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ORTHOFELLOW GUIDE · 12 MINUTE GUIDE

Orthopaedic Fellowships in Europe: Licensing, Language & Pay

There is no single European match for orthopaedic fellowships. You apply directly to a host hospital, or to a European society that runs its own fellowship scheme, and you then need permission to work in the host country before you touch a patient. Rules differ sharply between countries and between EU-qualified and non-EU-qualified surgeons. This guide sets out what official regulator, government and society pages say, with dates and amounts as published. Schemes reopen and change every cycle, so confirm the details with the host before you apply.

By Anissa Feby Canintika, Founder and Clinical EditorPublished · Materially updated
Educational guidance, not legal, immigration, licensing or admissions advice.

How orthopaedic fellowships work in Europe

Europe has no central application system for orthopaedic fellowships. Each country licenses doctors in its own way, and each host department or society runs its own selection. In practice, opportunities fall into three groups. Clinical fellowships are employed or salaried posts in which you work in theatre and clinic, so you need full or supervised registration in the host country. Society and travelling fellowships are short, funded visits organised by a European society, usually lasting a few weeks. Observerships are short visits where you watch rather than operate, and are often unfunded.

  • Clinical fellowship example: the EPOS FEPOS programme describes a paid one-year fellowship in which each fellow has a direct contract with the hosting hospital.
  • Travelling fellowship example: the EFAS Travelling Fellowship is three weeks visiting up to six clinics, with EFAS covering travel and housing.
  • Observership example: ESSKA's Observership Programme offers 2–3 day visits to ESSKA Teaching Centres, and ESSKA has no financial obligation to the observer.
  • The EFORT Foundation states that the fellow is responsible for insurance, vaccinations and visas, and must confirm that their medical licence is valid in the host country, especially outside the EU.
  • Whatever the format, ask the host in writing whether you will be employed, whether you will operate, and which licence or registration they will need from you.

European society fellowships: EFORT, ESSKA, EFAS and SECEC

Several European societies fund short fellowships for their members. Most require membership, set an age limit and expect a written report afterwards. The details below come from each society's own pages. Many 2026 deadlines have already passed, and later cycles usually follow a similar pattern, so check the page for the next call before planning around these dates.

  • EFORT Foundation, Smith & Nephew Visiting Fellowship: six months at a recognised host centre for orthopaedic specialists under 45, with a grant of EUR 12,000 each. The page says applications are currently closed, and that French and Belgian fellows cannot be funded under this programme. When it is open, there are three application rounds a year: January–April, May–August and September–December.
  • EFORT Foundation, Hip Multicenter Visiting Fellowship (Medacta): six months starting September 2026, hosted in Lyon with rotations in Winterthur, Paris and Zurich. It is open to specialists under 45 and final-year residents from listed countries who are fluent in French and English. A fixed grant is paid (no amount given), and the deadline was 15 May 2026.
  • ESSKA-AOSSM Travelling Fellowship: provisional dates are 16 June – 7 July 2027. Applicants must be certified orthopaedic surgeons under 45, European citizens and ESSKA members for two consecutive years. Registration closed on 9 June 2026.
  • Aspire Orthopaedics – ESSKA Clinical & Research Fellowship (Dublin): a 12-month knee and hip fellowship from 1 July 2028, with four to six surgical sessions and two knee clinics a week. Applicants must have CCST certification, be eligible for Irish Medical Council registration, be under 40 and have been ESSKA members for a year. Registration closes on 31 March 2027.
  • EFAS Travelling Fellowship 2026: six fellows across two routes, each spending three weeks visiting up to six clinics before the EFAS Congress. EFAS covers travel and housing. The 2026 deadline was 29 March 2026.
  • SECEC (shoulder and elbow): the Intra-European Travelling Fellowship runs in odd years. The next one is in Spring 2027 and lasts four weeks, visiting eight SECEC Education Centres, for two SECEC Full members under 40. SECEC books travel and accommodation. Applicants are usually told the outcome by the end of February.

