What Is Medical Residency?
Learn how residency works, how to match, and how to maximize your time as a resident.
Once you have your MD or DO, you’re a doctor. Residency is where you practice medicine under supervision, preparing for licensure, at which point you can practice without supervision.
How residency works and what to expect
Application process
The Match
Duration and program years
How much do medical residents earn?
Residency vs. fellowship
What happens after residency
Frequently asked questions
At the end of medical school, you earn a medical degree (MD or DO), and you are officially a doctor. However, you cannot practice medicine without supervision. Medical residency is the next step of your medical education, where you can practice patient care under supervision—gaining hands-on experience in clinical skills.
Every residency program has a medical specialty, such as Pediatrics, Internal Medicine, Anesthesiology, General Surgery, and so on. You have to apply to a specific specialty through ERAS—you can’t just apply to residency in general, then pick your specialty—although you are allowed to apply to multiple specialties.
During residency, you’ll take the USMLE Step 3 (or COMLEX-USA Level 3 for DOs), which is one of the last steps before applying to state medical licensure. Once you’re licensed, you can practice medicine without supervision.
This guide covers how residency works, how to successfully match into your preferred residency programs, average resident salary, and much more. Keep reading so you’re prepared for this vital step in your journey to becoming a practicing physician.
----
How residency works and what to expect
Medical residency works by providing newly graduated MDs and DOs with opportunities to practice medicine under supervision, a key step on the journey to getting licensed to practice without supervision. Let’s cover what to expect from residency as an incoming resident.
Residency is when you must choose a medical specialty to train for. Unlike med school, which covers broad medical topics, residency will provide specialized training in a particular field. What to expect will depend on your specialty.
Here are some critical terms to understand when starting out as a resident:
Intern: Most programs use the term “intern” to refer to those in the first year of residency. PGY-1 is another way to refer to first-year residents, meaning “postgraduate year 1.”
Junior resident stage: This is usually a PGY-2 in IM programs or PGY-2 to PGY-3 in a 5-year surgical residency.
Senior resident: A senior resident is in the later stages of residency, with added leadership responsibilities and less supervision.
Chief resident: The chief resident is a senior resident with the largest leadership role and often more administrative responsibilities.
Fellow: Someone who is in fellowship training—called a “fellow”—has completed residency (and state board licensure) and is now going through optional additional training in a subspecialty.
Attending: An attending physician is a fully licensed physician who has completed all licensure requirements and medical training, including residency. An attending will often supervise med students and residents. The attending is ultimately responsible for patient care.
Supervising physician: Sometimes the attending and the supervising physician are the same person. It’s mainly about context. Whereas the attending “attends” to patient care, the supervising physician “supervises” the residents outside of the direct patient care environment.
Below are the kinds of daily responsibilities you might expect from being a medical resident:
When to arrive: You should show up 30 to 60 minutes before your shift officially starts in order to pre-round. Most residency shifts are 12 hours and start at 7:00 or 8:00 in the morning or evening, but each setup is slightly different.
Pre-round: Before your shift begins in earnest, you need to gather data and assess patients independently before formal, team-wide rounds. During pre-rounds, you may review charts, check overnight events, perform brief physical exams, and formulate preliminary assessments or treatment plans to present to supervising physicians.
Round: This is the structured daily process where you and your team visit patients, review labs, and update treatment plans. Depending on your specialty, you may see 8-50 patients on any given day. Rounds make up the bulk of your work hours.
Hand-off: Also called the “sign-out,” you end your shift by transferring all your patients to the next shift of doctors, updating care info as needed.
Remember, since residencies vary wildly by specialty, it’s difficult to speak broadly about all residency programs. But this broad overview should certainly equip you to succeed as you become a resident physician.
----
Application process
Most residency candidates must apply through ERAS to be eligible for matching into a program.
That said, some specialties use different application systems, such as Ophthalmology (which uses the SF Match for application distribution and the Ophthalmology Matching Program), Urology, OB/Gyn, and Emergency Medicine.
