An orthopedic surgeon requires a doctor of medicine degree (M.D.). This requires a bachelor's degree, four years of medical school, and up to five years of residency in a graduate medical school program. The residency must include general surgical practice, patient treatment, research, and subspecialty work. The surgeon may require an additional fellowship after the residency so that they can specialize in an area that they want to mainly focus on. The undergraduate major does not have to be specific, but there need to be at least three years of college coursework, including biology, physics, chemistry, and math. Orthopedic surgeons must be able to examine patients accurately, diagnose their musculoskeletal medical condition, and decide whether or not surgery is absolutely necessary. They must also be able to perform surgery on ligaments, bones, and tendons. All doctors must be board certified and licensed.