Specialty focus

Orthopedic surgery: Tips on landing a residency in this specialty

The competition for orthopedics residency slots is fierce, but the rewards are high. Program directors share what it takes to win them over.

High pay, high demand and the immediate satisfaction of “fixing” patients’ problems puts orthopedic surgery near the top of rank lists for osteopathic medical students considering the cutting specialties.

“Orthopedics is such a rewarding specialty because you’re working with patients who have a significant problem, and oftentimes you’re correcting it,” says Wade Faerber, DO, program director of the orthopedic surgery residency at Riverside University Health System in Moreno Valley, California. “You see your patients’ functionality and quality of life dramatically improve.”

The specialty places high demands on physicians, and getting into an orthopedic surgery residency program is hard. Yet orthopedics appeals to results-driven individuals who are less inclined to puzzle over diagnoses or provide longitudinal care lasting years.

“There is an instant gratification that comes from repairing someone rather than taking care of someone with a chronic condition like high blood pressure,” points out Joel L. Rush, DO, who directs the orthopedic surgery residency at Broward Health Medical Center in Fort Lauderdale, Florida.

Getting started

Residencies in orthopedic surgery take five years to complete, with applicants far outnumbering available slots. The Broward program, which is a dually accredited AOA/ACGME orthopedic surgery residency, recently received 450 applications for 3 training slots.

Ranking at or near the top of your class, and a COMLEX score in the 85th percentile or above, are baseline qualifications for competitive applicants. Now with programs transitioning to ACGME accreditation under the single GME accreditation system, applicants should also be taking the USMLE and scoring in the 85th-plus percentile on that exam, suggests Dr. Rush. For his program, which recently transitioned from AOA to ACGME accreditation, Dr. Faerber prefers candidates who have a COMLEX score above the 75-80th percentile.

Clinical rotations

Many residency programs, including Dr. Faerber’s, prefer to interview candidates who have completed an orthopedic surgery rotation at their hospital.

“We screen candidates based on grades, board scores, research and extracurriculars, but we are absolutely looking for team players,” he says. “If you have what we’re looking for on paper and then come and rotate with us, that gives us a better idea of who you are as a person. I’m very hesitant to interview someone unless they have rotated with us.”

Dr. Rush recalls one student who had great credentials but blew his rotation. “He thought he was a shoo-in. But when he was on service, he was lazy,” Dr. Rush remembers. “He would be looking at football scores while other people worked, and he wasn’t prepared.”

Students who are interested in orthopedic surgery should research potential residency programs and try to do an elective rotation with one of them during their third year, says Dr. Faerber, who recommends starting a search early in the spring of second year. Make sure to pursue rotations at hospitals that have orthopedic surgery residency programs, he says, otherwise the elective may be educational but will also be a missed opportunity to get to know a program you might match into.

Dr. Faerber also advises students to seek out orthopedics programs that have a history of accepting DOs.

Physical talent

As with all surgical specialties, orthopedic surgeons need good hands, coordination and visual-spatial acumen. Stamina and strength are also important in orthopedic surgery, a physically demanding specialty. But brute strength isn’t essential.

“I’m just 5 foot 7—not a big guy,” Dr. Rush says. “For me to reduce a hip is a lot of work, and it’s going to be harder for someone who is 5 foot 3. But in this field, you learn how to use your body size appropriately to do what you have to do.”

An affinity for tools and technology also align well with the specialty. “I’m a tool junkie,” Dr. Rush admits. “I love that I get to use really cool battery-operated saws and all manner of drills, chisels and hammers in surgery.”

The lifestyle

The work hours of orthopedic surgeons are also very demanding, particularly in the early years after residency. “You have to assume that in your first few years of practice, you will be busy. You will be working all the time. And you’re not going to see your family much,” Dr. Rush says.

“I joke with my residents about the 80-hour work week rule. They don’t understand that when they get to go home at 9 a.m., and I’ve been up with them all night, I still have the rest of my office day ahead of me.”

Orthopedic surgeons can make choices that manage lifestyle and physical concerns. Those of smaller stature sometimes choose to subspecialize in hand surgery, which also tends to have more defined hours than specialties like trauma surgery. Becoming an employed physician or joining a group practice translates into less time on call.

Further reading on medical specialties

Quiz: What’s the ideal medical specialty for your personality?

Looking beyond the surface: The osteopathic approach to dermatology

Primary care sports medicine: The osteopathic approach

Editor’s Note: A different version of this story was originally posted in 2013. The story has been updated to include new information, including a new program director interview.


  1. Dan

    I am concerned about Dr. Rush, via TheDO, recommending students to take board two exams. Is not one of the reasons for dual accreditation of AOA/ACGME, to integrate training DO and MD counterparts and allow students to do well on their own respective board exams as a means to be competitive? This article seems to have sound advice otherwise, but I personally don’t think promoting the need for two board exams is really DO friendly. Programs who actually want DOs should value COMLEX scores as well as USMLE for adjudication. Should they not?

    Dan OMS-3

    1. James

      Not having Step1 USMLE will only limit options and may especially hurt you when it comes to fellowships. Now that AOA/ACGME programs will be under the same match for the most part, prospective DO applicants will have a greater chance at getting a traditional MD spot. I rotated at a prominent MD program and was asked if I was skipping the DO match. I told them I would not and thus was ruled out from their applicant pool. There was too much risk skipping the AOA match then. But now with both being in the same match pool that risk is gone for the most part. MD programs dont want the hassle of looking at 2 boards. Do yourself the favor and take the USMLE. I did and it is helping me now going through the fellowship application process.

  2. Ochola Henry

    I am a final year medical student from Uganda in Eastern Africa. I have great passion for surgery, specifically orthopedic surgery. Given their few number in my locality, I seek for more guidance into this speciality.
    Thank you

  3. Pingback: Medical specialties and careers ranked: USMLE mean score and average salary | Achievable Test Prep

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