Essential Guide for DO Graduates: Researching Orthopedic Surgery Residency

Understanding the Landscape: Orthopedic Surgery for DO Graduates

Orthopedic surgery is among the most competitive specialties in the residency match, and as a DO graduate you face a unique set of considerations. Since the single accreditation system merged AOA and ACGME programs, the number of doors theoretically open to DO applicants has increased—but so has the competition.

To succeed, you need a deliberate program research strategy, not just a scattered list of places you’ve heard are “DO-friendly.” Researching residency programs is where you start converting your academic record, clinical performance, and personal story into a focused, realistic, and strategic application plan.

This article will walk you step-by-step through:

• How to build a target list of orthopedic surgery residency programs
• How to evaluate residency programs as a DO graduate
• How to identify DO-friendly and realistic ortho match options
• How to use data, networking, and fit factors to refine your list
• Practical examples and templates you can adapt immediately

Throughout, we’ll focus on what matters most to DO graduates aiming for an orthopedic surgery residency and show you how to research residency programs efficiently and strategically.

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Step 1: Clarify Your Profile Before You Research Programs

You can’t intelligently evaluate residency programs until you understand what you bring to the table. This is especially true for a DO graduate in a highly competitive specialty like orthopedics. Before opening any program website, get clear on your profile in four domains:

1. Academic Metrics

For orthopedic surgery, programs often weigh standardized metrics heavily, even with Step 1/Level 1 now pass/fail.

Key components:

• USMLE Step 1 / COMLEX Level 1: Now pass/fail but still used as a threshold at some programs.
• USMLE Step 2 CK / COMLEX Level 2-CE: Increasingly critical. Ortho programs often look for:
  • Step 2 CK: Commonly 245–250+ at competitive academic programs
  • Level 2-CE: Often 620–650+ for top programs (ranges vary)
• Class rank, honors in preclinical and clinical years
• Any remediation or academic gaps

Action:
Make a simple one-page snapshot of your academic profile (scores, class rank, honors), so you can quickly compare with program averages and requirements.

2. Clinical Performance and Orthopedic-Specific Experience

Orthopedic surgery residency directors want evidence that you’ve already demonstrated excellence and commitment in relevant settings.

Key elements:

• Grades in:
  • Surgery core rotation
  • Orthopedic electives/sub-internships
  • Any surgical subspecialty rotations
• Number and type of orthopedic away rotations / audition rotations
• Letters of recommendation:
  • At least 2–3 from orthopedic surgeons
  • Ideally 1–2 from academic or well-known faculty
• OR experience, procedural comfort, and work ethic (often documented in letters)

Action:
List every ortho-related experience and rotation with:

• Institution name
• Dates
• Grade (if available)
• Faculty who can serve as references

3. Research and Scholarly Activity

Orthopedic surgery is research-heavy, especially at academic centers.

Consider:

• Ortho-focused projects, publications, posters, QI work
• Number of publications and whether you’re first or second author
• National presentations or specialty society involvement
• Ongoing projects with a clear timeline to completion

Action:
Create a mini “orthopedic research portfolio” list:

• Title, role, status (submitted, accepted, published)
• Conference presentations
• PI/faculty mentors

4. DO-Specific Strengths and Limitations

As a DO graduate, you bring unique strengths—but you also must manage structural realities.

Strengths might include:

• Strong MSK and OMM background
• Broad generalist training
• Often more community-based patient exposure

Challenges may include:

• Some programs still preferentially rank MDs
• A minority of programs do not routinely take DOs in orthopedic surgery
• Less access to large academic ortho departments at some DO schools

Action:
Write 3–5 bullets each on:

• Why you’re competitive as a DO applicant
• What barriers you may face in the ortho match

You’ll use these to filter programs and guide conversations with mentors as you build your list.

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Step 2: Build a Long List Using Systematic Program Research

Once your profile is clear, you can start building a long list of orthopedic surgery residency programs. Your goal is not to guess which ones you might like, but to systematically gather options, then narrow.

Core Data Sources for Orthopedic Surgery Program Research

Use these primary sources:

1. FREIDA (AMA Residency & Fellowship Database)

   • Filter by specialty: Orthopedic Surgery
   • Filter by state/region as desired
   • Note:
     • Program size
     • Type (university, community, hybrid)
     • Program director
     • Number of residents per year

2. ERAS / ACGME Program Listings

   • Confirm accreditation status
   • Confirm if they accept COMLEX only, or require or prefer USMLE
   • Review contact information and “Program Highlights”

3. Program Websites

   • Current resident roster and alumni destinations
   • Faculty interests and subspecialty representation
   • Requirements for DOs (if noted)
   • Explicit language regarding DO applications

4. NRMP and Charting Outcomes Data

   • Look up:
     • Match rates for DOs in orthopedic surgery
     • Score distributions for matched vs unmatched applicants
   • While not program-specific, this helps set realistic expectations.

