Table of content:
What is residency in medicine?
Interns vs. Residents vs. Fellows
Who needs to complete a residency?
What are the responsibilities of a resident?
How long is a doctor's residency?
Does a medical residency get paid?
How do the taxes work?
What are the weekly hours?
The different specialties
Legal aspects - Can you get sued?
What's the process of applying for residency?
What is the matching process and how does it determine where you do your residency?
What are the options if you don't match?
What if you don't want to do a medical residency at all?
Dismissed from residency - What now?
What alternatives to residency are there?
Things to know before starting a residency
Maintaining a healthy work-life-balance
5 ways to keep your mental health during residency



A residency in medicine is a postgraduate training program which allows a resident to perform as a licensed practitioner. During this time, you receive training in a specialized area of medicine.

In this guide, you will learn everything you need to know before starting a residency.



When researching medical residency, you will most likely stumble upon “interns” and “fellowships”. But what are the differences?


This term is a little bit outdated. After completing medical school, the doctor goes on to their first year of post-medical school training. This year is referred to as the intern year. As an intern, the doctor does not have the right to practice unsupervised medicine. Instead, they must practice within the confines of their training program. Usually, this one year internship is the first year of residency.


Residency follows the intern year. Residency can range from at least 3 years of education to an extra 7 years of training depending on the specialty. For example, a family practice residency would last 3 years, while a surgery residency may last 7 years or more.


A fellow is a fully credentialed physician who has completed their residency and elects to complete further training in a specialty. For example, a cardio-thoracic surgeon would use a fellowship to get specific training in heart and lung procedures.

A fellowship is optional. It is not required to practice medicine, but is necessary for training in a specialty. After a general surgery residency, a physician can perform general surgery. The fellowship is necessary for more specific training, such as pediatric neurosurgery.



Residency is a vital step of post-medical school training. After completing medical school, those hoping to practice medicine are highly recommended to apply for residency. There are very few exceptions where someone can practice without completing a residency. (See chapter What if you don’t want to do a medical residency?”)



Residency involves specialized training for a specific area of medicine. The exact skills and procedures differ by specialty.

In general, residents are responsible for assessing patients on admission, including performing physical exams. Residents also order appropriate diagnostic tests and consult with other specialties as needed. Attending patient rounds and performing treatments and diagnostic procedures are also resident responsibilities. In addition, residents will prescribe treatment, provide patient education, and write discharge summaries. In some specialties, residents help with surgeries and respond to emergencies, such as trauma pages or codes.

During the first year of residency (i.e. the internship), residents are supervised by senior residents and attending physicians. Residents are given more independence and responsibility as you go through the program. In the second year of residency, residents may supervise medical students. By the third year of residency, residents may supervise first-year residents and will have many of the same responsibilities as an attending physician.



The length of a residency depends on the specialty you are pursuing. Most residencies are between 3 and 7 years. For example, a 3-year residency is required for doctors in family practice, internal medicine, and pediatrics. Longer residencies exist for certain specialties, such as surgery and urology. Keep in mind; depending on your goals, you may need to get more training in the form of a fellowship after residency. Fellowship training will vary and is often 1 to 3 years depending on your sub-specialty.



Yes, you get paid as a medical resident! However, salaries for medical residencies vary. They depend on the medical specialty as well as which state/part of the country the residency is in. In 2017, the some of the highest-paying specialties were orthopedic surgery, cardiology, and thoracic surgery. Family medicine residents were at the low end of the pay scale. According to the Association of American Medical Colleges, the average salary for first-year residents in the United States for the 2016-2017 report was $54,107 a year. Salaries also increase with each year of residency. A second and third-year resident will earn more than a first-year resident.



Residents are employees, so tax rules that apply to residents are found in the sections of the IRS code that deal with employees.



The number of hours residents work varies by program and specialty. Some residents may work 45 hours a week, while others work much more.

For example, a dermatology residency may not need you to be on call, which cuts down on the hours worked. Other specialties, such as surgery, need someone on call and are more time-consuming. The first year of residency is often the worst when it comes to the number of hours required to put in. First-year residents are often required to work more on call hours than third and fourth year residents.

Residents may also be required to attend lectures and conferences, which also places extra demands on your time. The good news is laws changed in 2003, which limit the number of hours a resident can work to 80 hours.