Note: The Electronic Residency Application Service (ERAS) is administered by the Association of American Medical Colleges (AAMC), which also administers the American Medical College Application Service (AMCAS) that undergrads fill out to apply to medical school.
The residency application may look similar to the med school application. Below, I’ll list the sections of the ERAS application:
Personal Information: Basic personal info, like your name, address, and couples match status.
Biographical Information: More personal info, including your demographic information and location preference.
Experience Section: One of the most vital sections, where you’ll categorize and describe up to 10 of your relevant experiences that make you the outstanding candidate that you are—including three “most meaningful” experiences.
Personal Statement: The most important section, where you’ll make your case for why you’re the right fit for a given residency program.
Specialty Questions: A new section with questions specific only to certain specialties.
Education: A list of institutions where you’ve been trained or educated.
Publications: A list of your published research or major presentations.
Letters of Recommendation: another important section, where you’ll assign 3-4 recommendation letters to a program.
MSPE or “Dean’s Letter”: The dean’s office at your medical school is responsible for this summary of your time in med school.
Transcript: The dean’s office at your medical school is responsible for uploading your transcripts from med school at the proper time.
If you’re an international medical graduate (IMG), check out our free guide for getting into residency as an IMG. There are different, important considerations (e.g., visas) if you are an IMG and applying for residency.
ERAS season opens in June, and you can start sending applications in September. Interview season is October-January, after which you will transition from applying through AAMC’s ERAS to matching through the NRMP. Learn more about the ERAS timeline here.
Looking for medical residency personal statement essay examples? Click here to access over 30 of them, with in-depth analyses of why they work.
Gain instant access to 30+ exclusive full-length residency personal statement essay examples, complete with thorough breakdowns to help you match with your first choice.
----
The Match
The Match is the process of getting accepted into a residency program. Here’s how it works:
After you apply through ERAS, hopefully you’ll get several interview invites. You can interview wherever you’re invited.
You rank the places you interviewed at. The programs also rank everyone they interviewed.
The National Resident Matching Program (NRMP) uses its proprietary algorithm to “match” candidates with programs so that the maximum number of applicants match into a residency program. This algorithm is built to be specifically applicant-favoring (e.g., based on the preference of the applicant first). Match Week is when you find out whether you matched and where.
If you are unmatched, you have a chance to apply to unfilled residency positions.
Let’s go into more detail about the Match below.
Interview
You’ll receive interview invites from interested programs through email or the MyERAS notification system. Accept as many as you can, and organize your interview schedule in a spreadsheet or with an app like Thalamus.
For interview day, expect to sit in on morning reports, participate in interviews (either in the traditional panel format or MMI format), go on tours, and eat meals with current residents or faculty.
Arrive early, dress professionally, and have practiced answers in your back pocket for your strengths and weaknesses, as well as why you chose this specialty or why you’re a good fit for this specific program. Come with questions ready to ask.
After all your interviews, it’s time to rank the programs for the Match algorithm.
Rank order list
The rank order list (ROL) is how you express your preference on where to go for residency, in the order of your genuine preference. If you rank the residencies based on your genuine preference, you should have the best chance of getting matched with your preferred program.
You may list all the places you interviewed, but only include programs where you would actually accept an offer. However, don’t get too choosy; rank all the programs you would be willing to go to. The more programs you rank, the higher chance you’ll match with one of them.
The top reasons the recent residency applicants listed as important to their ranking decisions included the following:
Location
Reputation
Culture fit
Interview day experience
While it’s possible that program directors let you know how they plan to rank you, they’re prohibited from asking how you plan to rank them. Similarly, you are prohibited from asking a program how they’ll rank you.
You have the option of sending a letter of intent to the program that you ranked number one on your ROL. This letter can include updates, but mainly lets the program director know that this is your top-choice residency.