5. Former AOA/DO-Oriented Programs

   • Identify historically osteopathic-friendly sites (pre-merger)
   • These often still have a strong DO presence or culture

Action:
Create an initial spreadsheet with every orthopaedic surgery residency program you might plausibly consider. Include at least:

• Program name
• Location (city, state, region)
• University vs community vs hybrid
• Number of positions per year
• COMLEX accepted? USMLE required?
• Current DO residents present? (Y/N/Unknown)
• Notes (first impressions, special features)

This becomes your program research strategy hub.

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Step 3: Identify DO-Friendly and Realistic Programs

Not every orthopedic surgery residency is equally welcoming to DO applicants. As a DO graduate, one of your main tasks is to distinguish between:

• Programs that regularly train DOs
• Programs that occasionally take DOs
• Programs that rarely or never rank DOs

How to Assess DO-Friendliness

Use a combination of objective and indirect indicators.

1. Resident Roster Analysis

On each program website:

• Scan every current resident’s degree:
  • Count how many DOs per class
  • Look at trend over the last 3–4 years (if archived)
• Check if any chief residents or faculty are DOs

Strong DO-friendly signs:

• Multiple DOs in several consecutive classes
• DOs serving as chief residents or core faculty
• Explicit mention that DOs are encouraged to apply

Mixed signals:

• 1–2 isolated DOs over many years
• DOs only in earlier classes but none recently

Weak signs:

• No DOs on the roster, ever
• Historical bias against DOs reported by alumni/upperclass students

2. Program Requirements and Testing Preferences

Check for:

• COMLEX accepted vs USMLE required
• If USMLE is “strongly preferred,” consider how your testing profile fits
• Language like:
  • “We welcome both MD and DO applicants”
  • “We accept COMLEX alone” vs “USMLE is required to be considered”

For a DO graduate, COMLEX-only friendly ortho programs may be particularly strategic if you did not take USMLE.

3. Word-of-Mouth and Hidden Culture

Consult:

• DO alumni from your school who matched into orthopedics
• Recent graduates who applied ortho (matched or not)
• Faculty mentors with national ortho networks

Ask targeted questions:

• “Did this program historically rank DOs competitively?”
• “Any known bias against DO applicants?”
• “How did they treat DO rotators or away students?”

Creating DO-Friendliness Tiers

In your spreadsheet, add a “DO-friendly Tier” column:

• Tier 1: Strongly DO-Friendly

  • Multiple DOs per year
  • COMLEX accepted or COMLEX-only OK
  • Explicit outreach to DOs or legacy as prior AOA program

• Tier 2: Moderately DO-Friendly

  • Occasional DOs
  • Accept COMLEX but prefer USMLE
  • No clear bias, but not DO-heavy

• Tier 3: Unclear or DO-Neutral

  • No DOs visible but no negative signals
  • Limited data on DO applicants

• Tier 4: Historically DO-Unfriendly

  • Never/rarely take DOs despite large classes
  • Repeated negative feedback from DO applicants or mentors

Action:
Populate the DO-friendly tiers for each program, using both your research and mentor input. This will be crucial when you refine your ortho match list.

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Step 4: Evaluate Residency Programs Using Objective and Subjective Criteria

Now that you have a long list and a sense of DO-friendliness, the next step in evaluating residency programs is to assess fit. Think in two categories:

1. Objective competitiveness (Can you realistically match there?)
2. Subjective fit (Would you actually thrive there?)

Objective Competitiveness: Matching Your Profile to the Program

Since programs don’t always publish exact cutoffs, you’ll need to triangulate from multiple signals.

Key factors:

• Average board scores (if known or approximated)
• Interview invitations for similar DO profiles (ask upperclass students)
• Emphasis on research vs clinical productivity
• Academic prestige and match outcomes of graduates

You can roughly categorize programs as:

• Reach programs

  • Highly academic
  • Top research output
  • Score thresholds commonly very high
  • Historically selective with DOs

• Target programs

  • Solid academic or hybrid
  • DOs present
  • Scores and CV expectations closer to your profile

• Safety programs (in a competitive specialty, “safer” rather than truly safe)

  • Smaller or community-oriented
  • Historically more DO-friendly
  • More flexible with metrics if clinical performance is strong

Action:
For each program, add one more column: Competitiveness Tier (Reach/Target/Safer) based on your specific scores, experiences, and DO status.

Subjective Fit: Where Will You Actually Be Happy?

Orthopedic surgery training is long and intense. How to research residency programs isn’t only a numbers game; it’s about fit with your values, learning style, and life priorities.

