What is residency?

Residency serves as a crucial phase in a physician's training, following the completion of medical school. It is a supervised clinical training period and an intensive, full-time job—requiring 60-80 hours per week—which provides physicians, also referred to as residents or trainees, with hands-on experience and increasing autonomy in delivering health care under the guidance of experienced attending physicians.

Residency programs vary in duration, ranging from three to seven years, depending on the specialty pursued. These programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME) to ensure quality and consistency in training.

Experts emphasize the importance of residency as a bridge between medical school and independent practice. During residency, residents gain a tailored, immersive learning experience where they apply their medical school knowledge to patient care, developing expertise in specific health care areas. They are trained to provide complex differential diagnoses, formulate treatment plans considering multiple organ systems and interpret tests in the context of a patient's overall health. This comprehensive training prepares them to lead multidisciplinary health care teams effectively. The gradual transition from supervised to independent practice allows resident physicians to develop professionalism, confidence, clinical judgment and autonomy in patient care—all essential attributes for successful practice in health care. Resident physicians can begin or continue prior work in research, medical education, quality improvement, administration or other scholarly work, contributing to the advancement of medical knowledge and evidence-based practice.

Researching programs

Researching residency programs is a crucial step for medical students preparing to apply. Prospective residents should consider factors such as program reputation, curriculum structure, faculty expertise, patient population diversity, geographic location, presence of a union and other protections for trainees’ rights, and opportunities for scholarly activity. Online resources, such as FREIDA™, the AMA Residency & Fellowship Database®, the AAMC’s Residency Explorer Tool and Doximity among many others, provide valuable information about residency programs, including program characteristics, application requirements and Match statistics.

Applying/interviewing

The application process for most residencies involves submitting materials through an application service such as the Electronic Residency Application Service (ERAS)®, including a personal statement, curriculum vitae (CV), letters of recommendation and U.S. Medical Licensing Examination (USMLE) and/or Comprehensive Osteopathic Medical Licensure Examination (COMLEX) scores. After applications are reviewed by programs, selected candidates are invited to interview with program directors, faculty members and residents. The interview is an opportunity for applicants to showcase their academic achievements, clinical experiences, research endeavors and personal attributes. Prospective residents have the chance to discuss their career goals and learn more about the program's culture and training environment during interviews.

Matching

Most residency match processes are conducted by the National Resident Matching Program (NRMP), which uses a computer algorithm to pair applicants with residency programs. Applicants submit rank order lists of preferred programs, while programs submit rank order lists of preferred applicants. The NRMP algorithm matches applicants and programs to their most preferred ranked choices to make the best possible match for all participants. Some specialties use other mechanisms to apply and match to programs. The Match results are first released to programs before being released to applicants on Match Day. Matched applicants are then committed to beginning residency training at the matched program.

Applicants learn on Monday morning of Match Week whether they have matched. For applicants who do not get matched with a program, there is a process called the Supplemental Offer and Acceptance Program (SOAP), a system for residency programs to fill unfilled positions with eligible unmatched or partially matched applicants during Match Week. Usually within a couple of hours of finding out they have not matched, applicants can begin to work on their SOAP applications, with programs viewing applications as soon as Tuesday morning and all applications due by Thursday morning.

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Program year 1 (PGY-1) of residency and beyond

The first year of residency, also known as the PGY-1 year or internship year, is a foundational period where residents build essential clinical skills and knowledge. For most specialties, this is training in their specific field, though some specialties include an internship in a related but broader field so as to ensure residents have a solid grounding in the broader practice of medicine. Beyond the PGY-1 year, residents progress through subsequent years of training, advancing in clinical responsibilities and autonomy in patient care, and refining their expertise in their chosen specialty.

After completing residency, physicians may choose to pursue further specialization and skills development in fellowship, or they may choose to begin practicing as autonomous physicians in their field.

The Resident & Fellow Section (RFS) of the AMA gives voice to and advocates for issues that impact resident and fellow physicians. From attending RFS meetings where members influence policy on key issues to serving on the governing council, AMA councils and various committees—residents and fellows have an opportunity to develop leadership skills, network and advocate for the issues that matter.

AMA members can ease the financial burdens of interviewing for residency positions with Laurel Road. Read more about the benefits of AMA resident membership.

Other key AMA resources include:

• AMA Road to Residency Guide
• FREIDA™, the AMA Residency & Fellowship Database®
• View CME courses relating to residency
• Learn about the AMA Resident & Fellow Section

Reviewed by: John S. Andrews, MD, and the AMA Resident & Fellow Section (RFS) Governing Council

Reviewed on: May 14, 2024