Orthopedic surgery residency is five years long, or 60 months, as required by the Accreditation Council for Graduate Medical Education (ACGME). That makes it one of the longer surgical training programs, and the five years of residency are only one piece of a much longer educational path. From the start of college to the point where you’re a fully board-certified orthopedic surgeon, the total timeline is typically 13 to 14 years.
What the Five Years Look Like
The five-year residency is structured as a progression from broad surgical foundations to increasingly independent orthopedic practice. The first year (PGY-1, or “intern year”) splits roughly in half between orthopedic rotations and general surgery rotations. At Yale, for example, interns spend six months on orthopedics (pediatric orthopedics, night float, day float) and six months rotating through trauma surgery, vascular surgery, the surgical ICU, the emergency room, and plastic surgery. The idea is to build a wide surgical skill set before narrowing focus.
Years two and three shift heavily toward orthopedic training, with residents taking on more responsibility in the operating room and managing patients with greater autonomy. By the fourth and fifth years, residents function more like junior attending surgeons, leading cases and making treatment decisions with attending oversight. The final year typically includes chief resident responsibilities, where you oversee junior residents and coordinate patient care across the service.
Some Programs Add a Sixth Year
A growing number of academic programs offer an optional six-year track that inserts a dedicated research year into the middle of training, usually between the third and fourth clinical years. The University of Colorado, for instance, selects one resident per class for this track through a separate match process. The extra year is designed for residents aiming for academic careers as clinician-scientists. It doesn’t change the five years of clinical training; it adds a year on top of them. Not every program offers this, and it’s not required for board certification.
The Full Path to Becoming an Orthopedic Surgeon
Residency doesn’t happen in isolation. Here’s the complete timeline most orthopedic surgeons follow:
- Undergraduate degree: 4 years, typically with a pre-med course load
- Medical school: 4 years (MD or DO)
- Residency: 5 years
- Fellowship (optional): 1 year for a subspecialty
That puts the minimum at 13 years after high school before you’re practicing independently, or 14 if you pursue a fellowship. Add the research year and it’s 15.
Fellowships and Subspecialties
Many orthopedic surgeons choose to subspecialize after residency. Fellowships in areas like sports medicine, spine surgery, hand and upper extremity, trauma, joint replacement, and pediatric orthopedics generally last one year. Pediatric orthopedic fellowships, for example, are a standard 12-month commitment. Fellowships aren’t required to practice orthopedic surgery, but they’re increasingly common, especially for surgeons who want to work at academic medical centers or build a practice around a specific type of surgery.
Board Certification After Residency
Finishing residency doesn’t automatically make you board-certified. The American Board of Orthopaedic Surgery (ABOS) requires a two-part examination process. Part I is a computer-based exam you can take right after completing residency. Part II is an oral examination, but you can’t sit for it until you’ve been in practice for at least 17 months in one location. You’ll also need to submit a list of every surgical case you performed during a defined six-month period for review.
After passing Part I, you have five years to complete Part II. If you don’t pass within that window, you lose your “board eligible” status and have to retake Part I before trying again. Most surgeons complete the full certification process within two to three years of finishing residency.
Work Hours During Residency
Orthopedic surgery residency is demanding by any standard. ACGME rules cap residents at 80 hours per week, averaged over four weeks. Continuous shifts cannot exceed 24 hours, and residents must get at least 14 hours off after a 24-hour call shift. They’re also guaranteed a minimum of one day off per week, averaged over four weeks. In practice, orthopedic residents regularly work near the 80-hour ceiling, especially in the early years when overnight call is more frequent.
Resident Pay During Training
Residency salaries are modest relative to the hours worked and the eventual earning potential of an orthopedic surgeon. As of July 2025, one program lists salaries ranging from about $73,000 in the first year to roughly $87,000 in the fifth year. These figures are fairly representative across programs nationwide, though salaries vary somewhat by region and institution. Residents also typically receive health insurance, malpractice coverage, and a small stipend for educational expenses like textbooks and conference travel.