Medical school general prepares students for a broad foundation of medicine. The residency is where you choose your specialty and smooth the way for your final goal.

As of June 2018, there are 26 different specialties (not counting sub-specialties and fellowships). Below, you will find a list with all current specialties, including length, potential salaries, and fellowships.



Residency Length 

(not counting subspecialties/ fellowships)

Potential Salary 

(Average, without subspecialty/fellowship)

Required for the Following Fellowships


4 years

$ 386,000

Critical Care, Pain Medicine

Child/Pediatric Neurology

5 years (2 pediatrics/ 3 neurology)

$ 250,000

Vascular (Stroke) Neurology, Epilepsy and Electrophysiology, Neurodevelopmental Disorders (Autism and Autism Spectrum disorders)


4 years

$ 392,000

Dermatopathology, Pediatric Dermatology, Procedural Dermatology

Emergency Medicine

3-4 years

$ 350,000

Medical Toxicology, Pediatric Emergency Medicine, Sports Medicine, Ultrasound, Undersea and Hyperbaric Medicine

Family Medicine

3 years

$ 219,000

Adolescent Medicine, Geriatric Medicine, Hospice and Palliative Care, Sleep Medicine, and Sports Medicine

Internal Medicine

3 years

$ 230,000

Cardiology, Pulmonary and Critical Care, Nephrology, Gastroenterology, Hematology/Oncology, Infectious Disease, Endocrinology, Rheumatology, Transplant Medicine, Palliative Care, Sleep Medicine, and Geriatrics

Internal Medicine/ Pediatrics

4 years (2 internal/ 2 pediatrics)

$ 200,000

Unique: Med-Peds Generalist

Combined: Allergy and Immunology, Cardiology, Endocrinology, Gastroenterology, Hematology/Oncology, Infectious Disease, Nephrology, Neurology, Pulmonary/Critical Care, Rheumatology, Palliative Care

Special: Adolescent Medicine, Epidemic Intelligence Service (EIS), HIV Medicine, Medical Genetics, Medical Informatics, Outcomes Research, Quality Improvement, Robert Wood Johnson Clinical Scholars Program, Sports Medicine

Medical Genetics

2 or 4 years

(first two completed in another specialty, usually pediatrics, internal medicine, or ob-gyn)

$ 158,000

Medical biochemical genetics, Molecular genetic pathology

Nuclear Medicine

3-4 years

$ 290,000



4 years

$ 244,000

Behavioral Neurology, Vascular (Stroke Neurology), Neurocritical Care, Interventional Neurology, Multiple sclerosis and Neuroimmunology, Movement Disorders, Epilepsy and Electrophysiology, Neuromuscular, Headache, Sleep Medicine, Neuro-Infectious Disease, Neuro-oncology, Neuro-ophthalmology, Neuro-otology, Neuro-Hospitalist, Neuro-Rehab, and Sports Medicine

Neurological Surgery

7 years

$ 462,000

Endovascular Surgical Neuroradiology, Pediatric Neurosurgery

Obstetrics & Gynecology

4 years

$ 300,000

Maternal-fetal medicine, Reproductive Endocrinology and Infertility, and Gynecologic Oncology

Radiation Oncology

5 years

$ 363,000


Radiology - Diagnostics

5 years

$ 401,000

Neuroradiology, Nuclear Radiology, Pediatric Radiology, Vascular and Interventional Radiology


4 years

$ 357,000

Oculoplastics, Retina, Neuro-ophthalmology, Cornea, Pediatric Ophthalmology, Glaucoma, Ocular Pathology

Orthopedic Surgery

5 years 

(1 year general surgery / 4 years orthopedic surgery)

$ 497,000

Joint Replacements, Spine Surgery, Pediatric Orthopedic Surgery, Trauma Surgery, Hand Surgery, Foot/Ankle Surgery, Sports Medicine


5 years

$ 383,000

Neurotology, Pediatric otolaryngology, Head and Neck Reconstructive Surgery

Pathology - Anatomic & Clinical

4 years

$ 286,000

Blood Banking/Transfusion Medicine, Chemical Pathology, Cytopathology, Dermatopathology, Forensic Pathology, Hematology, Medical Microbiology, Molecular Genetic Pathology, Neuropathology, Pediatric Pathology


