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

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by Jennah Heger in Uncategorized

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.

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Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored USMLE 270 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.

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