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Orthopaedic Surgery Training Pathway

How to become an orthopaedic surgeon in Australia — the RACS Surgical Education and Training program delivered by the AOA as the 'AOA 21' program, how national selection and regional allocation work, the exams, and what the published ATO data shows orthopaedic surgeons earn.

Orthopaedics is one of the largest surgical training programs but also one of the most applied-to — on RACS's published numbers, only around one in four or five applicants is made an offer, and the prerequisites mean almost everyone does unaccredited orthopaedic time before they can apply.

Orthopaedic Surgery
RACS / AOA · Royal Australasian College of Surgeons / Australian Orthopaedic Association
Training length
~5 (SET, min 4)
Competitiveness
Very high
Exams
GSSE + OPBS + Fellowship Exam
Lifestyle
Mixed — trauma on-call; large private/elective component
Fellowship
FRACS (Orthopaedic Surgery)
Time to qualify
9–12 years

Why orthopaedic surgery

You manage the musculoskeletal system — fractures and trauma, joint replacement, arthroscopy, sports injuries, spine, hand, foot and ankle, and paediatric orthopaedics — across high-volume elective operating lists and real acute trauma on-call. It's physically demanding, technology-rich surgery with power tools, implants, navigation and increasingly robotics.

✓ Draws
  • Decisive, hands-on procedural surgery with clear, often dramatic outcomes
  • Broad case-mix — trauma, arthroplasty, sports, spine, hand, paeds, tumour
  • Strong earnings — its own ATO code sits above the blended surgeon average
  • A very large private/elective component alongside public trauma work
⚖ Trade-offs
  • Among the most applied-to surgical selections — a low offer rate
  • Rotation and radiation-safety prerequisites effectively require prior orthopaedic time
  • A long, expensive CV-build before selection
  • Physically demanding work with real acute trauma on-call

Subspecialties

Trauma surgeryArthroplasty (hip & knee replacement)Sports & arthroscopic surgerySpine surgeryHand & upper limbFoot & anklePaediatric orthopaedicsOrthopaedic oncology (bone & soft-tissue tumours)

The training pathway

The same fellowship, two very different timelines. The fast route assumes everything goes right; most people land on the realistic one.

Fastest route
~8 years
The arithmetic floor — internship, the orthopaedic experience and prerequisites needed to apply, then the competency-based program completed at its four-year minimum. In practice almost nobody is selected this early.
Internship
PGY1
General registration. The GSSE is typically attempted before applying.
Residency / pre-SET requirements
PGY2–3
Applicants must be PGY3+ with ≥26 weeks of orthopaedic experience in the last two years, a GSSE pass and a state-licensed Radiation Safety Course by the closing date.
SET selection (Orthopaedic Surgery)
from PGY3+
National AOA 21 selection. RACS checks generic eligibility; the AOA assesses specialty criteria and ranks applicants. Eligible applicants may apply at their discretion (the 2027 regulations set no maximum attempts; a four-attempt cap applied to the 2025 intake).
Introduction to Orthopaedics
min 12 months
The first SET phase; in-training assessments, orthopaedic modules and the eLogbook begin.
Core Orthopaedics
min 24 months
The core phase; the Orthopaedic Principles and Basic Sciences (OPBS) examination and the research requirement are completed during training.
Transition to Practice
min 12 months
The senior phase; the Fellowship Examination is sat here.
Fellowship — FRACS (Orth)
Qualified · ~PGY8+
Specialist registration on passing the Fellowship Examination.
Realistic route
9–12 years
Typical — internship, residency and several unaccredited/service-registrar orthopaedic years to meet the prerequisites and build a competitive CV, before a roughly five-year program. RACS/AOA don't publish a required number of pre-SET years.
Internship & residency
PGY1–3
General registration plus surgical experience; the GSSE and the radiation-safety course are usually completed here, and the ≥26 weeks of orthopaedic experience is accrued.
Unaccredited / service-registrar orthopaedics
a few years
Most do unaccredited orthopaedic terms to meet the rotation and referee prerequisites and build the CV. No required number of years is published.
SET selection (Orthopaedic Surgery)
the hardest step
The bottleneck. RACS's figures show recent intakes ran roughly 317–336 applicants for about 72–78 offers nationally — around one offer for every four to five applicants. The 2027 regulations set no maximum number of attempts.
AOA 21 program (3 phases, SET 1–5)
~5 years (min 4)
Competency-based training across Introduction, Core and Transition-to-Practice phases, including the OPBS exam, work-based assessments and a research requirement.
Fellowship Examination — FRACS (Orth)
Transition to Practice · ~PGY10+
Two written segments then five clinical/viva segments; pass for specialist registration. Many then add a 1–2 year (non-accredited) subspecialty fellowship.