The Couples Match gets complicated, from linking rank order lists and deciding where to place "No Match" codes to navigating early-match specialties and coordinating logistics if one partner is a year ahead or behind.
Also, it’s a little complicated if you need to rank preliminary and advanced programs. Essentially, preliminary programs are only for your first year of residency (intern year), and advanced programs are PGY-2 and onward, meaning you’ll start them in your second year of residency.
A few specialties that may require a preliminary residency program are radiology, ophthalmology, and dermatology.
If you rank any advanced programs, you may need to make a supplemental ROL of preliminary programs (or transitional year programs) in the case that you match to that advanced program; that way, if you match with an advanced program, you won’t have a year one gap to deal with.
Match Week
NRMP’s Match Week is held annually in the third week of March.
On the Monday of Match Week at 10:00 A.M. ET, you’ll find out whether you matched (not where you matched) or didn’t match.
If you did match into a program, congratulations! You will find out where you matched on Friday (Match Day) at 12:00 P.M. ET.
If you did not match on Monday, you will have the opportunity to participate in the Supplemental Offer and Acceptance Program (SOAP).
Note that the Match is a binding contract between you and the program. In other words, you cannot switch programs after the Match (with rare exceptions).
SOAP
If you weren’t matched by the algorithm as of Monday of Match Week, you’re not out of options. There are also residency spots that have gone unfilled.
On Monday of Match Week, the NRMP gives unmatched candidates a list of all SOAP-eligible unfilled positions to apply to through ERAS (or, in rare cases, ResidencyCAS). Programs review applications almost immediately and may contact you for a virtual interview.
On Thursday, four rounds of offers are sent out via the NRMP’s R3 system. Most of the SOAP matches are made in the first round.
If you remain unmatched after the fourth round of SOAP offers, your best option left is to contact unfilled positions directly—after Match Week is fully concluded—or wait until the next application cycle. Some positions tried to match through the NRMP algorithm but remained unfilled. Some available positions did not participate in the Match at all.
----
Duration and program years
Different residency programs last for different amounts of time—typically between three and seven years, depending on the specialty and the specific program. There are some three-year residencies and some seven-year ones.
Specialties like Psychiatry and Dermatology generally take four years to complete residency, while several surgery specialties take six or seven years. The shortest residencies are typically Internal Medicine, Family Medicine, and Pediatrics—each taking about three years to complete.
(Note: Fellowships may add years onto your postgraduate training.)
PGY-1, PGY-2, and so on refer to the “post-graduate year” followed by which year of residency you’re in. PGY-1 is often referred to as the “intern year.” Senior residents are generally in the latter half of their residency—year three or four for four-year programs, or year four through six for 6-year programs, etc.
As you continue in your residency program, your responsibilities increase. Make the most out of your time in residency by asking questions, taking responsibility for your actions, communicating openly, and always looking for opportunities to learn.
----
How much do medical residents earn?
The average salary (occasionally called a stipend) for PGY-1 medical residents is $68,166. Every year, residents get a predetermined salary increase; there’s typically no possibility of negotiation.
Salary is consistent within each program but not across all programs. Pay is often determined by local cost of living and is otherwise heavily reliant on nationwide standards, which rise each year with normal inflation.
There are other benefits that are not reflected in the average resident salary. Programs offer different levels of medical insurance. Some offer paid vacation, while others may offer meal stipends. Though salary doesn’t really differ that much program to program, when adjusted for cost of living, benefits may greatly differ.
Below is a table of the average residency salary by year of postgraduate training, according to the American Medical Colleges (AAMC).
| Year of Residency | Year of Residency |
|---|---|
| PGY-1 (Postgraduate Year 1) | $68,166 |
| PGY-2 | $70,499 |
| PGY-3 | $73,301 |
| PGY-4 | $77,593 |
| PGY-5 | $81,807 |
| PGY-6 | $84,744 |
| PGY-7 | $89,187 |
| PGY-8 | $94,215 |
----
What happens after residency
After residency, you should have already completed your board exams (USMLE or COMLEX) and should seek to complete state medical board certification. Then you’re a fully licensed doctor of medicine, able to practice healthcare without supervision.
