Attending Vs Resident

In the United States, the hierarchy of doctors you may encounter in a hospital is as follows:

Intern vs Resident vs Fellow vs Attending: What Are the Differences?

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Do you wonder why you apply to residency only to be called an intern? Does the difference between a residency and a fellowship elude you? Do you find it strange that a fellow can practice as an attending while still learning? For many medical students (and IMGs), the language used during the different stages of medical training can be confusing.

However, these terms are more than semantics. They are important milestones in the journey to becoming a practicing physician. Titles change with experience and responsibility. So, if you want to better understand your path or are tired of trying to explain to your great aunt’s best friend why you aren’t (yet) licensed to consult on her bunion, check out this article.

Medical student vs. intern vs. resident vs. fellow vs. attending: let’s walk through the differences.

Summary:

• The time it takes to become an attending physician varies by specialty.
• Medical students are individuals pursuing a medical degree.
• Residents are medical graduates training in a specific field.
• Interns are first-year residents who may, for that year, practice in something that is not directly in their field to gain experience.
• Fellows are Qualified doctors who are training in a subspecialty.
• Attendings are full-time, independent physicians.

Table of Contents

Training and Responsibility Are the Biggest Differences

While no two journeys are identical, the general path from medical student to practicing attending is relatively the same (for US graduates). This is because physicians must meet specific training requirements for medical licensing. However, the length of this training process is anywhere from 7-14+ years, depending on the specialty.

• Medical Student: An individual accepted into medical school and working towards a medical degree (in the US, that would be an MD or a DO).
• Resident: A medical school graduate training in an accredited clinical setting.
• Intern: A first-year resident.
• Fellow: A physician training after residency for specialization.
• Attending: A licensed physician who can practice without supervision and oversee interns, residents, and fellows in their field. In addition, they “attend to” patients.

Medical Student: In Pursuit of a Medical Degree

Imagine medical school, like tilling soil and planting seeds for your medical training.

As many of you will know (from personal experience), a medical student is an individual pursuing a medical degree. This will either be an MD (Doctor of Medicine) or a DO (Doctor of Osteopathic Medicine) degree. In the US, it is usually a four-year program. You spend the first two years devoted mainly to theoretical study and lectures. Then, during the final two years, you spend more time in clinical settings.

In the clinical training years, you rotate through different specialties. You aren’t qualified to practice, diagnose, or treat patients during this time. However, teaching hospitals may allow you to observe, participate in rounds, study patients’ diagnoses, take patient histories (with a resident or attending reviewing), and more.

After graduating from medical school, the world considers you a physician… though you still must undergo years of training before you are solely responsible for patients.

Resident: A Med School Graduate Training in an Accredited Clinical Setting

So, you survived (and hopefully thrived in) medical school. You have a mind full of theoretical knowledge, physiological systems, and information that you are ready to start applying. After doing rotations as a student, you know what specialties you enjoy and which you want to avoid. So, what now?

Residency is a growing period. You establish roots and strengthen knowledge through practice.

Now you start your postgraduate medical education years, often referred to as PGY. Residency is the next step on the road to practicing medicine. It is a period of clinical training in an accredited hospital or clinic. Unlike medical school, residency has a specialized focus.

You apply to Match into residency programs for a chosen specialty. These programs can be anywhere from 3 (pediatrics) to 7(neurosurgery) years long. During this time, you can treat and provide care to patients, but only under the supervision of an attending physician, fellow, or a more senior resident.

Depending on your residency program, training may include seminars, lectures, and other further education requirements. In addition, your responsibilities will increase as your training progresses and you gain experience. For example, you may be given more independence or you may be charged with supervising more junior residents or interns (which we will explain now).

Intern: A First-Year Resident

An intern is a first-year resident. No matter which specialty you enter, you are an intern in your first year (PGY1) of residency. This differentiates you from residents with more training. As someone new to working full-time in a clinical setting, you will have many more questions and need more guidance than someone who has already been around for a year or two.

The term “intern” also may indicate that you are not rotating or training in your final specialty. For example, your first year may be training in internal medicine or general surgery for some specialties, such as neurology, dermatology, or oncology. When your internship is in a different setting than the rest of your residency, they call it a preliminary (or prelim) year. This is because it lays a strong foundation of basic skills for the rest of your residency.

After your intern year, you are a resident in whichever field you pursue (pediatrics resident, anesthesiology resident, etc.). The good thing is residents and interns earn a salary. According to the AMA, the average starting salary in the first year of residency is about $60,000. It increases after that, depending on residency year and specialty.

If financial incentive (and paying off student loans) plays a significant role in deciding which specialty you want to study, check out our Physician Salary Per Hour article.

Fellow: A Physician Training in a Subspecialty After Residency

In a fellowship, you use the foundation of your residency specialty to grow further, like roots growing around an already established tree.