How competitive is it?

Per the RACS Activities Reports, Orthopaedic Surgery (Australia) recorded about 317 applications for 72 offers for the 2023 intake (roughly a 23% offer rate) and about 336 for 78 offers for 2024 (about 23%) — close to one offer for every four to five applicants, and the largest application volume of any RACS specialty. By commencement, RACS appointed around 52–61 trainees a year across the 2023–2025 intakes. The gap from the offer counts is one of scope, not a data error: the Activities Report offer figures cover the combined Australia and Aotearoa New Zealand selection region (for the 2024 intake, 78 offers split 60 to Australia-resident and 18 to NZ-resident applicants), while the trainees-appointed counts above are for the Australian program only. The Reports recorded about 316 active SET trainees and about 1,746 active Fellows (around 1,385 Australia-based) in 2024. The national count of accredited posts and the public/private split aren't published.

Unaccredited time: In practice, effectively yes — there's no formal rule, but the 26-week orthopaedic-experience, radiation-safety and referee prerequisites mean almost everyone does unaccredited orthopaedic/service-registrar time before selection. RACS/AOA don't publish a required or typical number of years.

Sources: RACS — Activities Report 2024 (applications, offers, Fellows & SET trainees by specialty), RACS — Activities Report 2023 (applications, offers, Fellows & SET trainees by specialty), RACS — Orthopaedic Surgery (Australia) specialty page (trainees appointed by year), AOA — Selection into Training.

Selection criteria & how to apply

Selection is national — run by the AOA under RACS SET as the 'AOA 21' program — with applicants allocated to a training region. The model changed after the 2025 intake: for the 2027 intake the ranking score is just two weighted tools — a semi-structured interview (60%) and a verbal referee report (40%) — while a structured CV (minimum 6 points) and an Orthopaedic MCQ test combined with a departmental referee report act as pass/fail gates to reach the interview. (The older 2025 model scored an SJT 30%, interview 40%, referees 30%; the MCQ replaced the SJT from 2026.) Separately, a GSSE pass, a state-licensed Radiation Safety Course and ≥26 weeks of orthopaedic experience at PGY3+ are eligibility gates. The scored steps, with their published 2027-intake weightings:

Semi-structured interview60%
The single largest weighting and the main separator. Conducted across multiple panels of at least two members, with applicants rotating between them; the interview score is the mean across panels.
Verbal referee report40%
A structured verbal report from nominated referees, scored against a key. The second of the two weighted ranking components for the 2027 intake.
Structured CVGate
A gate, not a weighted component: applicants must score a minimum of 6 points across surgical/medical experience, skills courses, higher qualifications and research before progressing. Not part of the final ranking score.
Orthopaedic MCQ test + departmental referee reportGate
A combined gate for the 2027 intake: the OMCQ test and a departmental referee report are scored together, and applicants must do better than one standard deviation below the mean to progress to interview. The OMCQ replaced the situational judgement test from the 2026 intake.
GSSE, Radiation Safety Course & rotationsGate
Eligibility gates that must be met before assessment: a GSSE pass, a state-licensed Radiation Safety Course, and ≥26 weeks of orthopaedic surgical experience in the last two years at PGY3+ in a hospital with an emergency department and on-call roster.

Key documents: AOA — AOA 21 Selection Regulations (2027 intake), AOA — Selection into Training, RACS — 2024 Guide to Surgical Selection (2025 intake): Orthopaedic Surgery.