3 years

$ 212,000

Adolescent Medicine, Neonatal-Perinatal Medicine, Cardiology, Pulmonary and Critical Care, Nephrology, Gastroenterology, Hematology/Oncology, Infectious Disease, Endocrinology, Rheumatology, Emergency Medicine, Transplant Medicine and Palliative Care

Physical Medicine & Rehabilitation

4 years

$ 269,000

Neuromuscular Medicine, Pain Medicine, Pediatric Rehabilitation Medicine, Spinal Cord Injury Medicine, Sports Medicine

Plastic Surgery

6 years

$ 501,000

Hand Surgery, Head and Neck Surgery, Breast Surgery

Preventive Medicine

3 years

$ 199,000

Medical Toxicology, Undersea and Hyperbaric Medicine


4 years

$ 273,000

Addiction Psychiatry, Child and Adolescent Psychiatry, Forensic Psychiatry, Geriatric Psychiatry, Psychosomatic Medicine

Surgery, General

5 years

$ 322,000

Hand surgery, Surgical critical care, Vascular surgery, Pediatric surgery

Thoracic Surgery

6-8 years

$ 475,000

Congenital cardiac surgery


5 years

$ 373,000

Pediatric Urology, Urologic Oncology


Mistakes happen, this is part of the learning process. However, since residents are majorly involved with peoples health and wellbeing, mistakes are more critical.

That leads to the question of how residents are protected from medical malpractice lawsuits.

Capson’s former Director of Claims, Laura A.Cook, Esq. put some light on the legal aspects of medical residency and has some tips for young residents.

Hello Laura, thank you for taking the time. Let’s dive in right away. How are medical residents protected from lawsuits?

Residents are closely supervised and doctors-in-training by definition.  As such, they are less likely to be targeted for medical malpractice suits. Rather, their teaching institution is responsible for the medical care provided by its residents during training. In those instances in which residents are sued, they are often dismissed from the case once the hospital is confirmed to be responsible for them legally and financially.

What kind of insurance does the teaching hospital or the resident need?

Residents of a teaching hospital are typically afforded the same type (MPL) and same levels of professional liability coverage as other physicians in their specialty.

What is your advice for medical residents in order to protect themselves from lawsuits?

Essentially, trust no one and triple check.

  • Good documentation – differential diagnoses, plan for treatment, orders, discharge instructions
  • Informed consent – discussion along with a counselling note and signed informed consent form which also has a witness’s signature; discussion to include risks, benefits, alternatives to proposed treatment
  • Chaperone present whenever patient is female and when conducting a physical exam on any patient
  • Good communication with staff (attendings, nurses, consultants, other residents)
  • Follow up on all lab-work and imaging which was ordered

From your experience, how should a medical resident react if threatened with a lawsuit? How is this situation handled best?

Be careful not to fall into some of the easy traps that new doctors or doctors new to litigation can be prone to.

  • Avoid placing blame on other healthcare providers when a medical mishap occurs; what goes around, comes around. The only person that benefits from finger-pointing amongst providers is the plaintiff.
  • Don’t worry too much or too little about a lawsuit; be engaged and cooperate, but don’t let it consume you or undermine your confidence.
  • Listen to your attorney and be prepared for meetings, interviews, depositions, etc., Refrain from conducting any additional research unless asked to do so.   





When do you apply?

Most students start applying for residency during their 3rd year or early in their 4th year of medical school.


Where do you apply?

MyERAS (Electronic Residency Application Service) is an online application service used to research and apply to residency programs. ERAS opens in mid-May for residencies that would start the following year. This allows applicants to start preparing the application and necessary documents. On September 15, ERAS applications and supporting documents can be submitted to ACGME-accredited residency programs. Find specific info on ERAS, including timelines for U.S. medical students and graduates (USMGs) and IMG residency applications, on the ERAS website.


What do you need for your application?

Personal Statement - This is an opportunity to show your passion for a specific specialty and paint a personal picture. The ERAS system allows you to create many personal statements for many specific programs and specialties. Begin writing the personal statement 3 to 4 months before applying for residency. Try to finish by the end of August, at the beginning of the 4th year of medical school.