You may enroll in a fellowship for sub-specialty training, or you may find a more permanent job. Here are the most common places you can secure employment as a doctor:
Hospital
University
Private practice
Independent practice
Locum tenens
Looking for medical residency personal statement essay examples? Click here to access over 30 of them, with in-depth analyses of why they work.
Gain instant access to 30+ exclusive full-length residency personal statement essay examples, complete with thorough breakdowns to help you match with your first choice.
----
Residency vs. fellowship
Fellowships are for fully-licensed doctors to train another one to three years in a specific medical sub-specialty, like Surgical Oncology, Neonatal-Perinatal Medicine, Gastroenterology, Addiction Psychiatry, or Hospice Palliative Care.
These postgraduate fellowship programs follow the completion of residency, but many doctors do not need to enroll in a fellowship.
During both residency and fellowship, you are a doctor with a medical degree. Internship, residency, and fellowship are all considered graduate medical education (GME).
During fellowship, however, you’re a fully licensed doctor who can practice medicine without supervision. Fellowships cover specific sub-specialties, whereas residencies cover more generalized specialties.
----
Frequently asked questions
How many hours do residents typically work each week?
The average work week for a medical resident is between 60 and 80 hours per week. It can be grueling, but time management is key. Plus, it is not unlike a fully licensed doctor’s weekly schedule.
The Accreditation Council for Graduate Medical Education (ACGME) puts a cap on residents’ workload: 80 hours/week averaged over each four-week period.
What happens during an Internal Medicine residency?
Internal Medicine residencies are typically three-year programs that offer medical school graduates hands-on opportunities to diagnose illnesses and manage short-term and long-term treatment regimens for adults.
PGY-1 interns may have a smaller patient load but still interact with half a dozen patients every day, focusing on inpatient care. PGY-2 and PGY-3 residents take on more of a leadership role, managing interns and med school student trainees. More time may be spent on sub-specialty elective work and outpatient care.
Since Internal Medicine is a very generalized specialty, and these residency programs usually only take three years, it is very common to follow up an Internal Medicine residency with a fellowship where you train in a sub-specialty.
What residency specialties are the most competitive?
The most competitive residency specialties are:
Dermatology
Diagnostic & Interventional Radiology
Interventional Radiology
Neurosurgery
Orthopedic Surgery
Otolaryngology (ENT)
Plastic Surgery
These are the specialties with the lowest rate of unfilled positions every year, the highest average USMLE Step 2 scores for successful candidates, and the highest ratios of applicants to available spots. These specialties are often coveted because of the high salary or the work-life balance.
What residency specialties are the least competitive?
The least competitive residency specialties are:
Emergency Medicine
Family Medicine
Internal Medicine
Neurology
Pathology
Pediatrics
Physical Medicine & Rehabilitation
Psychiatry
These are the specialties with the highest rate of unfilled positions every year and the lowest average USMLE Step 2 scores for successful candidates. These specialties are often less competitive because of the lower salary or lack of work-life balance.
Final thoughts
Medical residency is the bridge between medical school and a fully licensed medical practice. You need to choose a specialty and train for three to seven years before securing permanent employment as a healthcare worker or applying to a medical fellowship to learn a sub-specialty.
About the Author
Dr. Shirag Shemmassian is the Founder of Shemmassian Academic Consulting and one of the world's foremost experts on medical school admissions. For over 20 years, he and his team have helped thousands of students get into medical school using his exclusive approach.
THERE'S NO REASON TO STRUGGLE THROUGH THE HIGH-STAKES MEDICAL RESIDENCY APPLICATION PROCESS ALONE. CLICK BELOW TO SCHEDULE YOUR COMPLIMENTARY CONSULTATION TO ENSURE YOU LEAVE NOTHING TO CHANCE.