Consider the following domains:

1. Clinical Volume and Case Mix

• Approximate number of operative cases per resident by PGY year
• Breadth of exposure:
  • Trauma, joints, sports, hand, pediatrics, spine, foot & ankle, oncology
• Distribution between:
  • Academic tertiary referrals vs community trauma vs elective practice

Ask yourself:

• Do you want high-volume trauma?
• Are you leaning toward a specific subspecialty that needs strong early exposure?

2. Faculty and Mentorship

On program websites and social media:

• Number of faculty and their subspecialties
• Presence of DO faculty in leadership roles
• Known educational champions or mentors (ask current residents)

Strong program indicators:

• Dedicated mentorship structure
• Assigned research mentors in resident’s area of interest
• Culture of advocacy for residents (e.g., letters, fellowship prep)

3. Resident Culture and Wellness

Use these signals:

• How residents talk about the program on interview day
• What alumni and away rotators say off-the-record
• Evidence of:
  • Reasonable call schedules
  • Supportive attendings
  • Protected didactics and learning time
  • Program responsiveness to resident feedback

Red flags:

• Residents discouraged from speaking freely to applicants
• High attrition or transfers
• Rumors of malignant culture or consistent burnout

4. Location, Lifestyle, and Personal Priorities

Location is not trivial for a 5-year orthopedic surgery residency.

Think about:

• Proximity to family/support system
• Cost of living, especially on a resident salary
• Climate and city size
• Partner’s job prospects, schools (if you have or plan a family)

Action:
For each program, add columns rating (1–5 or Low/Med/High):

• Clinical exposure
• Research opportunities
• Culture/support
• Location fit

This becomes a powerful tool when prioritizing your rank list later.

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Step 5: Use Rotations, Networking, and Social Media to Deepen Insights

Purely online research is not enough for a specialty as competitive as orthopedics. You must supplement digital data with real-world intelligence through rotations, mentoring, and direct contact with programs.

Away Rotations: Your Most Powerful Research Tool

Away (audition) rotations serve two roles:

1. They let a program evaluate you
2. They give you a front-row view of:
   • Resident culture
   • Faculty dynamics
   • OR expectations
   • Teaching quality

For a DO graduate, away rotations are often critical at:

• DO-friendly academic programs
• Places where you’re especially keen to match
• Institutions where you need to prove you can thrive in a rigorous ortho environment

How to choose away rotations strategically:

• Prioritize programs in your Target and upper Safer tiers that are DO-friendly.
• If aiming for a higher-tier academic center, consider one “Reach” away rotation where you have some connection (mentor, geographic tie, home institution affiliation).
• Don’t overload your schedule; 2–3 strong ortho aways often beats 4–5 rushed ones.

During the rotation, pay attention to:

• How attendings treat residents and students
• Who actually operates (residents vs fellows vs attendings)
• How residents talk about their training when attendings aren’t around
• Whether DO rotators and residents seem fully integrated

Networking and Mentor Input

Your program research strategy should include active networking:

• Meet with:
  • Home institution orthopaedic surgeons
  • DO alumni in orthopedic surgery
  • Fellowship-trained subspecialists with wide networks

Ask pointed questions:

• “Which programs do you consider realistic for my profile?”
• “Where do you know the culture well enough to recommend (or avoid)?”
• “Which program directors are known to be DO-friendly?”
• “If you were in my shoes, what 10–15 programs would you be sure to apply to?”

Keep notes from each conversation in your spreadsheet or a separate document.

Social Media and Virtual Events

Many ortho programs now maintain active Twitter/X, Instagram, and host virtual open houses.

Use these to:

• Sense how programs present themselves publicly
• Learn about:
  • Recent resident and faculty achievements
  • Research initiatives
  • Diversity/inclusion efforts
  • New rotations or curriculum changes

But remember:

• Social media shows the curated side; validate what you see with real insiders whenever possible.

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Step 6: Narrowing Your List and Building a Balanced Application Strategy

After building your long list, assessing DO-friendliness, and evaluating fit, you need to turn all that research into a concrete ortho match plan.

How Many Orthopedic Surgery Programs Should a DO Graduate Apply To?

Numbers change over time and depend on your profile, but rough guidance for a DO applicant might be:

• Highly competitive DO (excellent scores, strong research, strong letters):
  • 40–60 ortho programs
• Solid but not top-tier DO candidate:
  • 60–80 ortho programs
• More borderline DO candidate (lower scores, less research, but strong clinical performance and letters):
  • 70–100+ ortho programs
  • Strong consideration of a parallel plan (e.g., prelim surgery or backup specialty)

Always check current NRMP and specialty society data, and get personalized advice from your home ortho faculty or advisors.

