How to Become an Orthopaedic Surgeon in the United States

To become an orthopaedic surgeon in the United States you complete medical school, pass the USMLE examinations, apply through ERAS, match through the NRMP Main Residency Match, finish a 60-month ACGME-accredited residency, and then certify with the American Board of Orthopaedic Surgery (ABOS) through Part I and Part II. Orthopaedics is entered directly from medical school, and it fills every position each year. This guide gives the official rules and numbers for each stage. For a comparison with other countries, see the hub guide to becoming an orthopaedic surgeon.

The US route at a glance

Which USMLE examinations matter?

The United States Medical Licensing Examination (opens in a new tab) is a three-Step examination for medical licensure, sponsored by the Federation of State Medical Boards and the NBME. All three Steps are delivered at Prometric centres.

Step 1 has been reported as pass or fail only (opens in a new tab) for examinations taken on or after 26 January 2022. Step 2 CK and Step 3 are still reported as three-digit scores as well as pass or fail, so of the two examinations sat before applying, only Step 2 CK gives programmes a numerical score.

How do ERAS and program signals work for orthopaedics?

Applications go through the AAMC's Electronic Residency Application Service (ERAS). In the 2027 ERAS season timeline (opens in a new tab), the season opened on 4 June 2026, applicants could submit to September-cycle programmes from 2 September 2026, and programmes could begin reviewing applications on 23 September 2026.

Orthopaedics adds its own recruitment rules through the American Orthopaedic Association's Council of Orthopaedic Residency Directors (AOA/CORD). The AOA/CORD 2026–2027 recommended guidelines (opens in a new tab) are:

• 30 program signals per applicant, with applicants and programmes opted in to preference signaling through ERAS.
• A limit of four medical student rotations, home and away combined.
• A Universal Interview Offer Day on Monday 16 November at 12:00 ET.
• Each programme decides on virtual or in-person interviews, but should not mix the two for its main applicant pool.
• Use of the eSLOR (electronic standardised letter of recommendation) by applicants and letter writers.

The AOA preference-signaling guidance (opens in a new tab) advises applicants to use all their signals, including on home programmes and sub-internship programmes they want, and notes that orthopaedic applications no longer carry a geographic preference option. Applicants can still apply to as many programmes as they wish.

The NRMP Main Residency Match

The National Resident Matching Program (opens in a new tab) is not an application service: it matches the rank order lists of applicants and programmes using its matching algorithm. Applicants rank the programmes where they interviewed; unmatched applicants can seek unfilled positions through the Supplemental Offer and Acceptance Program (SOAP) during Match Week.

The NRMP Advance Data Tables for the 2026 Main Residency Match (opens in a new tab) show for orthopaedic surgery:

Positions have grown from 875 in 2022 to 899 (2023), 916 (2024), 929 (2025) and 963 in 2026, and every one filled in 2026, leaving no orthopaedic positions for SOAP. Applicants from outside the US should read our guide to ECFMG certification and the USMLE first.

What does ACGME orthopaedic residency involve?

The ACGME Program Requirements for Orthopaedic Surgery (opens in a new tab) state that the educational programme "must be 60 months in length". The orthopaedic programme director is responsible for the PGY-1 year.

PGY-1 must include:

• Six months of non-orthopaedic rotations, of which at least three months are surgical (general surgery, general surgery trauma, plastic or burn surgery, surgical or medical intensive care, vascular surgery). The other three come from a wider list including anaesthesiology, emergency medicine, internal medicine, musculoskeletal radiology, neurosurgery, paediatric surgery, rehabilitation and rheumatology. No single non-orthopaedic service may exceed two months.
• Six months of orthopaedic rotations covering inpatient and clinic care, emergency department management and an orthopaedic knowledge base.
• Formal instruction in basic surgical skills, including splinting, casting, traction and immobilisation, soft-tissue handling, suturing, bone management, arthroscopy, fluoroscopy and basic orthopaedic equipment.

PGY-2 to PGY-5 must include at least 36 months on orthopaedic services, and each required rotation must last at least six weeks. Every resident's operative experience is tracked in the ACGME Case Log. Alongside the ACGME requirements, the ABOS runs its Knowledge, Skills, and Behavior (KSB) Program during residency, and participation is a condition for sitting Part I.

ABOS board certification: Part I and Part II

The ABOS states that board certification is voluntary (opens in a new tab) and distinct from licensure, which is regulated by each state. A valid medical licence is needed to be certified, but certification is not needed for a licence.

Part I is a computer-based examination of general orthopaedics and basic science, taken after completing an ACGME-accredited residency. PGY-5 residents apply in the autumn before the examination; the checklist for the 2027 examination (opens in a new tab) sets an application deadline of 1 December 2026 and a test date of 15 July 2027 at Pearson centres. The session lasts nine hours: eight hours of testing, 40 minutes of breaks and a 20-minute tutorial. Passing Part I makes you board eligible for five years; fellowship time after Part I does not count towards that limit.

Part II is an oral examination held each July in Chicago. To be admitted, you must have been in operative practice in one location for at least 17 consecutive full calendar months, from a 1 November start through 31 March of the examination year, with hospital privileges and an unrestricted licence (Part II requirements (opens in a new tab)). You submit a case list of your operative cases from a defined six-month period through the ABOS Scribe system, verified by each hospital's records department. Case selectors choose 12 cases, which you present to pairs of examiners over four sessions; you are scored on data gathering and interpretation, diagnosis, treatment plan, technical skill, outcomes and applied knowledge. Peer reviews from surgeons and hospital leaders familiar with your work form part of the credentialing.

Candidates who pass become Diplomates of the ABOS with a certificate valid for 10 years. For the KSB requirements, case-list rules and pass rates, see our ABOS board certification guide.

Fellowship

Fellowship is optional for ABOS certification. Residents who want subspecialty training apply during residency for fellowships in areas such as sports medicine, hand, spine, adult reconstruction, trauma, paediatrics or foot and ankle. Our orthopaedic fellowship application guide explains how the fellowship matches work.

The US route compared

The United States shares direct entry from medical school with Canada, but certification is split from training: residency ends with programme completion, while the ABOS examines you again after you have been in practice. The hub guide to becoming an orthopaedic surgeon compares this with the UK, Australia and other systems.