Every orthopaedic surgeon's website says "board-certified." But what does that mean, and does it matter?
The Training Pipeline
Before an orthopaedic surgeon can even sit for the board certification exam, they've completed:
1. 4 years of college (pre-med)
2. 4 years of medical school (MD or DO degree)
3. 5 years of orthopaedic surgery residency (supervised surgical training in all orthopaedic sub-specialties)
4. Optional: 1 year of fellowship (additional training in a sub-specialty: sports medicine, spine, hand, joint replacement, pediatric, trauma, foot and ankle, oncology)
That's 13-14 years of education and training before they see their first independent patient.
What Board Certification Requires
After completing residency, an orthopaedic surgeon can take the board certification exam administered by the American Board of Orthopaedic Surgery (ABOS). The exam has two parts:
Part I (written): A comprehensive exam covering the entire field of orthopaedic surgery. Taken shortly after residency.
Part II (oral): A case-based oral examination where the surgeon presents and defends their management of real surgical cases to a panel of board examiners. Taken after practicing independently for 22 months.
Both parts must be passed to earn board certification. The pass rate for Part I is approximately 80-85%. Part II is roughly 90%.
Board certification is not a one-time achievement. The ABOS requires ongoing Maintenance of Certification (MOC), which includes continuing medical education, self-assessment modules, and periodic re-examination. Surgeons who don't maintain these requirements lose their board-certified status.
Board-Eligible vs. Board-Certified
Board-eligible means the surgeon completed an ABOS-approved residency but hasn't yet passed (or taken) the certification exam. This is normal for recently graduated surgeons who haven't had time to complete both parts.
Board-certified means they passed both parts of the exam and maintain their certification.
A board-eligible surgeon who finished residency last year is in a very different position than a board-eligible surgeon who finished ten years ago and still hasn't passed the exam. If a surgeon is "board-eligible" more than 2-3 years after residency, it's worth asking why.
Does It Actually Matter?
Board certification is a minimum competency standard, not a ranking. It confirms that the surgeon met the training requirements and passed examinations demonstrating knowledge and surgical judgment.
It does NOT tell you:
- How skilled the surgeon is in the specific procedure you need
- How many procedures like yours they perform per year
- What their complication rate is
- Whether they stay current with newer techniques
What matters more than the certificate:
- Volume. Surgeons who do more of a specific procedure tend to have better outcomes. Ask how many knee replacements (or whatever you need) they do per year.
- Fellowship training. A surgeon who completed a sports medicine fellowship and does 200 ACL reconstructions per year will generally outperform a generalist who does 10. Sub-specialty matters.
- Hospital outcomes. Joint replacement outcomes vary significantly by hospital. High-volume joint replacement centers (performing 100+ per year) have lower complication rates.
How to Verify
You can verify any orthopaedic surgeon's board certification at certificationmatters.org (ABOS's public verification tool). Enter their name and check if certification is current.
You can also verify their medical license through your state medical board's website and check for disciplinary actions.
Fellowship Training Explained
After the 5-year residency, many orthopaedic surgeons do an additional fellowship year. The main sub-specialties:
- Sports Medicine: ACL, meniscus, rotator cuff, shoulder instability
- Adult Reconstruction (Joint Replacement): Hip and knee replacement, revision surgery
- Spine Surgery: Spinal fusion, disc replacement, decompression
- Hand and Upper Extremity: Carpal tunnel, fractures, tendon repair, microsurgery
- Foot and Ankle: Bunions, ankle replacement, Achilles repair
- Pediatric Orthopaedics: Scoliosis, growth plate injuries, clubfoot
- Trauma: Complex fractures, polytrauma
- Orthopaedic Oncology: Bone tumors, soft tissue sarcomas
Fellowship training isn't required, but for complex or sub-specialty specific procedures, a fellowship-trained surgeon brings deeper expertise.
The Practical Takeaway
Board certification is table stakes. You should expect your orthopaedic surgeon to be board-certified. But don't stop there. Ask about their fellowship training, their volume for your specific procedure, and their approach to your particular problem. The best surgeon for your knee replacement might not be the best surgeon for your teenager's scoliosis. Specialization within orthopaedics matters.