Letters of Recommendation - Most programs need no less than 3 letters of recommendation. Potential letter writers may be attending physicians from 3rd or 4th-year rotations, department chairs, program directors, research collaborators, deans, and faculty. ERAS allow applicants to store an unlimited number of letters and to choose different letters for each program. However, applicants can’t send more than four letters to an individual program. It’s best to avoid asking residents to write letters. Letter authors upload their letters to the ERAS system. Check individual program websites and ERAS for details on due dates and what types of letters of recommendation are expected.

The Medical Student Performance Evaluation (MSPE) - The MSPE details an applicant’s academic history and performance through the first 3 full years of medical school and, in some cases, as much of the 4th year as possible. The MSPE is written by an applicant’s student affairs dea, along with other faculty members. At most schools, students have an opportunity to review their MSPE for accuracy. The MSPE release date (the date the document becomes available to programs through ERAS) is October 1 each year.

Curriculum Vitae (CV) - Although a CV is not required as part of the ERAS application, most of the info included on a CV will be required for the residency application. Having it all in one place makes completing your residency application and personal statement easier.



During the last year of medical school, medical students start the matching process. After deciding where they are most interested in doing residency, medical students apply for residency. Residency programs review applications and invite candidates they are interested in to an interview. During that time, medical students may be interviewed by a panel of senior residents and attending physicians.

After being interviewed at different programs, medical students will submit a rank order list of their choices to the National Resident Matching Program. The residency programs also submit a list of their candidates in preferred order of acceptance. The info is placed into a computer program, which uses an algorithm to match students to residencies.

Each year a small percentage of medical students fail to match with a residency program. One reason for failing to match may be only applying to a few residency programs. Another reason med students may not match is if they apply to very competitive residency programs and failed to impress the board.

If a medical students does not match, there are a couple of options. Residency programs are sometimes in the same boat. They may not have matched with enough candidates to fill their resident spots. Also, residents can apply for a one-year research fellowship or can just take a year off and try again next year.



Continue to seek a residency position.

– Work with the student affairs dean, to identify available opportunities

– Check the AAMC’s FindAResident program, which will list any positions that remain available

– Check the NRMP’s list of unfilled positions

– Check with the many specialty associations that maintain listings of available programs and positions in their specialty


Reapply in the next match cycle. Consider the following tips:

– Consider applying to a different specialty

– Seek research opportunities that support a specific specialty choice

– Closely consider strengths and weaknesses in relation to the specialty choice

– Rethink or expand your geographic search


Talk to student affairs dean about delaying graduation.

– Complete electives and rotations that support a specific specialty choice

– Look for teaching or tutoring opportunities


Consider pursuing an additional degree (MPH, MBA, MS, etc.).


Seek guidance and support from the student affairs dean, advisers, mentors, alumni, family members, and others close to you.


Make an appointment and talk with your financial aid officer. Discuss strategies for managing student loans.


Review/revisit Careers in Medicine (CiM), aamc.org/cim:

– Retake the assessments, especially the Medical Specialty Preference Inventory, Revised Edition, and the Physician Values in Practice Scale

– Explore CiM’s specialty pages

– Review articles and resources about applying for residencies and interviewing (“Land Your Residency”)

– Consider alternative career options, such as consulting or working for health care research firms, health maintenance organizations, or nonprofits


Although you can reapply the following year, the chances of a successful match are much lower for previous graduates of U.S. medical schools than for students. For example, the NRMP 2015 Main Residency Match Data report shows that only 43.6% of previous graduates matched to PGY-1 positions. This compares with the 93.9 percent of fourth-year students in U.S. medical schools who matched.



Is a medical residency required?

A medical residency not only takes between 3 and 7 years, but there are good chances that a match does not happen at all. This leads to many students asking what opportunities they might have without a residency.

Is there a way around it?

The good news is, med students don’t have to do a residency. It comes down to which career path you want to pursue.

If you want to see patients and specialize in a certain field, then there is no way around a medical residency. This is where you learn everything you need to know to become specialized.

But if you only want to practice basic medicine, there are options to do so without a completed residency. Depending on the state(s) an internship might be enough. That, and completing step 3 of USMLE or COMPLEX, which should happen between the 3rd and 4th year of med school.

