Orthopaedic Fellowship Application Guide: Matches, Timelines and Choosing a Programme

An orthopaedic fellowship is a period of supervised subspecialty training taken after residency or specialist certification. It usually lasts between six months and two years. How you apply depends on the country. In the United States almost every subspecialty fills through a single match about two years before the start date. The UK, Australia, New Zealand and Canada mostly recruit post by post. This guide covers each system's routes, timelines, documents and registration rules, and explains how to judge a programme before you commit to it. If you have not yet settled on a subspecialty, start with when to choose your orthopaedic subspecialty.

What counts as an orthopaedic fellowship?

The word covers four different things.

• Accredited clinical fellowships follow a curriculum set by a regulator or college. Examples are ACGME-accredited fellowships in the US, JCST interface fellowships in the UK and RACS-approved post-fellowship education and training (PFET) programmes in Australia and New Zealand.
• Unaccredited or voluntarily accredited clinical fellowships are posts created by a unit or a group of surgeons. Many fellowships outside the US are of this kind. The Australian Orthopaedic Association accredits fellowships on a voluntary basis, but AOA states (opens in a new tab) that these "are not formalised surgical training programs".
• Research fellowships give protected research time with little or no operating. The University of Toronto, for example, defines its research fellows (opens in a new tab) as having no patient contact.
• Travelling fellowships are short funded tours of several centres, not training posts. One example is the AOA's ASEAN Travelling Fellowship, which visits the Philippines, Malaysia and Thailand over ten days in October.

Which orthopaedic subspecialties offer fellowships?

The ACGME accredits eight orthopaedic subspecialties (opens in a new tab): adult reconstructive orthopaedic surgery, foot and ankle, hand surgery, musculoskeletal oncology, orthopaedic sports medicine, spine, orthopaedic trauma and paediatric orthopaedics. Shoulder and elbow is not on that list, but shoulder and elbow programmes still take part in the US match. The table gives 2026 US match figures for each subspecialty: the SF Match report published by the Orthopaedic Trauma Association (opens in a new tab) for seven of them and the NRMP hand surgery report (opens in a new tab) for hand.

Fill rates differ widely. In 2026, 98% of trauma positions were filled (96 of 98), compared with 71% in spine and 58% in foot and ankle. An unfilled post does not make a programme easy to get into. It shows where applicants chose to rank. Unfilled posts are also listed after Match Day, which matters if you do not match.

The US board also offers subspecialty certification in two areas. The American Board of Orthopaedic Surgery (ABOS) awards two subspecialty certificates (opens in a new tab): Surgery of the Hand (established 1989) and Orthopaedic Sports Medicine (established 2007). You can sit the subspecialty examination once you finish an ACGME-accredited fellowship, but you cannot be certified until you hold primary ABOS board certification.

How does the US orthopaedic fellowship match work?

The US subspecialty matches used to run separately on different dates. The first single combined match was held in April 2019 and covered every subspecialty except hand, according to the AAOS Fellowship Committee's account (opens in a new tab). Paediatric orthopaedics, coordinated by POSNA, has since joined. You complete one Central Application Service (CAS) form, apply to programmes in any subspecialty, and rank them all on one list. The matching algorithm does not take subspecialty into account. AOSSM notes that sports medicine programmes will not accept applications sent directly (opens in a new tab), and that only ACGME-accredited sports programmes may take part.

Hand surgery runs its own match through the NRMP because applicants come from orthopaedic, plastic and general surgery residencies. The typical hand fellowship lasts one year. The 2026 hand match (Match Day 13 May 2026, for posts starting in 2027) had 198 applicants who submitted rank lists, and 187 of them matched.

The cycle for a 2028 start. This example uses the American Association of Hip and Knee Surgeons timetable for the 2027 match (opens in a new tab):

Each subspecialty sets its own interview window. For the 2026–27 cycle, sports medicine interviews by region between 3 January and 27 March 2027. ACGME residency lasts 60 months (opens in a new tab), so for a resident finishing in June, registration falls at the start of the fourth year (PGY-4). In practice, your choice of subspecialty is made on the experience of your first three years.

Match statistics. In 2026, 979 applicants registered, 877 submitted rank lists and 818 matched: 735 US graduates, 20 Canadian graduates and 63 international medical graduates. Fifty-nine applicants with rank lists did not match. On average each applicant applied to 34 programmes. Of the 818 who matched, 380 matched at their first choice and 584 at one of their top three. In the first combined match in 2019, 92% of applicants applied to programmes in only one subspecialty.