More society schemes: FESSH, EPOS, EUROSPINE and AO Trauma

Hand, paediatric, spine and trauma surgeons have their own schemes. Some are clinical posts, such as FEPOS, and others are short funded visits or research awards. Where a page gives no grant amount, none is stated here.

  • FESSH Research Fellowship 2027: a one-week stay at a research department in the Czech Republic before the FESSH Congress in Prague. Up to EUR 1,500 is available per applicant for two fellows, and the deadline is 15 February 2027. Applicants must belong to a national hand society with full FESSH membership and must live and work in Europe.
  • FESSH Clinical Research Grant: EUR 10,000 for a one-year clinical project in hand surgery, with a deadline of 15 February 2027.
  • EPOS FEPOS (paediatric): a paid fellowship in which fellows contract directly with the hospital. For example, the Lyon post starts on 1 November 2026, runs for one year with on-call duties, and requires fluency in French at an academic level. Its deadline was 1 September 2026.
  • EUROSPINE Robotics & Navigation Travelling Fellowship 2026: three weeks from 6–24 October 2026 for ten consultant-level members working in Europe, with up to EUR 5,500 per fellow. The deadline was 1 June 2026.
  • AO Trauma Fellowship: 6–12 weeks for AO Trauma members under 45 who have completed the Basic and Advanced Principles courses. A small stipend is benchmarked at USD 550 a week for a US placement and adjusted by purchasing-power parity elsewhere. The fellow pays for travel and insurance. The 2027 call is closed, and the 2028 call is expected to open in spring 2027.

EU-qualified versus non-EU-qualified surgeons

Your route depends on where you qualified as much as on where you want to go. Under Directive 2005/36/EC, each EU Member State must recognise the formal qualifications of doctors with basic training and of specialised doctors (Article 21). The EU's Your Europe portal lists doctors among the professions with automatic recognition. You still have to submit proof of your qualification and wait for permission before you work, and you may be asked to sit a language test. Qualifications from outside the EU are recognised country by country under national rules, so the process is usually longer and may include exams or supervised practice.

  • Article 53 of the Directive requires people whose qualifications are recognised to have the language knowledge they need to practise.
  • UK (GMC): Academic IELTS with at least 7.0 in each area and 7.5 overall, or OET Medicine at grade B or above in all four sub-tests. The certificate is valid for two years.
  • Germany (Baden-Württemberg authority): general German at B2 plus medical German at C1, tested by the Ärztekammer in a Fachsprachprüfung.
  • France (DFMS/DFMSA): French at B2, for example via DELF or DALF.
  • Switzerland (FOPH/MEBEKO): B2 in the language of practice for entry in MedReg. Employers and cantons can ask for more.
  • Netherlands (BIG register): proof of Dutch and of English reading skills. The register says learning Dutch to the required level takes 1.5–2 years on average.

United Kingdom: GMC registration, English and visas

To work clinically in the UK, a fellow needs GMC registration with a licence to practise. International graduates can register through the sponsorship route. You are eligible if you hold an acceptable primary medical qualification and have been selected for postgraduate training by a UK medical royal college or faculty, or are sponsored by an approved body. You also need to have practised medicine for three of the last five years, including ten of the most recent 12 months. Many UK clinical fellow posts are employed as locally employed doctors, and the employer sets the pay and terms.

  • The Medical Training Initiative (MTI) closed to new applicants at noon on 31 March 2026, after NHS England decided to end the scheme. Doctors already on placements can complete their two-year attachments, but the MTI is no longer open to new fellowship applicants.
  • On the sponsorship route, the GMC cannot extend the validity of an IELTS or OET certificate. You need a certificate awarded within the last two years, unless both your nationality and your primary medical degree come from countries where English is the first and native language.
  • The GMC accepts IELTS One Skill Retake in one section and does not accept the IELTS Indicator test.
  • Health and Care Worker visa: you need a confirmed job offer from a Home Office-approved employer and a certificate of sponsorship. Medical practitioners fall under occupation codes 2211 and 2212. Fees are £324 for up to three years and £628 for longer, and visa holders do not pay the immigration health surcharge.
  • GOV.UK says you will usually need to be paid at least £25,000, and it points to national pay-scale tables for some health roles. Confirm the threshold that applies to your post with the employer.

