Orthopedic Surgeon

What orthopedic surgeons make

Net income after overhead. Most bill the province per operation, so income depends on how much operating room time your hospital gives you. Pay varies by province and billing model. CIHI (Canadian Institute for Health Information) reports average gross payments of about $538,000 for orthopedic surgery in 2023 to 2024, before overhead, and Job Bank puts the median for all surgeons at about $419,000.

During residency

Residents are paid employees. Quebec pays the least. Expect 60 to 80 hour weeks and frequent overnight call for trauma.

The catch: operating time is rationed

Hospitals fund a fixed number of operating room hours. Patients are waiting, but without a funded slot a surgeon cannot bill. Some new grads do 2 or more fellowships or leave for the US while they wait.

What it costs to get there

Undergrad degree (3 to 4 years)

$7,000 to $10,000 a year

Medical school (3 to 4 years)

$15,000 to $28,000 a year

MCAT (medical school admission test), applications, interviews

$2,000 to $5,000

MCCQE (the national medical exam) plus the Royal College exam

$1,500 for the MCCQE, plus several thousand more for the Royal College exam

Malpractice fees once practising

Tens of thousands a year, partly reimbursed

Roughly, all in

$73,000 to $167,000

Tuition, fees, exams and kit. Not rent, food or travel

The low end is a three year undergraduate degree and a three year medical school at the cheaper end of Canadian tuition, plus the MCAT (medical school admission test), the MCCQE (the national medical licensing exam) and the Royal College certification exam. The high end is four years of each at the priciest schools with the full range of application and exam fees. Residency and the usual one or two fellowship years are paid at roughly resident wages, so they add no tuition. The malpractice fees quoted in the tens of thousands a year are a cost of practising later, partly reimbursed, not a cost of qualifying.

Typical debt at the end of medical school is $80,000 to $150,000. Fellowships add another 1 to 2 years at roughly resident pay.

What comes with the job

• No employer pension

  Most surgeons are self-employed and save through a professional corporation.

• On-call stipends

  Hospitals pay extra for covering trauma nights and weekends.

• Malpractice coverage

  Through the CMPA (Canadian Medical Protective Association). Orthopedics sits in a higher fee band than most specialties.

• Team and clinic work

  Some sports surgeons work with professional teams or private sports clinics on the side.

The path

Same road as every surgeon, with a match that is hard to win.

1. 1

   High school

   Grades 11 and 12

   Top marks in biology, chemistry, math and English. A very high average is the entry ticket.

2. 2

   Bachelor's degree

   3 to 4 years

   Any major, usually life sciences. High GPA, research, volunteering. Write the MCAT (medical school admission test).

3. 3

   Medical school, the MD (doctor of medicine)

   3 to 4 years

   Acceptance rates are 5 to 15%. Orthopedic electives and research in your final year matter a lot for the match.

4. 4

   Orthopedic surgery residency

   5 years

   Matched through CaRMS (the residency matching service). Paid, supervised. Trauma call, fracture clinics, joint replacements, kids, spine, sports.

5. 5

   Royal College exam, licence, fellowship

   1 to 2 years

   Pass the Royal College of Physicians and Surgeons of Canada exam, register with your provincial College of Physicians and Surgeons. Almost everyone does at least one fellowship.

High school courses that help

• Biology and chemistry

  Required for nearly every pre-med path.

• Physics

  Orthopedics is applied mechanics: levers, loads, materials.

• Calculus and functions

• English

  Half the job is explaining an operation to a scared patient.

Time and money, at a glance

Years after high school

12 to 15

Med school acceptance rate

Roughly 5% to 15%

Orthopedic residency spots in Canada

About 70 a year

Total tuition

$90,000 to $150,000

Paid while training?

Only from residency on

Heavily regulated

You need a licence from your provincial College of Physicians and Surgeons to practise, and specialist certification from the Royal College of Physicians and Surgeons of Canada to work as an orthopedic surgeon. Hospitals grant operating privileges only with both. Licences transfer between provinces with paperwork and fees.

Fellowships that shape the job

Nearly every new orthopedic surgeon does 1 to 2 years of fellowship.

• Joint replacement (arthroplasty)

  Hips and knees. Huge demand from an aging population.

• Sports surgery

  Torn ligaments, shoulders, keyhole knee surgery.

• Spine

  Shared territory with neurosurgeons. Long, high-stakes cases.

• Trauma

  Broken bones at big-city trauma centres. Lots of night work.

• Hand, foot and ankle, pediatric

  Smaller subspecialties with steady demand.

Nice-to-haves

• Orthopedic electives and research in med school

  Reference letters from orthopedic surgeons decide the match.

• Physical strength and stamina

  Reducing a dislocated hip or holding a leg for an hour is real work.

• Comfort with tools

  Saws, drills, plates and screws. Shop class is not a joke here.

• Sports background

  Common in the field, and useful in sports medicine.

The job market is the hard part

Demand from patients is enormous: wait times for hip and knee replacements are among the longest in Canadian health care. But the number of funded operating room hours limits how many surgeons a hospital can take on. For more than a decade, surveys by the national orthopedic association have found many new grads working locums, extra fellowships or part-time for years before landing a permanent job.

A typical day

7:00 a.m. rounds on post-op patients. 8:00 first case in the operating room (OR): a total knee replacement, about 90 minutes, then another, then a hip. Fracture clinic on other days: 30 to 50 patients, casts, X-rays and follow-ups. On trauma call, a broken hip from a fall or a motorcycle crash can pull you in at any hour, and you may operate through the night.

The honest trade-offs

Work life

Typical hours

50 to 70 a week, plus call

Remote work

None

Physical demand

Very high

Unionized

Residents yes, staff surgeons no

Similar paths

• General SurgeonOperate on the abdomen, breast, skin and trauma cases. About 13 years of training for one of the broadest jobs in medicine.
• NeurosurgeonOperate on the brain, spine and nerves. The longest surgical training in Canada, one of the highest paid, and one of the smallest job markets.
• PhysiotherapistGet people moving again after injury, surgery and illness. A tough master's to get into, then steady work everywhere.

The tools look like they came from a hardware store

Orthopedic operating rooms use power saws, drills, mallets, chisels and reamers. Implants are held in with screws and plates. It is carpentry on living bone.

Waiting a year for a new knee

The national target is a hip or knee replacement within 6 months. Many provinces miss it, and waits over a year are common in places. The bottleneck is funded operating time, not a lack of trained surgeons.

The least gender-balanced specialty

About 1 in 7 orthopedic surgeons in Canada are women (about 14% in 2022), the lowest share of any surgical specialty. Programs are actively trying to change that.

You get to spell it two ways

Orthopaedic and orthopedic are both correct. The national association uses the older spelling with the extra a. Either way it comes from the Greek for straight and child, because the field began with correcting children's deformities.