How it works, region by region

Selection is national, but training is delivered in regions. The AOA runs one national process and ranks applicants; you nominate regional preferences and are generally offered a post in the region in which you interviewed. Several regions pair jurisdictions — Tasmania sits with Victoria and the Northern Territory with South Australia — and New South Wales runs as two regions (Sydney and Newcastle). A per-state breakdown of trainee numbers isn't published for orthopaedics, so the regional notes below describe how each region fits the national process rather than quoting post counts.
NSW Run as NSW–Sydney and NSW–Newcastle regions — a per-state trainee breakdown isn't published for orthopaedics

Who runs selection: Run as two AOA regions — NSW–Sydney and NSW–Newcastle. Selection is national (AOA 21); the region employs and rotates you through accredited posts.

Where to apply: AOA national SET selection (regional allocation) — application portal.

Positions: Run as NSW–Sydney and NSW–Newcastle regions — a per-state trainee breakdown isn't published for orthopaedics

Worth knowing: NSW is split into two training regions (Sydney and Newcastle), with the Sydney region further organised into sub-areas.

Links: AOA — Selection into Training, RACS — Orthopaedic Surgery (Australia).

VIC Part of the Victoria region (incl. Tasmania) — a per-state trainee breakdown isn't published for orthopaedics

Who runs selection: Part of the Victoria training region, which includes Tasmania. National selection; the region employs and rotates trainees.

Where to apply: AOA national SET selection (regional allocation) — application portal.

Positions: Part of the Victoria region (incl. Tasmania) — a per-state trainee breakdown isn't published for orthopaedics

Worth knowing: A major training hub; Tasmanian training is delivered within this region.

Links: AOA — Selection into Training.

QLD Its own Queensland region — a per-state trainee breakdown isn't published for orthopaedics

Who runs selection: Its own Queensland training region. National selection; Queensland Health hospitals employ and rotate trainees. An optional Far North Queensland rural pathway exists.

Where to apply: AOA national SET selection (regional allocation) — application portal.

Positions: Its own Queensland region — a per-state trainee breakdown isn't published for orthopaedics

Worth knowing: A standalone region spanning Brisbane and regional Queensland, with an opt-in Far North Queensland rural rotation pathway.

Links: AOA — Selection into Training.

SA Part of the SA/NT region — a per-state trainee breakdown isn't published for orthopaedics

Who runs selection: Part of the South Australia / Northern Territory training region, anchored by the Adelaide teaching hospitals. National selection applies.

Where to apply: AOA national SET selection (regional allocation) — application portal.

Positions: Part of the SA/NT region — a per-state trainee breakdown isn't published for orthopaedics

Worth knowing: A combined region; Northern Territory training is delivered within it.

Links: AOA — Selection into Training.

WA Its own WA region — a per-state trainee breakdown isn't published for orthopaedics

Who runs selection: Its own Western Australia training region, anchored by the Perth teaching hospitals. National selection applies.

Where to apply: AOA national SET selection (regional allocation) — application portal.

Positions: Its own WA region — a per-state trainee breakdown isn't published for orthopaedics

Worth knowing: A standalone region; small numbers make timing important.

Links: AOA — Selection into Training.

TAS Within the Victoria region — a per-state trainee breakdown isn't published for orthopaedics

Who runs selection: No standalone region — Tasmania is part of the Victoria training region. National selection applies.

Where to apply: AOA national SET selection (regional allocation) — application portal.

Positions: Within the Victoria region — a per-state trainee breakdown isn't published for orthopaedics

Worth knowing: Training is delivered through the Victoria region, so rotations can include interstate time.

Links: AOA — Selection into Training.

ACT No standalone ACT region — a per-state trainee breakdown isn't published for orthopaedics

Who runs selection: The ACT does not run as its own AOA region; the national process applies and training is delivered through host regions.

Where to apply: AOA national SET selection (regional allocation) — application portal.

Positions: No standalone ACT region — a per-state trainee breakdown isn't published for orthopaedics

Worth knowing: Canberra orthopaedic training is delivered through neighbouring regions rather than running as its own.