Germany: Approbation, Berufserlaubnis and the Fachsprachprüfung

Germany has two forms of medical licence. The Approbation allows permanent, unrestricted practice. The Berufserlaubnis is a temporary licence that, in Baden-Württemberg, is valid for two years and limited to supervised work (non-self-employed and non-managerial). If you trained outside the EU, your training must be judged equivalent to the current German medical degree before you can receive the Approbation, and the application forms include registration for the knowledge test (Kenntnisprüfung). Licences are issued by each federal state's authority, so procedures vary between states.

  • Language: Regierungspräsidium Stuttgart says that to receive the Approbation you must show general German at B2 and medical German at C1.
  • The Fachsprachprüfung is held by the Ärztekammer on behalf of the authority. Fees are usually about EUR 250–450, and the chamber confirms the exact amount.
  • The exam is needed if you do not have a German-language university degree, at least ten years of schooling in German, or at least three years of vocational training in German.
  • Specialist recognition is a separate step. Confirm with the host and the Landesärztekammer whether your orthopaedic title can be recognised and which licence the post needs.

France: DFMS/DFMSA, FFI posts and the PADHUE route

Non-EU doctors usually train in France through the DFMS or DFMSA university diplomas. Université Paris Cité describes the DFMS as lasting 2–6 semesters for doctors still in specialist training outside the EU, EEA, Switzerland and Andorra. The DFMSA lasts 1–2 semesters and follows the matching DESC curriculum. During training these doctors have the status of étudiants faisant fonction d'interne (FFI). The university warns that the diplomas do not allow you to practise as a doctor in France afterwards.

  • Language: B2 French, shown by a French baccalauréat, a recognised test at B2 or above, or DELF/DALF B2.
  • Paris Cité's 2026–2027 application platform was open from 23 February to 15 March 2026. Check the university's page for the next window.
  • Full authorisation to practise for non-EU graduates (PADHUE) goes through the épreuves de vérification des connaissances (EVC). The 2026 session was opened by an arrêté dated 12 June 2026, with registration from 17 June to 16 July 2026 and exams from November 2026.
  • In that 2026 arrêté, orthopaedic and trauma surgery had 101 posts in the internal track (voie interne), which is for doctors already working in France. It was not listed among the specialities in the external track (voie externe).
  • EU-qualified specialists rely on automatic recognition instead. Confirm the post type and status directly with the hospital.

Switzerland, the Netherlands and Spain

In Switzerland, diplomas are recognised federally by the Medical Professions Commission (MEBEKO), but permission to practise is regulated by each canton. The FOPH says that, in principle, diplomas from outside the EU/EFTA cannot be recognised in Switzerland. Indirect recognition is possible if an EU/EFTA state already recognises your diploma and you have at least three years of recent clinical experience within the last five years, gained in that state and/or Switzerland. Anyone practising a university medical profession must be entered in MedReg, and authorisation for supervised employment rests with the cantonal health authority. The Netherlands requires BIG registration, and Spain has its own procedure for non-EU specialist titles.

  • Swiss language rule: B2 in the language of practice. Accepted proof is a recognised diploma no more than six years old, training completed in that language, or three years of work in it within the last ten years.
  • Netherlands, non-European diplomas: the Declaration of Professional Competence procedure includes a professional test (the BI test) and assessment by the CBGV. The BIG register currently says the BI test for physicians is full for this year and next year.
  • Netherlands specialists: specialist recognition is a separate process run by the specialist registration commission, and BIG registration must come first.
  • Spain: Real Decreto 459/2010 regulates professional recognition of non-EU specialist titles. The assessment can lead to supervised practice of up to three months or a theory-and-practice test.
  • Italy: we could not confirm current official requirements for non-EU orthopaedic surgeons, so ask the host and the Ministry of Health directly.

