, which takes four years at a standard college or university. There’s no single required major, but most aspiring orthopedic surgeons study biology or chemistry and complete a full set of pre-med science courses. Medical schools expect applicants to have strong foundations in organic chemistry, physics, biochemistry, and anatomy. You’ll also need to prepare for and take the MCAT, the standardized admissions test for medical school, typically during your junior year.
Your GPA during these four years matters significantly. Orthopedic surgery is one of the most competitive medical specialties, so building a strong academic record from the start gives you more options later.
Four Years of Medical School
Medical school adds another four years. The first two years focus on classroom and lab-based learning: anatomy, physiology, pharmacology, pathology, and the basic science of how the body works and what goes wrong. The final two years shift to clinical rotations, where you work directly with patients in hospitals and clinics, cycling through specialties like internal medicine, surgery, pediatrics, and psychiatry.
During medical school, you must pass both Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE). Step 1 is typically taken before your final year of clinical rotations, and both exams must be passed before you can graduate and enter the residency matching process. These scores, along with your clinical evaluations and research experience, shape how competitive your application is when you apply for orthopedic surgery residency spots.
Five Years of Residency
Orthopedic surgery residency lasts five years. The structure at most programs begins with six months of general surgical training as an intern, followed by four and a half years focused specifically on orthopedic surgery. During residency, you progress from assisting in the operating room to performing surgeries with increasing independence.
Rotations cover the full spectrum of orthopedic care: joint replacement, fracture repair, hand surgery, spine surgery, sports injuries, pediatric conditions, and musculoskeletal tumors. By the end of residency, you’re trained to diagnose and surgically treat conditions across the entire musculoskeletal system. Most residents work long hours, often 60 to 80 per week, and the training is physically and mentally demanding.
The final 24 months of residency must be completed at a single program, a requirement set by the American Board of Orthopaedic Surgery (ABOS) for anyone who wants to pursue board certification.
Optional Fellowship Adds One More Year
After residency, many orthopedic surgeons complete a one-year fellowship to subspecialize. This isn’t required, but it’s increasingly common. Fellowship options include:
- Orthopedic sports medicine
- Hand surgery and upper extremity
- Orthopedic surgery of the spine
- Joint preservation and adult reconstruction
- Foot and ankle orthopedics
- Orthopedic trauma
- Pediatric orthopedics
- Musculoskeletal oncology
Each fellowship lasts one year and provides concentrated training in a narrower area. A surgeon who wants to focus on ACL repairs and rotator cuff injuries, for example, would pursue a sports medicine fellowship. Someone interested in scoliosis correction would train in spine surgery. Fellowship training can make you more competitive for certain jobs and referral networks, though some orthopedic surgeons go into general practice directly after residency.
Board Certification After Training
Completing residency makes you eligible to practice, but most orthopedic surgeons pursue board certification through the ABOS, a two-part process that extends beyond training.
Part I is a computer-based exam with roughly 320 multiple-choice questions covering all areas of orthopedics. You can take it after finishing residency. Once you pass Part I, you’re considered “board eligible” and have five years to complete Part II.
Part II is an oral examination. To qualify, you must have been practicing in one location for at least 17 months and submit a list of every surgical case you performed during a defined six-month period. Examiners review your case list and question you on your decision-making, technique, and management of complications. Passing Part II grants you board certification for 10 years, after which you must recertify.
The Full Timeline at a Glance
Here’s how the years add up from the start of college:
- College: 4 years
- Medical school: 4 years
- Residency: 5 years
- Fellowship (optional): 1 year
- Total: 13 to 14 years
If you start college at 18, the earliest you’d be in independent practice as a general orthopedic surgeon is around age 31. With a fellowship, that pushes to 32. Board certification typically comes a couple of years after that, once you’ve accumulated enough practice experience to sit for the oral exam. The path is one of the longest in medicine, comparable to neurosurgery, but the reward is a career performing surgeries that restore mobility and relieve pain for millions of patients each year.