However, this brings a lot of challenges. For example, medical professionals without a residency will never be able to become board qualified. You might want to keep this possibility open rather than disqualify yourself right in the beginning of your career.

Another important aspect which needs careful consideration is the legal situation. As a practicing physician without a completed residency, getting malpractice insurance might be difficult. A lot of typical insurances cannot provide this important protection.

If your desired goal is to practice, to specialize, and to become board qualified, you need a residency.



Being fired from residency is unpleasant, but it can happen. It is also possible to recover from it and continue on this career path. Important in this case are the exact reasons for the involuntary end of the residency.

Generally speaking, being fired from medical residency does not mean the end of your career. However, the next steps should be taken very carefully.

1. Don’t burn bridges. Even though a termination is tough, staying professional comes a long way. If you display unprofessional behavior, this will show up on your record. A bad record makes it very hard to get accepted for a different residency program.

2. Normally, termination doesn’t come without a warning. Be cooperative to working on addressed issues. Also, seek further consultation or programs can help to prevent termination altogether.

3. Reflect what leads to your termination. Is it behavior issues or might the chosen specialties just not be right for you? Talk to supervisors, coworkers and staff to get their opinions.

4. Remember: Being asked to leave a certain program does NOT mean you are a “bad” doctor and shouldn’t be practicing at all. Depending on your personal skill set and character, a different specialty might suit you better. Talk to your superiors to find out as much as you can.

5. If termination is not avoidable, remain calm. End terms with everyone as constructive as possible. Ask for letters of recommendation. Apply for different residencies.

6. Be prepared to be questioned about the reasons behind your termination. The new teaching hospital will want to make sure that the issue for the termination won’t be a problem for them. Be open, transparent and show your efforts on how to prevent the mistake from happening again.

7. Be open to different paths. Have alternative plans if you should not be able to get into a different residency program.



If you are absolutely sure that you want to pursue a different career path, a residency is not necessary.

In fact, there are a lot of options for MDs without license and residency. Medical research, informatics, instructors, pharmaceutics, business, and media are just a few examples.

We talked to Derek DuBois, MD. He is the founder of www.DOCjobs.com, the leading website for doctors seeking alternative careers. He was previously a Partner at McKinsey & Company and a Managing Director at Accenture. He knows from own experience what it takes to leave residency to pursue a different career.

Hello Derek, thank you so much for your time and answering our questions. From your experience, what does a medical resident need to know, before dropping out of residency? What are the main things that change and which opportunities might be out of reach after dropout?

The most important gating factor before deciding to leave a residency is whether you want to practice clinical medicine (or at least preserve that option for the future). If you do, then you need to finish your residency (or perhaps transfer to another one). Leaving mid-stream will make it very hard to return and may shut the door on clinical medicine.

I left after internship to join an internet startup but I knew that I did not want to practice and was making a "burn the boats" decision that I would support myself and my family in business not in clinical medicine.

For most jobs in business it is not necessary to have a completed residency (there are exceptions such as Medical Director positions in biopharmaceutical companies that are looking for people trained in specific specialties - but those are generally also looking for people with substantial experience in those specialties as well).

How have medical career paths changed in the last years? Are there more opportunities for “dropouts” now than 10 years ago?

There have always been a number of paths for doctors to work in industry -- there are approximately 80,000 Medical Doctors in the US working in biotech, pharma, med device, consulting, investing, or high tech. However, there is a wider range of opportunities today, and there is much more awareness today among students and residents of the range of possibilities.

Biopharma, med device, insurance companies and hospital administration have always been active in hiring medical doctors. But the startup, health IT, health analytics and related scenes are more active today than they were 10 years ago and present various options. Biomedical investment firms (sell side equity research, buy side investment funds, VC, private equity) have consistently hired doctors for the last 20 years and regularly recruit doctors (although there are relatively few slots and they are very competitive).

Overall there is a more active dialogue today than 10 years ago about the range of opportunities for doctors, reflected in part by the existence of web sites such as our own (DOCjobs.com) but also reflecting the broader range of roles and changes in the level of career satisfaction among physicians with practice consolidation and various types of health reform and managed care

What advice do you have for medical residents that are thinking about dropping out, or already dropped out (voluntarily or involuntarily)?

