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Postgraduate PA fellowships allow for advanced specialty-specific education and experience for entry-level graduates. The Wake Forest School of Medicine created a postgraduate orthopaedic surgery PA fellowship (OPAF) that consists of 3 components: independent clinical experience, structured supervised rotations, and learning modules. The fellow is exposed to an all-inclusive experience via active rotations in each orthopaedic subspecialty, manages and operates an autonomous clinic, and receives additional training via learning modules related to systems-based practice and health-care quality improvement. The Wake Forest School of Medicine’s OPAF can provide a framework for similar fellowship programs throughout the United States.