The rules of conduct. The AAOS Board of Specialty Societies code of conduct (opens in a new tab) applies to every programme in the single match:

• Programmes must let you meet the faculty and the current fellows at interview. They must also give you contact details for current and former fellows if you ask. They may not require a visit before or after the interview.
• Ask all your questions on the interview day. After the interview, you may not tell a programme how you intend to rank it or ask how it will rank you. Thank-you notes are discouraged. Logistical questions go to the programme coordinator.
• Your residency faculty are discouraged from contacting the fellowship faculty after your interview to support your application. The old advice to have your chief "make a call" runs against the code once interviews have taken place.
• A match is binding. If you accept a post outside the match, withdraw from the match and tell every programme you applied to.

How do international graduates apply to US fellowships?

To train in an ACGME-accredited programme you need an ECFMG certificate. J-1 visa sponsorship for clinical training in these programmes comes only from Intealth, which trades as ECFMG; its fact sheet (opens in a new tab) describes it as the exclusive sponsor. Under section 212(e) of the Immigration and Nationality Act, J-1 physicians and their J-2 dependants must return to their home country for at least two years in total (opens in a new tab) before they become eligible for certain other US visas. This affects anyone hoping to take a US job straight after fellowship. Each programme decides whether it accepts international graduates, so check its listing before you pay to apply. The ECFMG certification and USMLE post covers the examinations.

How do UK post-CCT fellowships work?

The UK has no national match for most orthopaedic fellowships. Individual trusts create the posts, usually for six to twelve months, and many advertise on NHS Jobs. Lead times vary. In the Orthopaedic Trauma Society's listing (opens in a new tab), the Middlesbrough complex trauma fellowship is "routinely booked up from two years ahead". The Edinburgh Trauma Fellowship runs from August to July and asks for candidates within three years of completing training. Contact units well before they advertise.

JCST interface fellowships. The Joint Committee on Surgical Training (opens in a new tab) oversees 12-month post-certification fellowships in areas that certification does not train to unsupervised level. Three of these are open to trauma and orthopaedic surgeons: hand surgery (shared with plastic surgery), spinal surgery (shared with neurosurgery) and major trauma. Fellows must be on the specialist register, and ideally within two years of certification. For hand surgery, the British Society for Surgery of the Hand (opens in a new tab) says selection starts in October for posts beginning the following August. Final-year trainees who will gain their CCT before the start date may apply.

BSSH also reported that NHS England withdrew central funding for the hand fellowships in September 2024 (opens in a new tab). As a result, no new fellows could be centrally appointed to English units for 2026. The Edinburgh and Swansea posts are funded separately and continue. Check the current position before you plan around a hand fellowship in England.

International applicants. You need GMC full registration with a licence to practise (opens in a new tab). An international graduate can qualify in six ways: passing PLAB, sponsorship by an approved body, an acceptable postgraduate qualification, a relevant European qualification, an acceptable overseas registration examination, or eligibility for the specialist register. The Medical Training Initiative, a sponsored entry route for overseas doctors to train in the NHS before returning home, closed to new applicants at noon on 31 March 2026 (opens in a new tab). An eligible NHS post can support a Health and Care Worker visa (opens in a new tab). For the wider picture, see international registration for surgeons and visas and immigration for surgeons.

How do Australian and New Zealand fellowships work?

After FRACS, most orthopaedic fellowships in Australia are posts listed in the AOA accredited fellowships directory (opens in a new tab) or arranged directly with a surgeon. AOA acknowledges that medical device companies fund accredited fellowships, and it offers a payroll service that pays the fellow directly so that the funder stays at arm's length from the training.

Two RACS-approved PFET programmes are relevant to orthopaedic surgeons:

• Hand surgery (Australian Hand Surgery Society). The AHSS PFET programme (opens in a new tab) lasts two years, and at least 12 months must be spent in an accredited centre in Australia or New Zealand. Up to six months can be credited from pre-fellowship training, and six to twelve months can be spent overseas with prior approval. Applications are accepted before you finish training, but you must have passed the RACS Part II examination and hold FRACS before you start. Posts begin in February or August.
• Spinal surgery. Spinal PFET programmes (opens in a new tab) are open to surgeons who hold a specialist qualification in orthopaedic surgery or neurosurgery.

International applicants. Overseas specialists usually register through the Medical Board of Australia's Short-term training in a medical specialty pathway (opens in a new tab). It allows up to 24 months of specialist or advanced training. To qualify, you must have completed your specialist training, or be within two years of completing it, and already hold an offer of a post. The relevant college then assesses whether the post suits you, and you apply for limited registration. This pathway does not lead to specialist registration, and you are expected to return home at the end. AOA's fellowship administration service (opens in a new tab) prepares and lodges the registration and visa paperwork for accredited fellowships.

