Fix broken bones, worn-out joints and torn ligaments. Thirteen years of training for one of the best paid jobs in medicine.
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What you earn and what it costs to get there.
Median
$358,550
Bottom tenth
$84,170
Top tenth
$659,290
The national median is $358,550 a year and the top tenth pass $659,290. The figure covers surgeons who are paid a wage. Many work in private groups and take partnership profits instead, so the real top end is higher than the survey shows. The low $84,170 end is mostly part-time and early-career work.
About $65,000 to $85,000 a year
Paid employee of the hospital, rising a little each year of residency
Five years of residency are paid, which helps, but you are also carrying medical school debt and working long protected hours.
$659,290 a year
Senior partners in busy private groups, spine and joint replacement specialists
Pay tracks the number of procedures you do. Surgeons who own a share of a surgery center or an imaging suite earn more again.
Tuition, fees, exams and kit. Not rent, food or travel
The low end is a community college start into a public university in your own state for the bachelor's degree, about 11,000 dollars a year, then a medical school in your own state at the cheaper end of 30,000 dollars a year. The high end is four full years of undergraduate study plus a private medical school at 65,000 dollars a year or more, with 3,000 to 8,000 dollars for the admission test, applications and interviews and several thousand more for the licensing and board exams. The five to six years of residency and fellowship are paid hospital jobs, so they add no tuition, but interest builds on the loans throughout. Most teaching hospitals are nonprofits, so residency years count toward the ten years of payments that cancel federal student debt.
Six figures of federal student loan debt is normal. File the FAFSA (Free Application for Federal Student Aid) each year. Residency salaries count toward the Public Service Loan Forgiveness program if your hospital is a nonprofit, which most teaching hospitals are.
Hospital salary
A set amount plus a bonus tied to how much work you do. Common for new graduates and academic surgeons.
Private group partnership
You buy in after a few years and share the group's profits. The biggest earners are here.
Call pay
Extra money for covering nights and weekends at a trauma center. Orthopedic call is busy and pays well.
Ownership stakes
Shares in a surgery center, physical therapy clinic or imaging suite. Legal but tightly regulated.
The exact path from high school to qualified.
One of the longest training routes on this site, and one of the most competitive.
High school
Grades 11 and 12
Top grades across biology, chemistry, physics and math. You need a strong college application first.
Bachelor's degree
4 years
Any major, but you must finish the science prerequisites, keep a very high GPA and sit the medical college admission test.
Medical school
4 years
Two years of science, two years of clinical rotations, leading to an MD (doctor of medicine) or a DO (doctor of osteopathic medicine). Pass the first two national licensing exams along the way.
Orthopedic surgery residency
5 years
Five years, matched through the national residency match. Accredited by the Accreditation Council for Graduate Medical Education. Paid, supervised, and long.
Fellowship and board certification
1 to 2 years
Most surgeons add a one-year fellowship in a subspecialty. Then the American Board of Orthopaedic Surgery certification, which is a written exam followed by an oral exam built on a list of your own cases.
Biology and chemistry
Required for every pre-medical track in the country.
Physics
Orthopedics is applied physics. Levers, loads and materials decide how a fracture is fixed.
Calculus and statistics
Both appear on the medical admission test and in reading research.
Sports, music or anything with your hands
Surgery rewards fine motor control and stamina. It also helps you understand injured athletes.
There is one national exam sequence, the United States Medical Licensing Examination, taken in three steps. Osteopathic students may sit an equivalent sequence instead. Passing it does not license you. Each state medical board issues its own license, checks your training and background, and sets renewal and continuing education rules. Working in two states means holding two licenses.
The American Board of Orthopaedic Surgery sets the education and performance standards for the specialty. Certification comes in two parts: a written exam after residency, then a second exam a couple of years later built around the real cases you have operated on, with peer review. It is voluntary in law but hospitals and insurers expect it, so in practice it is not optional.
Things you don't need, but that help.
Sports medicine
Knees and shoulders, arthroscopic surgery, team coverage. The most popular fellowship.
Joint replacement
Hips and knees. Steady volume, an aging population, good pay.
Trauma
Broken pelvises and open fractures at a major trauma center. Nights and weekends come with it.
Hand, spine, foot and ankle, pediatrics
Each is a one-year fellowship and each is a genuinely different job afterwards.
Research
Orthopedic residency applicants are expected to have published. Start in medical school, or earlier.
Away rotations
A month working in a program you want to join is close to a long job interview.
Athletic background
Not required, but a lot of the work is athletes and the culture reflects that.
Comfort with power tools
Saws, drills and mallets are real instruments here. This is the most mechanical specialty in medicine.
Day to day, pros and cons, where you'd work.
Two or three operating days, a clinic day or two, and call. On an operating day you start around 7am and run through a list of joint replacements, scopes or fracture fixations, standing most of the day in lead aprons under imaging. Clinic days mean 30 or 40 appointments: reading scans, injecting joints, explaining recovery times, deciding who really needs surgery. Call at a trauma center means coming in overnight for hip fractures and crush injuries.
The good
The hard parts
Things people don't tell you.
To finish board certification you submit a list of every case you did over a set period, and the oral exam is built from those cases with peer review of your outcomes. Very few professions test you on your actual work rather than a hypothetical.
Accreditation by the Accreditation Council for Graduate Medical Education is voluntary, but programs without it do not receive federal Medicare money for training residents. That is why almost every real residency in the country is accredited.
The federal outlook for this specialty is average. New openings are likely, but large numbers of them are not expected, because the number of residency places each year is fixed rather than set by demand.
Last checked September 2026. Pay figures are typical full-time annual amounts in United States dollars, based on Bureau of Labor Statistics wage data and published pay scales. They vary by state, employer and experience. Tuition is for in-state students at public schools unless the card says otherwise.