After residency, some physicians pursue further training. This can be by choice or may be required for specific subspecialties. For example, if you want to be a pediatric cardiologist or hematologist, you will need to subspecialize. This period is called a fellowship.

So, as a fellow, you completed residency but are still training. You may even be fully accredited to serve as an attending in the general field in which you completed your residency. Still, you will have someone oversee your work in the subspecialty until you complete your fellowship. For example, if you did a pediatric residency, you could practice as a pediatrician. However, you would not be able to practice as a pediatric cardiologist until you complete a cardiology fellowship. The length of a fellowship is typically around 1-3 years, but it varies by specialty.

Attending: A Physician Licensed to Practice Unsupervised

As an attending, you have established a root system in your specialty.

Finally! The role you have trained for: attending physician. As an attending, you are no longer in training. You are a full-time, independent physician in your field. You are board-certified and are eligible to practice without supervision. This means you can direct patient care, and the responsibility is on you.

An attending physician can also be called a staff physician or a supervising physician. As the name suggests, attendings often supervise or attend to more inexperienced physicians (interns, residents, fellows). However, they may have different degrees of involvement. For example, an attending might be very involved with the entire medical team working on a patient case and interact with different levels of the hierarchy. Or, he/she may only see interns or residents during patient rounds, preferring to leave direct contact to others.

These Milestones Have Different Titles Around the World

If you are an IMG or have spent time abroad, you may have heard terms such as medical officer, registrar, junior doctor, consultant, GP, locum doctor, and more. Diving into the similarities between the US terminology and other terms used abroad deserves an article of its own. Until then, here are some brief definitions and descriptions of other common international terms.

• Medical Officer: The title of Medical Officer (MO) is similar to that of MD or DO. It signifies that an individual has completed a medical degree and can work in a clinical setting. In Australia and South Africa, an MO works for public hospitals to gain clinical experience directly after completing an internship.
• GP: A general practitioner who treats acute and chronic illnesses. A GP is similar to a primary care physician in the States.
• Registrar: A medical practitioner studying further towards a higher qualification or specialization. Similar to the US resident, this is done in a clinical setting while still practicing. However, unlike the typical resident, a registrar would already be fully licensed to practice as a general practitioner or medical officer.
• Junior Doctor (UK system): A doctor who has completed a medical degree and is qualified as a medical practitioner but is still training in a clinical setting.
• Consultant: A physician who has completed specialist training and can independently practice. A consultant is similar to the US attending.
• Locum Doctor: A licensed physician who works temporarily in a clinic or practice.

Concluding Thoughts

Whether a medical student or a super-specialized attending, medical education never stops. That is part of the reason it is called practicing medicine. Of course, the journey from medical student to practicing physician can vary by individual, but hopefully, this article has helped make some of the common milestones a bit more clear.

Selected Resources for Medical School:

We have a range of free resources available to medical students. Use the “Search” feature on the website to find information on USMLE prep, study tips, motivation, wellness, and much more.

Selected Resources for Residency:

Selected Resources for IMGs:

Photos by Markus Spiske, Ritik Gupta, Rishi, and Jeremy Bishop on Unsplash.

Resident vs. Attending Physician: What’s the Difference?

A resident is someone who has graduated from medical school and is completing a post-graduate training program. An attending physician is a board-certified physician who has completed their residency training. Residents are supervised by attending physicians.

When you receive care from a resident, you are also receiving care from their attending physician. This means you’ll benefit from the experience and knowledge of both providers.

This article discusses what makes an attending and a resident. It also offers a breakdown of the other people that comprise a hospital care team who are either board-certified physicians or those on track to becoming one.

Doctors and Levels of Seniority

To better understand what a resident and an attending physician are, it’s helpful to know more about all of levels of physicians and how they compare.

In the United States, the hierarchy of doctors you may encounter in a hospital is as follows:

1. Attending physician: A doctor who has finished post-graduate training
2. Fellow: A doctor who pursues optional additional training before becoming an attending
3. Resident: A doctor who has finished their first year of post-graduate training
4. Intern: Medical school graduates who are first-year residents

In order to become an intern, one must go to medical school and then embark on further training at a teaching hospital.

Attending Physicians

An attending physician is a medical doctor who has completed all residency training. They are board-certified or eligible to practice independently in a particular specialty.

An attending physician typically supervises fellows, residents, and medical students and may also be a professor at an affiliated medical school. Attending physicians have final responsibility for all patient care—even if a subordinate provides the care. (They may or may not have legal liability, depending on circumstances.)

An attending physician is considered an expert in their field of medicine or surgery. Attendings are also referred to as staff physicians, supervising physicians, or simply “attendings.”