How do Canadian fellowships work?

Canadian orthopaedic fellowships are run by universities, and you apply to each fellowship programme director. The University of Toronto describes a clinical fellowship (opens in a new tab) as "ordinarily a one-year to three-year 'topping off' experience" that does not lead to Royal College certification. On its own, it is not a route to permanent practice in Ontario. To get the educational licence from the College of Physicians and Surgeons of Ontario, you must be recognised as a specialist where you currently practise, and you apply for it only after a fellowship has accepted you. Applicants from some countries must apply through a sponsoring agency, which has to provide a letter confirming full funding for the whole fellowship.

When should you apply? A working timeline

Registration takes longer than people expect. The Medical Board of Australia requires primary source verification of your qualifications through ECFMG's EPIC service before you apply, and each body sets its own fees. Start the paperwork as soon as you have a signed offer.

Documents and referees

When the combined US match began, the AAOS Fellowship Committee agreed a common document set and asked programmes not to request anything more:

• the CAS application form
• your CV
• USMLE Step 1 or COMLEX 1 scores, or the equivalent
• a letter of good standing from your programme director
• three letters of reference

The Orthopaedic Trauma Association also publishes an optional standardised letter of recommendation form. Outside the US, the job description lists what each post needs. Expect to provide a CV, a cover letter, a logbook summary and two or three referees.

• Logbook. Summarise the index procedures for the subspecialty and separate the cases you performed from those you assisted with. Fellowship directors read the logbook to judge what you can already do. See keeping a good surgical logbook.
• CV and cover letter. Name the programme's specific case mix, techniques or research that you want, and say how they connect to the job you are aiming for. How to write a surgical CV covers the format.
• Referees. Choose surgeons who have recently watched you operate and manage complications. Ask each one directly whether they can write a strong letter for this subspecialty. Prefer a detailed letter from a consultant who knows your work to a brief one from a well-known name.

How to judge a fellowship programme

In a survey of 283 residents at 44 North American academic centres, case volume, surgical variety and programme reputation were the top factors in choosing a fellowship programme (Li 2019). Reputation is visible on a website. Volume and variety are not, because the case numbers that matter are the ones the fellow performs. Ask the current and former fellows, whose contact details US match programmes must give you if you ask:

• What do you do in a major case? Over the last ten index cases, how many approaches, reductions or implant steps did you perform yourself?
• Who else competes for the cases? How many fellows, residents or registrars work on the same lists, and who takes priority?
• How does supervision change during the year? Is there a point when you operate with the consultant present but not scrubbed?
• How much of the week is service? What are the call duties, ward work and private-practice cover?
• What research is expected, and is there support for it, such as a coordinator, a database or a statistician?
• Where did the last three fellows find jobs, and did the director help them?
• Can you live on the pay in that city?

For international posts, ask in writing whether your registration and visa will allow you to operate as the primary surgeon under supervision. An observership is not a clinical fellowship. Prepare for the interview itself with orthopaedic fellowship interview questions.

Funding, pay and costs

Pay depends on the system and on who funds the post, so get the salary and benefits in writing before you rank or accept. UK posts state the salary in the NHS Jobs advert. In Australia, industry funding for accredited fellowships can be paid through AOA. Some European fellowships pay little. One example listed by AOA, a hand and upper limb fellowship in Chambéry, France, paid €1,400 a month without accommodation.

Budget for the fees of each body involved: ECFMG or AMC verification, college suitability assessments, GMC or Medical Board registration, visas and relocation. BSSH supports UK hand interface fellows with up to £500 towards BSSH-organised courses and meetings when its budget allows.

One fellowship or two?

Most surgeons do one. Of 9,776 applicants for ABOS Part II between 2004 and 2016, 444 (4.5%) had completed more than one fellowship (DePasse 2018). The most common second fellowships were trauma, sports medicine and joints. The most common pairings were joints with sports medicine, and foot and ankle with sports medicine. The proportion did not rise over the study period. Whether a second year pays off depends on the job you want, and job or fellowship: knowing when to stop training sets out the rules and numbers.

Making the fellowship year count

• Keep your logbook in the format your next employer or board will ask for, starting on day one.
• Collect the unit's protocols: preference cards, rehabilitation regimes and complication pathways. You will rebuild them in your first consultant post.
• Finish one project, ideally in the area your director publishes on.
• Plan around exams. If your exit examination is still ahead, the fellowship year will overlap with revision. The global orthopaedic board exam atlas compares the FRCS (Tr & Orth), FRACS, ABOS and other formats.
• Start the consultant job search early. In the UK you may be interviewed for consultant posts up to six months before your expected CCT date. How to land your first consultant job covers the process.