Editor’s Note: This account reveals the complexity of what it takes to match into an orthopaedic surgery residency program today. Those of us in practice and beyond may not fully understand the realities that present day medical students, both MD and DO, must contend with.
“Look to your left and look to your right. One of you won’t match [for an orthopaedic surgery residency spot], don’t let it be you.” These were words of guidance given to me by a senior resident.
In 2020, a merger between American Osteopathic Association and the Accreditation Council for Graduate Medical Education, (ACGME), led to the creation of the SAS, the Single Accreditation System. This unifies graduate medical education allowing both Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO) graduates to train in the same residency and fellowship programs accredited solely by the ACGME. Both MDs and DOs are, therefore, evaluated on the same set of milestones and clinical competencies.
Undergraduate education for both MD and DO students is grounded in the same scientific principles and prepares graduates to diagnose, treat, and prevent disease through evidence-based medicine. Both pathways provide comprehensive training in the biomedical and clinical sciences and lead to full physician licensure.
Doctor of Osteopathic Medicine education builds upon this shared foundation with additional training that emphasizes a patient-centered approach to care. DO students are taught to consider the relationship between the body’s structure and function, the impact of lifestyle and environmental factors on health, and the interconnectedness of body systems. In addition, osteopathic students complete dedicated training in Osteopathic Manipulative Treatment (OMT), a 200-hour medical school course that may be used alongside other medical and surgical treatments to support patient care.
Both specialties have multi-part medical board examinations which are of similar length and are fact based. For example, passing the COMLEX or Comprehensive Osteopathic Medical Licensing Examination, Level I and II, is required for all DO students to graduate. It is really a “sister” exam to the USMLE examinations. It differs primarily by including some questions about Osteopathic Manipulative Treatment.
USMLE or United States Medical Licensing Examination, Steps 1 and 2, is the licensing examination taken by MD students.
DO students aiming for highly competitive residencies such as in the surgical subspecialties often take the USMLE, Steps 1 and 2, in addition to the COMLEX examinations to enable standardized comparisons by residency programs.
I have just successfully matched into an orthopaedic surgery residency program and am very grateful. The process has given me time to reflect on my own journey, how applicants find our ways to the specialty, and the factors that influence those journeys. As orthopaedic surgery continues to evolve, there is an opportunity to continue to grow into a community that is more representative, supportive, and welcoming. I hope this adds to that conversation and helps inform future efforts within our field.
In the 2025 orthopaedic surgery residency match, 65-73% of MDs successfully matched. For DOs the number was 45-58%. Two of my close female colleagues who were recognized nationally for their leadership and research involvement, and who did 5-6 “audition rotations” were not successfully paired with any orthopaedic surgery residency programs. Of note, my MD friends did 3-4 audition rotation with one being at their home program.
Those who do not match into an orthopaedic surgery residency program have three options including:
- Find an open unmatched spot in the Supplemental Offer and Acceptance program (SOAP). Of note, in 2025, there were no SOAP spots available in orthopaedic surgery.
- Take a “research year” to bolster their CV and then enter the match again the following year.
- Accept an open spot in another specialty, operative or non-operative. Because of the possibility of not matching, many students simultaneously apply in more than one specialty. This is called a “dual applying” strategy. In other words, applicants rank all programs within their preferred specialty before ranking programs from a secondary specialty. This can be particularly challenging, as students must balance audition rotations with residency interviews. Many osteopathic applicants maximize the number of audition rotations they complete and, unlike some of their MD peers, may not dedicate a separate month exclusively to interviews.
When in the orthopaedic surgery match program, students must have a backup plan, as mentioned above. During Match Week, students receive emails letting them know if they have matched or not. If an applicant does not initially match, they may enter the Supplemental Acceptance Program (SOAP) in which unfilled residency positions are offered through multiple rounds over several days. Applicants must rapidly identify and apply to available programs, remain accessible for communication from program leadership, and make time-sensitive decisions regarding offers, often within a limited window.
58% of MD students who do not match into orthopaedic surgery residencies are successful the following year. The number for DO’s is 25.5%.
Medical and osteopathic students who wish to become orthopaedic residents participate in “away orthopaedic rotations,” “orthopaedic subinternships,” and “audition rotations” which are all essentially the same. These rotations are often considered the most important factor for successfully matching. They allow applicants and programs to get to know each other and to determine whether or not there is a good fit.
There is more to the residency selection process than board scores and publication counts. Factors such as mentorship, research connections, medical school reputation, applicant demographics, and less tangible qualities like work ethic, professionalism, interpersonal skills, and the ability to function as a strong team member may all influence an applicant’s success.
During my audition season, I was told by one of the female residents, that her program was looking for “the right type of woman.” My understanding of what was being implied was “no drama,” being one of the boys, and not causing negative attention that may reflect poorly on the other female residents there.
At a residency interview in the same part of the country, I was asked about my politics and ethical opinions about non-medical issues. I had done an “audition rotation” there and was quietly surprised by the probing questions. One of my friends had comments made about her weight and appearance during a residency interview.
In the NRMP (National Residency Match Program) post-match survey, students are asked about fairness and legality of questions they were asked during interviews. Of the people I know who were asked troubling questions, none reported them. They were worried about backlash which could affect their futures. This is especially true for students who are reapplying, as they do not want to affect their chances of matching in the next cycle. It’s a small world where people talk. Students are in vulnerable positions.
For me, having female residents at a program was often reassuring. It showed that other women had chosen that environment and were succeeding there. While female faculty representation was less of a deciding factor, mentorship and role models still mattered. One interaction that stuck with me was meeting an Assistant Program Director who seemed genuinely fulfilled in both her career and personal life. I remember thinking, “I’d be happy if my life looked like yours in 20 years.” Everyone prioritizes different things when choosing a residency program, but moments like that helped shape my own decisions.
My present goals are to have a satisfying practice, to be involved in mentoring, in leadership, and to have a balanced personal and professional life.
As I mentioned, I am grateful to have matched into an orthopaedic surgery residency program where I felt respected, supported, and valued throughout the interview process. Applying to orthopaedic surgery, and the year of audition rotations, interviews, board exams, and uncertainty that came with it, was both challenging and rewarding. I am excited to join a training environment where residents learn from one another and grow together through the challenges ahead. I have always believed that “it takes a village,” and this journey has only reinforced how true that really is.
As I am gearing up to start residency next month, I have spent time reflecting on the many people who helped me get to this point. Writing thank you notes to mentors, faculty, classmates, friends, and family has been a small reminder of how much this journey was shaped by the encouragement, guidance, and generosity of my village. While matching is often viewed as an individual achievement, it rarely happens alone. I am grateful for the community that supported me along the way and hope to pay that support forward by mentoring, advocating for, and supporting those who follow.
