How to Become an Orthopaedic Surgeon: Pathway and Timeline

To become an orthopaedic surgeon you complete a medical degree, one or two years of internship or foundation training, a period of general surgical or prevocational experience, competitive selection into specialty training, about five to six years of orthopaedic training, and an exit examination such as the FRCS (Tr & Orth), FRACS, FRCSC or ABOS certification. Some surgeons then add a subspecialty fellowship before a consultant or attending post. The sequence is the same everywhere; the names, lengths and selection rules differ. This guide sets out each stage, compares nine training systems side by side, and links to a detailed guide for each country.

The pathway in seven stages

1. Medical degree. Every route starts with a primary medical qualification: MBBS, MBChB or MB BCh BAO in Commonwealth systems, MD or DO in North America. Medical school is where to gain early orthopaedic exposure through placements, theatre time and a first audit; our guide to getting orthopaedic experience as a medical student covers how.

2. Internship or foundation years. Supervised general clinical training leads to full registration. Lengths vary: the UK Foundation Programme is two years, the Irish intern year one year, the Australian intern year 47 weeks full-time equivalent, New Zealand's prevocational training covers PGY1 and PGY2, India requires a one-year internship after the MBBS, and South Africa requires a two-year internship and a year of community service.

3. Core surgical or prevocational surgical experience. In the UK and Ireland this is a formal two-year core surgical training programme that ends with the MRCS. In Australia and New Zealand it is a period as a resident and unaccredited registrar, with the RACS Generic Surgical Sciences Examination: the AOA requires 26 weeks of orthopaedics at PGY3 or above, and NZOA 52 weeks at registrar level. In the USA and Canada there is no separate stage; the first postgraduate year sits inside the residency.

4. Selection into specialty training. This is the main competitive step. Each system publishes its scoring tools: national ST3 selection in the UK, a 50/50 split between core training performance and interview in Ireland, a knowledge test, referee reports and interview in Australia, multi-mini interviews in New Zealand, matching through CaRMS in Canada and the NRMP in the USA, the NEET-PG in India and centrally ranked matching by the Saudi Commission for Health Specialties.

5. Specialty training. Five to six years of supervised orthopaedic training across trauma and the elective subspecialties, with workplace-based assessments, a logbook and annual progression reviews. The UK curriculum, for example, sets an indicative 1,800 logged operations by certification.

6. Exit examination and certification. Usually a written examination followed by clinical and oral components; the UK curriculum and RACS both set theirs at the standard of a consultant starting independent practice. Passing it, together with completing the training programme, leads to specialist registration or board certification.

7. Fellowship and first consultant post. An optional subspecialty fellowship, then a consultant, attending or specialist appointment. Our fellowship application guide covers how fellowships are chosen and applied for.

Orthopaedic training in nine countries compared

Some details behind the table:

• United Kingdom. The ISCP T&O curriculum (opens in a new tab) splits training into four years covering eight areas of the specialty and two years with two special interests. The FRCS (Tr & Orth) is set by the JCIE (opens in a new tab) for the four surgical Royal Colleges.
• Ireland. RCSI (opens in a new tab) runs an eight-year pathway: two years of core training and six of specialty training, using the same ISCP curriculum and the same intercollegiate FRCS.
• Australia. AOA 21 (opens in a new tab) uses an orthopaedic MCQ test and departmental referee reports to rank candidates for interview, then weights the interview at 60% and verbal referee reports at 40%.
• New Zealand. NZOA (opens in a new tab) restricts applications to New Zealand citizens and permanent residents.
• Canada. The Royal College plans orthopaedic surgery as a five-year residency (opens in a new tab) in four competence-by-design stages. The 2026 CaRMS R-1 match (opens in a new tab) offered 73 orthopaedic positions, 72 of them filled in the first iteration.
• United States. The ACGME requirements (opens in a new tab) set 60 months of training including PGY-1. The 2026 NRMP Main Residency Match (opens in a new tab) offered 963 PGY-1 orthopaedic positions in 223 programmes, all filled. ABOS (opens in a new tab) Part II, the oral examination, is taken after 17 months in practice.
• India. The NEET-PG (opens in a new tab), run by NBEMS, is the single entrance examination for MD, MS and DNB seats outside the institutes that use INI-CET. MS orthopaedics runs three years under the NMC's postgraduate regulations (opens in a new tab), and DNB orthopaedics three years after the MBBS.
• South Africa. The CMSA regulations (opens in a new tab) for FC Orth(SA) require the FCS(SA) Primary, an intermediate examination and at least 48 months in an HPCSA-accredited registrar post before the final.
• Middle East. In Saudi Arabia, SCFHS (opens in a new tab) ranks applicants on the licensing examination (55%), grade point average (30%) and CV (15%) before interviews and central matching; residency is five years (R1–R5).