First - think long and hard about what really drives you, what you are excited about. Focus on the long-term -- what is it you want to spend the next 30 years working on? Second, talk to a LOT of people. Network actively in the areas you are interested in. Research online. Find out what those career paths are really like and calibrate your views on whether they are for you. Third, expect challenges. Residency and practice are not easy paths. Neither are any business paths -- and in general they are less predictable and there will be more twists and turns along the way than a clinical career.

So focus on the overall theme of what you want to do and don't expect you can predict each step along the way. Lastly, recognize that the first job is the hardest one to get -- there are lots of MDs interested in most of these jobs -- you can't just toss your resume (and please, make it a business focused one page resume, NOT an academic CV) in the ring and expect to get hired...you need to clearly articulate how you meet a firm's needs (not vice versa) and you may need to find ways to get needed experience before your perfect role. Once you are in industry, the experience you gain there defines you -- not where you got your medical degree or what grades you got. You just need to get started.

Good luck.



“The journey is a marathon, not a sprint.” – Dr. Onur Gilleard

Applying to medical residency programs is a long and stressful process. However, knowing how long it will take, what is required, and the wide range of specialty options makes applying much less daunting. Before you apply for residency, focus on getting a well-rounded CV to help you pave the way for training.

Research requirements for application and set appropriate expectations for your career in medicine. The New England Journal of Medicine (NEJM) mentions that, although clinical training is the traditional path, students should talk with their advisers to look at nonclinical career options, too.

The prerequisites for residency programs include passing the USMLE STEP 1 and STEP 2. According to the United States Medical Licensing Examination (USMLE) site, Steps 1 and 2 can be taken in any order. Most students end up taking Step 1 at the end of their 2nd year of medical school and Step 2 in their 4th. Also, different specialties and residency programs will have their own application requirements. Familiarize yourself with the requirements of each program you are interested in. This ensures you are not missing anything once your application has been submitted.



Among other questions that plague medical students before starting a residency program, how to achieve work-life balance is at the top of the list. The American Medical Association (AMA) suggests that, to get a better balance, new residents need to know their priorities. Making a schedule and planning a routine you can stick with will help with your general mental health.

Use the vacation time you get as a resident. Plan your vacations well and recharge. The website Board Vitals also recommends to focus on events that are most important to you.  Try not to feel guilty about about prioritizing yourself. Although it is tempting to believe life will be set on pause through medical training, it just isn’t possible. Take care of your own health, get to know the people and the area around the hospital, and try to enjoy yourself.

Helpful Resources



Stay hydrated 
And don’t forget to eat. The first year of residency is dominated by stress and limited time for everything. Never forget yourself and the needs of your body. Stay hydrated and take the time to eat healthy meals. You will be rewarded with a better health and wellness. Remember, residency will pass; your body will stick around!

Embrace the bad days
Some days will be super awesome. You will have the best time, your diagnosis is on point, your patients love you, and your co-workers and superiors declare you the next House. Celebrate that!

But some days will just suck. Embrace those days as well. Buy your favorite pizza, watch “Grey’s Anatomy” and cry as much as you need to. Then go to bed, have a good night sleep and conquer the new day.

Don’t put your life on hold
Completing your residency will take time. Especially when you want to specialize even further after residency. That’s why you should put your life on hold. Use vacations to travel, start building your family, read that book and (try to) do all the things you want to do.

Remember that residency is not forever

The early stages of your residency won’t always be fun. Medicine has a hierarchy. As a first-year-resident, you are starting on the lowest step of the “food-chain”. This might not always be fair, but keep in mind, that it won’t be like this forever. Keep your dignity, your friendliness, and get through it. And don’t forget this feeling when you get to work with newer residents.

Also Remember that quitting does not equal failure

Maybe the time will come where you decide, that you don’t want to continue your residency. You feel that you are on the wrong path and you are just not happy. Dropping out of residency is something you might think about for a while. Don’t decide based on one bad day or one bad week. Without a residency, some doors will close for you. But you may come to the decision that you never want to go through these doors anyway.

Don’t let people tell you that dropping out equals failure. Even more important: Don’t tell yourself that you failed. Quitting is not failure. It just means that you were on the wrong path. You learned a lot in your time as resident, including what you want and what you don’t want. That gives you a lot of strength, experience and motivation for your new career path.