Depending on the field of medicine, the route from medical student to attending can take seven years or more. Some specialties can take 14 years or more of post-undergraduate studies and training before credentials are fully obtained.

• Provide direct care to patients without supervision
• No limits on services they are able to deliver
• Hold all responsibility for care given by them or subordinates

• Can provide direct care to patients with supervision and guidance of an attending
• Allowed to do more as they gain experience
• Do not hold ultimate responsibility for care provided

Fellows

A fellow is someone who has completed their residency and elects to pursue further training. A fellowship is optional but is required to practice certain subspecialties.

An example is a general surgeon who wants to pursue a career in pediatric brain (neuro) surgery or heart/lung (cardiothoracic) surgery.

There are fellowships in many fields of medicine, including:

• Cardiology (cardiovascular system)
• Neurology (brain and nervous system)
• Obstetrics/gynecology (female reproductive health)
• Ophthalmology (eyes)
• Orthopedics (muscles/bones/joints)

Interns and Residents

Medical school graduates then enter a residency program in a hospital, clinic, or doctor’s office.

The goal of residency—also referred to as a graduate medical education (GME) program—is to continue training in a specialized field of medicine. A medical residency can last anywhere from two to three years for a family doctor to seven or more years for a surgeon.

First-year residents are referred to as interns. After that, they are known as resident doctors, resident physicians, or simply “residents.”

Residents provide direct care under the supervision of an attending physician or senior resident.

Residency Specializations

Residents can choose different specialties to train in after graduation. Some potential specialties include:

• Emergency medicine
• General surgery
• Family practice
• Pediatrics
• Anesthesiology
• Diagnostic radiology

Chief Residents

Chief residents are selected to lead a group of residents. They are residents who are elevated to a level that puts them senior to the rest of the residents and junior to the program’s management.

The duties of chief residents may vary, but can include patient care; mentoring, training, and advocating for team members; and carrying out some administrative duties.

Chief residents are chosen by hospital leadership during their residency program.

Medical Students

Medical students are those who have obtained a bachelor’s degree and have been accepted to medical school after meeting certain requirements, including passing the Medical College Aptitude Test (MCAT).

The first two years of their four-year program is devoted to classroom studies. During the latter two years, time is largely spent in a hospital- or clinic-based setting.

Upon completion of medical school, medical students graduate with either a doctor of medicine (MD) or a doctor of osteopathic medicine (DO) degree.

It is only at this point that they are referred to as physicians, even though their training is not yet complete.

How Can You Tell Who’s a Resident vs. an Attending?

You can sometimes tell where a person fits in the hierarchy based on the length of their lab coats. Residents typically wear longer coats, while attending physicians will wear full-length coats.

The shortest white coats, on the other hand, are worn by medical students.

Even so, a lab coat is not an absolute indication of a person’s status as other health professionals also wear them, including nurse practitioners and phlebotomists (technicians who draw blood).

Today, many health professionals of all ranks also wear scrubs.

When in doubt, look at a staff member’s ID badge or just ask what their role is. It is your right to know who does what and which member of the hospital staff is ultimately in charge.

Summary

People training to be a medical doctor are given different titles as they progress through the ranks. They begin as medical students, then progress to interns, residents, and fellows. Once residency and fellowship trainings are complete, a person can become a board-certified attending physician.

From the time of enrollment in medical school to board certification, it can take anywhere from seven to 14 years (or more) to become an attending physician.

Frequently Asked Questions

Yes. Resident doctors earn a relatively modest salary and get benefits such as health and dental insurance. Resident salaries typically start low and increase every year.

First-year residents earn an average of $60,000 a year. The median salary for a physician is $208,000, though this can vary widely according to specialty, with anesthesiologists earning around $332,000 a year and pediatricians earning $198,000.

Yes. Resident doctors can prescribe medication to the patients under their care.

The highest position a doctor can attain is medical director. Medical directors supervise staff, enforce policy, and manage the services provided by the facility. They have the most authority and responsibility within a hospital.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Bureau of Labor Statistics. How to become a physician or surgeon.
2. Mowery YM. A primer on medical education in the United States through the lens of a current resident physician. Ann Transl Med. 2015;3(18):270. doi:10.3978/j.issn.2305-5839.2015.10.19
3. Weggemans MM, van Dijk B, van Dooijeweert B, Veenendaal AG, ten Cate O. The postgraduate medical education pathway: an international comparison. GMS J Med Educ. 2017;34(5):Doc63. doi:10.3205/zma001140
4. Teo WZW, Brenner LH, Bal BS. Medicolegal sidebar: resident physician liability. Clin Orthop Relat Res. 2017;475(8):1963-1965. doi:10.1007/s11999-017-5402-x
5. American Medical Association. 6 things medical students should know about physician compensation.
6. U.S. Bureau of Labor Statistics. Physicians and surgeons.

By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.