How long does it take to become an orthopaedic surgeon?

Counting from graduation to the end of specialty training, on each system's standard timetable:

Australia has no fixed total: AOA 21 has a four-year minimum but requires orthopaedic experience at PGY3 or above before application, and progression is competency-based. The AOA's careers page quotes one of its surgeons putting surgical training at six to ten years after graduation.

Three things lengthen every route. Repeat applications add a year each, because selection runs annually. Research degrees and out-of-programme time can pause the training clock: NZOA, for example, does not count approved interruptions towards its five-year minimum. Less-than-full-time training extends training pro rata.

What selection panels score, and how to prepare

Each system publishes how it scores applicants, which turns general advice ("build a portfolio") into specific targets:

• UK. The ST3 person specification (opens in a new tab) makes the MRCS, evidence of core surgical competences, current ATLS competences and a validated logbook essential. It lists as desirable eight months in two related specialties, an orthopaedic casting course, academic output and a defined career plan.
• Ireland. RCSI's core training selection weights suitability for specialty training at 30%, professional development (research, audit, teaching) at 20% and surgical aptitude tests at 10%.
• Australia. The AOA's structured CV is a hurdle, not a score. Referee reports carry real weight: the departmental report helps decide who is interviewed, and verbal referee reports make up 40% of the final ranking.
• New Zealand. NZOA weights workplace assessments at 70% of the first stage and the structured CV at 30%.
• United States. Under American Orthopaedic Association guidance, orthopaedic applicants can send up to 30 preference signals through ERAS, so programme choice has to be deliberate.

Three habits serve every one of these systems:

1. Finish projects. Scoring schemes count completed audit and research, presentations and publications. Choose work you can finish alongside clinical commitments and be ready to discuss what you found.
2. Keep evidence as you go. Logbooks, course certificates, teaching feedback and letters confirming dates of service are all demanded at application; the AOA and NZOA both refuse prospective evidence such as contracts for future posts. Our guides to building an orthopaedic portfolio early and keeping a surgical logbook cover the detail.
3. Earn your referees. Australia and New Zealand score workplace and referee reports directly; the AOA's departmental and verbal referee reports cover the applicant's last two years of work. See also electives and placements for orthopaedics and how to write a surgical CV.

Treat the interview as a separate skill. Practise structured answers to clinical, ethical and motivation questions with people who will challenge you, and rehearse them aloud.

The exit examinations

Each system ends with a high-stakes examination:

• FRCS (Tr & Orth) in the UK and Ireland: two computer-based single-best-answer papers (Section 1), then clinical and oral examinations (Section 2). See the FRCS (Tr & Orth) exam guide.
• RACS Fellowship Examination in Australia and New Zealand: seven segments, most commonly two written papers and five clinical or viva segments. See the FRACS orthopaedic exam guide.
• ABOS Part I and Part II in the USA: a computer-based examination at the end of residency and an oral examination after time in practice. See the ABOS board certification guide.
• MS and DNB examinations in India: see the MS and DNB orthopaedics exam guide.

For a side-by-side view of every major orthopaedic board examination, including the EBOT for European surgeons, see the global orthopaedic board exam atlas.

Training in a different country

Moving between systems is possible, but rarely by applying for specialty training as an outsider. Some routes are closed to non-residents: NZOA selection requires New Zealand citizenship or permanent residency. Others offer side doors: Ireland's Equivalent Standards Route takes candidates with equivalent certified training from countries such as the UK, and the UK's portfolio pathway places doctors trained elsewhere on the specialist register. Our guides to IMG routes into orthopaedic surgery and the international medical graduate's path in orthopaedics set out the options country by country.