Balancing Reach, Target, and Safer Programs

Once you have a preliminary application count, distribute across your tiers:

Example for a solid DO candidate applying to 70 programs:

• 15–20 Reach programs
• 30–35 Target programs
• 15–25 Safer programs

Ensure that:

• A meaningful proportion are Tier 1 and Tier 2 DO-friendly
• You don’t over-concentrate on highly academic programs that rarely take DOs
• You include several historically osteopathic or community-based programs where your DO background is an asset

Integrating a Parallel Plan (If Needed)

Given ortho’s competitiveness, some DO applicants wisely pursue a parallel plan, such as:

• Applying both ortho and:
  • Categorical general surgery
  • A non-surgical specialty they also genuinely like
  • A prelim surgery year with the intent to reapply ortho

If you go this route:

• Make sure your program research strategy extends to the other specialty
• Don’t neglect researching and evaluating those programs with the same rigor

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Putting It All Together: A Sample Research Workflow

Here’s an example of how a DO graduate might structure their ortho program research over several months:

Month 1–2: Foundation

• Compile scores, CV, and honest assessment of competitiveness
• Meet with at least 2–3 ortho mentors to calibrate expectations
• Build a master spreadsheet from FREIDA, ACGME, and NRMP data

Month 2–3: DO-Friendly and Fit Assessment

• For each program, review:
  • Current residents (count DOs)
  • Website for COMLEX/USMLE requirements
  • Location and program type
• Assign:
  • DO-friendliness tier
  • Competitiveness tier
  • Preliminary fit (location, culture, research)

Month 3–5: Deepening Intel

• Lock in away rotations at priority programs
• Attend virtual open houses and follow programs on social media
• Talk to DO ortho alumni and current residents
• Update spreadsheet with culture and fit impressions

Month 4–6: Finalizing Application List

• Re-meet with mentors with your updated data
• Finalize:
  • Number of programs
  • Balance of reach/target/safer
  • Any parallel application plans
• Start tailoring personal statements or program-specific notes where appropriate

By the time ERAS opens, your list will not be based on guesswork, but on a structured, data-informed, and DO-specific research process.

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FAQs: Researching Orthopedic Surgery Programs as a DO Graduate

1. As a DO, do I need to take USMLE for orthopedic surgery, or is COMLEX enough?

Many orthopedic surgery programs now accept COMLEX, but numerous competitive programs still prefer or require USMLE. If you haven’t taken USMLE:

• Focus your applications on:
  • Programs explicitly accepting COMLEX-only
  • Historically DO-friendly institutions
• Check each program’s website and FREIDA listing carefully; if unclear, email the coordinator politely.

If you’re early in medical school and strongly aiming for ortho, taking USMLE Step 2 CK in addition to COMLEX Level 2-CE can widen your options, but this decision should be made in consultation with your advisors.

2. How many away rotations should a DO student aiming for orthopedic surgery complete?

Most DO applicants targeting ortho complete 2–3 orthopedic away rotations, plus a home ortho rotation if available. More than 3 aways may:

• Lead to fatigue
• Limit time for research or Step 2/Level 2 studying
• Not add proportional value

Choose aways at:

• DO-friendly programs where you’re a realistic candidate
• Programs in regions you’re especially interested in
• One aspirational/Reach program if you have a strong connection or strong profile

3. What if my Step/COMLEX scores are below average for orthopedic surgery—should I still apply?

Lower scores make ortho more challenging, but they don’t automatically rule you out, especially as a DO candidate with:

• Strong letters from orthopedic surgeons
• Excellent clinical evaluations
• Significant ortho research or leadership
• Great performance on away rotations

However, you should:

• Be strategic and realistic in your program research
• Emphasize DO-friendly, community, and former AOA programs
• Strongly consider a parallel application (e.g., general surgery or a second specialty you’d be content with)

Discuss your specific situation with ortho faculty or a residency advisor who knows your full profile.

4. How can I tell if a program’s culture is supportive without rotating there?

You’ll never get a complete picture from afar, but you can approximate by:

• Talking to:
  • Current residents (especially DOs if present)
  • Recent grads
  • Away rotators from your school
• Observing:
  • How residents and faculty interact at virtual open houses
  • Turnover of program leadership
  • Any public statements about wellness, diversity, and feedback systems
• Asking residents directly (in a respectful way):
  • “What do you wish you had known before coming here?”
  • “How does leadership respond when residents raise concerns?”

Combining these insights with your other research will give you a much more accurate sense of fit than relying on reputation alone.

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By building a structured, data-driven program research strategy, carefully evaluating DO-friendliness, and actively engaging mentors and away rotations, you can transform a daunting orthopedic surgery match into a clear, deliberate plan. As a DO graduate, you have a distinct background and strengths—your task is to find the programs that recognize and value them, and to show them, through your research and preparation, that you’ll be an outstanding orthopedic surgery resident.