Pay, funding, visas and timelines

Few European countries publish a single salary for fellows. The NHS pay circular for England is one of the clearest official sources, but it also says that local contracts for clinical fellows are set locally. Society grants are fixed amounts meant to cover travel and living costs, not salaries. Outside the UK, check pay and contract terms with the host in writing.

  • England, from 1 April 2026: specialty doctors (2021 contract) earn £63,696–£102,689, and consultants (2003 contract) £113,565–£150,569, after a 3.5% uplift.
  • Clinical fellows on local contracts: NHS Employers says employers may mirror resident-doctor pay but are not required to, because local terms are a matter for local determination.
  • Schengen: short visits are limited to 90 days in any 180-day period, and longer stays follow national procedures. A clinical post of several months therefore needs that country's national visa or permit.
  • Plan 12–24 months ahead. For example, the Aspire–ESSKA fellowship closes on 31 March 2027 for a July 2028 start, and FESSH's 2027 calls close on 15 February 2027.
  • Language exams, recognition decisions and visas take extra months. Start these alongside your fellowship application, not after an offer.
EVIDENCE AND ACTIONS

Sources checked and applicant checklist

Every rule, date and amount in this guide was read on an official regulator, government, EU, university or society page on 8 October 2026. Society fellowships reopen with new dates and amounts each cycle, and several 2026 deadlines listed here have passed. Confirm current terms with the host and the regulator before applying.

Before you act

  • Confirm whether the post is employed clinical work, a funded visit or an observership, and what licence it needs.
  • Check the host country's language level and book any required test early.
  • Ask the regulator which recognition route applies to your EU or non-EU qualification.
  • Get funding, contract and visa terms in writing before you resign or relocate.

Official sources

Sources reviewed 8 October 2026. Recheck the linked source because cycles and regulatory requirements can change.
COMMON QUESTIONS

Frequently asked questions

Is there a European fellowship match?

No. You apply directly to host hospitals or to individual society schemes such as EFORT, ESSKA, EFAS, SECEC, FESSH, EPOS, EUROSPINE or AO Trauma. Each has its own eligibility rules, deadlines and selection process.

Can I still use the MTI to do a UK fellowship?

No, not as a new applicant. The Academy of Medical Royal Colleges and NHS Employers say the Medical Training Initiative closed to new applicants at noon on 31 March 2026. Doctors already on placements can complete their two-year attachments. Other routes to GMC registration, such as sponsorship by an approved body, are still described on the GMC website.

What English score does the GMC need?

Academic IELTS with at least 7.0 in each area and 7.5 overall in the same sitting, or OET Medicine with grade B or above in all four sub-tests. Certificates are valid for two years. On the sponsorship route the GMC cannot extend an older certificate.

Which German level do I need for a clinical fellowship?

For the Approbation, Regierungspräsidium Stuttgart asks for general German at B2 and medical German at C1, tested in a Fachsprachprüfung run by the Ärztekammer. Requirements are set by each federal state, so confirm with the authority where your host is based.

Do EU-trained orthopaedic surgeons need to sit exams?

Usually not. Directive 2005/36/EC gives automatic recognition to doctors' and specialised doctors' qualifications that meet EU minimum training standards. You still submit proof and wait for permission, and the host country can check your language skills.

Does a DFMS or DFMSA let me practise in France afterwards?

No. Université Paris Cité says these diplomas do not allow you to practise as a doctor in France after you finish. During training you work with FFI status. Full authorisation for non-EU graduates goes through the EVC procedure.

Are society fellowships paid?

They are usually grants rather than salaries. For example, the EFORT Foundation's Smith & Nephew fellowship grant is EUR 12,000 for six months, the EUROSPINE robotics fellowship pays up to EUR 5,500, and EFAS covers travel and housing. FEPOS posts are paid through a contract with the host hospital.

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