Links: AOA — Selection into Training.

NT Within the SA/NT region — a per-state trainee breakdown isn't published for orthopaedics

Who runs selection: No standalone region — the Northern Territory is part of the South Australia / Northern Territory training region. National selection applies.

Where to apply: AOA national SET selection (regional allocation) — application portal.

Positions: Within the SA/NT region — a per-state trainee breakdown isn't published for orthopaedics

Worth knowing: Orthopaedic training capacity in the NT is small; training is delivered through the SA/NT region.

Links: AOA — Selection into Training.

How to optimise your application

The honest read: Entry is the bottleneck. The weightings are in the Selection section; sustained, recent orthopaedic experience is what makes the referees, rotations and CV land.
  • Build sustained orthopaedic experience (tied to Referee reports (40%) & CV gate, start PGY1–3) — Unaccredited orthopaedic/service-registrar terms meet the 26-week experience gate and let you field strong consultant and departmental referees — continuous, recent orthopaedic time counts most.
  • Prepare hard for the interview (tied to Semi-structured interview (60%), start pre-application) — The interview is the single largest weighting and the main separator — practise structured surgical-selection scenarios across multiple panels.
  • Pass the gates early — GSSE, radiation safety and the OMCQ (tied to Eligibility & interview gates, start PGY1–3) — A GSSE pass and a state-licensed Radiation Safety Course are required before you can be assessed; the orthopaedic MCQ test (with the departmental referee report) then gates the interview. Prevocational doctors get unlimited GSSE attempts.
  • Build the CV — experience, courses and research (tied to CV gate (min 6 points), start early) — The CV must clear a minimum score across surgical experience, skills courses, qualifications and research/publications before you progress — build it deliberately over time rather than at the last minute.

Key documents & official links

FAQ

Is orthopaedic surgery hard to get into?
Yes — see the Competitiveness section for the published figures (roughly one offer for every four to five applicants). Selection, not the exams, is the bottleneck. The 2027 regulations set no maximum number of attempts (a four-attempt cap applied to the 2025 intake).
How long does training take?
The AOA 21 program is competency-based with a four-year minimum and takes about five years on average, across three phases (Introduction, Core and Transition to Practice). You can't apply until you're PGY3+ with 26 weeks of orthopaedic experience, so a realistic span from graduation is around 9–12 years. RACS/AOA don't publish a maximum total training duration.
Is selection national or state-based?
National. The AOA runs one process (AOA 21) and allocates applicants to a training region. For scoring detail and gates see the Selection section above. The 2027 regulations set no maximum number of applications.
What are the exams?
The Generic Surgical Sciences Examination (GSSE) as an entry prerequisite; the Orthopaedic Principles and Basic Sciences examination (OPBS) during the core phase; and the Fellowship Examination (two written segments then five clinical/viva segments) in the senior phase, plus a research requirement. RACS does not publish pass rates for these exams.
How much do orthopaedic surgeons earn?
Orthopaedics has its own ATO code (253514), and in 2023–24 orthopaedic surgeons (981 taxpayers) averaged about $554,839 taxable income with a median of about $434,435 — above the blended four-digit "surgeon" group (about $519,998 average, all surgical specialties combined) that headlines usually quote. The driver is a very large private and elective component — joint replacement, arthroscopy and spine surgery billed per MBS item with a private gap on top.

Trained overseas? (IMG pathway)

How overseas-trained orthopaedic surgery doctors get recognised

Overseas-trained orthopaedic surgeons are assessed by RACS as a Specialist International Medical Graduate (SIMG) for comparability to an Australian-trained orthopaedic surgeon, within the Medical Board's specialist pathway. Substantially comparable applicants do up to 12 months of supervised clinical assessment with no Fellowship Examination; partially comparable applicants do up to 24 months of supervised practice and must pass the Fellowship Examination; not-comparable applicants are directed to the AOA 21 training program instead.

See the RACS — SIMG specialist assessment and our IMG internship guide.

General Surgery RACS / GSAPlastic & Reconstructive Surgery RACS / ASPSUrology RACS / USANZ

Last reviewed 2026-06-09.

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