How to become an orthopedic surgeon

1. 1Earn a bachelor's degree with premed courses

   Time: 4 yearsCost: Varies by collegeSources 1

   No specific major is required, but you need the science courses medical schools expect, typically biology, general and organic chemistry, physics and biochemistry with labs. Keep your science GPA high, since orthopedics is one of the more competitive residencies later on. Get clinical hours by working or volunteering in a hospital, shadow an orthopedic surgeon in clinic and the operating room, and join a research project if you can.

2. 2Take the MCAT and apply to medical school

   Time: About 1 year (application cycle)Cost: $360 MCAT registrationSources 7, 1

   The MCAT is a full-day computer-based test of biology, chemistry, physics, psychology and critical reasoning. Standard registration is $360, or $145 through the AAMC Fee Assistance Program. Applications go through AMCAS for MD schools and AACOMAS for DO schools, followed by secondary essays and interviews. Admission is selective, so most applicants apply to many schools.

3. 3Complete medical school (MD or DO)

   Time: 4 yearsCost: AAMC median 4-year cost: $297,745 public, $408,150 privateSources 5, 6, 8

   Two years of basic sciences are followed by two years of clinical rotations. Students aiming for orthopedics usually do away rotations at orthopaedic programs in their fourth year, publish research and seek strong letters from orthopedic faculty. The first two licensing exams also fall in medical school: USMLE Step 1 and Step 2 CK for MD students, COMLEX-USA Levels 1 and 2-CE for DO students. You apply to residency through the national match in your final year.

4. 4Complete a 5-year orthopaedic surgery residency

   Time: 5 years (60 months)Cost: Paid as a residentSources 2, 3

   Residency must last at least 60 months. The first year includes six months of non-orthopaedic rotations that build basic surgical skills, perioperative care, image reading and airway management. The next four years are orthopaedic training in trauma, joints, spine, hand, sports, pediatrics and tumors, with steadily more operating responsibility. Residents take USMLE Step 3 or COMLEX Level 3 early, and fifth-year residents can apply for the ABOS Part I Examination.

5. 5Get a state medical license

   Time: During or right after residencyCost: State license fees varySources 9, 2, 1

   Every state requires a license to practice medicine. Medical boards generally require graduation from an accredited MD or DO school, passing all three USMLE steps or COMLEX levels and a minimum period of accredited residency, plus background checks. ABOS also requires a full and unrestricted license before the Part II oral exam. Check your state's exact rules through the CareerOneStop License Finder or the state medical board.

6. 6Optional: complete a subspecialty fellowship

   Time: 1 to 3 yearsCost: Paid as a fellowSources 4, 1, 2

   Many orthopedic surgeons add fellowship training in an area such as hand, spine, sports medicine, adult joint reconstruction, trauma, foot and ankle, pediatric orthopedics or tumor surgery. ABOS offers subspecialty certificates in Surgery of the Hand and Orthopaedic Sports Medicine, which require an ACGME-accredited fellowship. Fellowship time does not count toward the five-year window to pass the Part II exam.

7. 7Earn ABOS board certification

   Time: About 2 years into practiceCost: $1,240 Part I + $1,175 and $1,550 Part IISources 2, 3, 10

   Pass the ABOS Part I written exam, a computer-based test with 8 hours of testing time, in the summer you finish residency (you apply during the fifth year). Then practice operative orthopedics for 17 months while collecting your case list. The Part II oral exam, held each summer in Chicago, has examiners review 12 of your own cases over four 30-minute sessions. Certification lasts 10 years. DOs may instead certify through AOBOS.

Programs, tuition and graduates’ earnings

U.S. Department of Education, College Scorecard (most recent cohorts, released 2026-10-15). Scorecard groups programs by 4-digit field, so a row can include related programs. Tuition is the median published undergraduate tuition and fees of the colleges offering the program (shown only for undergraduate credentials); debt is the median of programs’ median federal loan debt at completion; earnings are the national median for the field and credential four years after completion.

Requirements differ by state. Check your state’s rules in the CareerOneStop License Finder (U.S. Department of Labor) before you enroll.

Three-dimensional anatomy

Fixing a fracture or placing an implant means picturing exactly where nerves, vessels and bone surfaces lie beneath the incision.

Manual skill with tools

Orthopedic surgery uses saws, drills, reamers and arthroscopes, and a few millimeters of error can change how a joint works.

Reading imaging

Diagnosis and surgical planning rest on interpreting X-rays, CT and MRI, often before the patient is examined.

Physical stamina

Long cases on your feet, sometimes under lead aprons, plus overnight trauma call are routine.

Judgment about when not to operate

Many back, knee and shoulder problems improve without surgery, and choosing the right patients drives good outcomes.

Training cost

$304K–$415K

Before financial aid

Time

14-15 years

Typical path

Median pay

$358,550

All US jobs: $50,980

Payback once qualified

1.0–1.3 yrs

Pay above the all-jobs median vs. cost

Low: AAMC median 4-year cost of attendance at a public medical school (Class of 2026), $297,745, plus MCAT $360, USMLE Step 1 $695, Step 2 CK $695 and Step 3 $955, and ABOS Part I $1,240 plus Part II $1,175 application and $1,550 exam = $304,415 (AAMC's cost of attendance already counts some exam costs, so this slightly overstates). High: private-school median $408,150 plus MCAT, COMLEX-USA Level 1 $745, Level 2-CE $745, Level 3 $950 and the same ABOS fees = $414,915. Cost of attendance includes living costs. Not included: college tuition, application and interview travel, state license fees. Residents are paid. Median federal loan debt for medical graduates in our data is $208,644.

Rough guide only: ignores taxes, aid, interest and earnings given up during training. How we calculate it.

• Subspecialist (hand, spine, sports, joints)$300,080 median

  A fellowship of one or more years lets an orthopedic surgeon limit practice to one region or type of surgery, and hand or sports surgeons can earn an ABOS subspecialty certificate.

• Practice partner or surgery center owner

  After several years in a group, surgeons may buy into the partnership or invest in an outpatient surgery center; this takes business knowledge rather than more medical training.

• Academic orthopedic surgeon$82,250 median

  Faculty at medical schools teach residents and run research, and usually hold a fellowship and a record of publications.

• Chief of surgery or medical director$123,860 median

  Experienced surgeons can lead a department or hospital service line; some add an MBA or MHA.