OCS eligibility
OCS Without a Residency: Clinical Hours vs Residency
You do not need a residency to sit for the OCS. Most candidates qualify through clinical hours, which ABPTS calls Option A. Residency graduates (Option B) pass more often, 93% vs 84% in 2025, but the gap is something you can close with the right practice.
The two routes side by side
| Clinical hours route | Residency route | |
|---|---|---|
| Requirement | 2,000 hours of direct orthopaedic patient care in the last 10 years, 300 of them in the last 3 years (2027 rule) | Completion of an ABPTRFE accredited orthopaedic residency |
| Time | Builds up during normal practice | At least 10 months full time and 1,800 hours |
| Mentoring | Optional; observed or mentored hours under an OCS count toward the 2,000 | At least 150 hours of one on one mentoring, 100 in person |
| Pay | Your normal salary | A resident stipend, for example $66,566 at Mayo Clinic and $58,656 at Boston University |
| 2025 OCS pass rate | 84% | 93% |
What the 2027 hours rule adds
- Hours follow a body region breakdown: 750 spine, 500 upper quarter, 500 lower quarter and 250 of your choice.
- Within those, at least 100 hours in several regions of each quarter, so a narrow caseload may need planning.
- Observed or mentored hours with a certified orthopaedic clinical specialist count hour for hour. For the arm, elbow, wrist and hand, a certified hand therapist can supervise.
Why residents pass more often
A residency is a year of reasoning out loud. Residents see a wide caseload, defend every decision to a mentor and take written and practical exams along the way. That is exactly what the OCS tests: given this patient, what do you do, and why not the other options.
How to close the gap on the hours route
- Fill the regions you rarely treat. The exam is weighted by body region, not by your caseload. Use the body region breakdown to find your blind spots.
- Get a mentor in the loop. Talk cases through with an OCS at your clinic. Under the 2027 rule, mentored hours with an OCS also count toward eligibility.
- Practice decisions, not facts. Case based questions with full explanations are the closest thing to residency case review.
- Follow a plan. The OCS study plan spends your time the way the exam does.
Frequently asked questions
Do you need a residency to take the OCS?
No. ABPTS offers two routes. The clinical hours route requires 2,000 hours of direct orthopaedic patient care in the last 10 years, with 300 in the last 3 years for the 2027 exam. The residency route is completing an ABPTRFE accredited orthopaedic residency.
Do residency graduates pass the OCS more often?
Yes. In 2025, 93% of residency graduates passed compared with 84% of candidates who qualified through clinical hours, according to ABPTS. Residency graduates have passed at a higher rate every year since 2014.
How long is an orthopaedic residency?
ABPTRFE requires at least 10 months full time and at least 1,800 hours, including 1,500 hours of patient care, 300 educational hours and 150 hours of one on one mentoring.
Can residents take the OCS before they finish?
Yes. ABPTS can conditionally approve candidates enrolled in an accredited residency to sit for the exam, as long as they document completion in time.
Is a residency worth it just to pass the OCS?
For most clinicians, no. A residency is worth it for the mentoring and the faster growth. If the OCS is the goal, the hours route plus structured, case based practice gets most people there.
Practice like a resident
Every question starts with a patient and one deliberate trap, and every answer explains why the other choices are wrong.
Sources: ABPTS orthopaedics eligibility for 2027; ABPTS pass rates; ABPTRFE quality standards; Mayo Clinic residency stipend; Boston University fact sheet.
Pass the OCS is not affiliated with ABPTS or ABPTRFE.