How long is residency? Residency lengths and structures vary by specialty and can be intimidating aspects of planning your career following medical school. Whether you’re applying to the in Canada and the US, this guide will provide you with useful data to give you a better sense of what lies ahead on any of your potential paths forward.
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Transitioning from medical school to a residency program should be a time for celebration and renewed perspective. Making it through four of the hardest years of your academic life is no small feat, and one of the rewards of that hard work is getting to that engages your strengths and interests as a budding medical professional. This is no small decision though—although physicians occasionally change specialties once in practice, doing so requires completing another residency as well as the likelihood of a pay cut and relocation. It’s crucial to make the best decision you can for your initial residency, and a big part of that is considering residency lengths.
Residency involves tremendous dedication and long hours worked within a chosen specialty. The term “residency” comes from the historical tradition of trainee physicians literally residing in their appointed hospitals, effectively spending every moment in-hospital during their placement. For better or worse, not much has changed since those early years of sleep deprivation and intimidatingly long shifts, with current weekly work-hours in the U.S. averaging around 60-80 hours, with shifts of up to 24 continuous hours on-duty. With this in mind, it’s essential to determine which residency programs will allow you to mature and thrive rather than collapse under the pressure.
This is where the length of residency programs comes into play. For instance, you may have a strong interest in neurosurgery, but the reality of nearly 7 years of surgical resident workload/scheduling is not to be underestimated. It’s in your best interest both short- and long-term to consider the length of commitment involved in each type of residency program in relation to your strengths and limitations. Residency is a challenge no matter what, of course, but unless you’re the rare person who’s inextricably drawn to only one specialty, you’ll want to approach the decision with a few options in mind. So if that 7-year neurosurgical residency track sounds like maybe more than you can handle, and you’re equally interested in pediatrics, it may be a better fit for you to embark upon a 4-year pediatrics track and lower your risk of burning out.
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Numbers vary somewhat between countries, but there’s also a great deal of symmetry between the Canadian and U.S. residency systems. In both, the first year after graduating from medical school—post-graduate year 1, or simply PGY1—is almost always dedicated to general clinical acclimation and residency in a broad field like Internal Medicine or General Surgery. Following this, programs begin to diverge and specialize. Before we get into detail on each of these residencies, here’s an overview of residency lengths:
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With the overview above in mind, it’s important to understand that not only the length but the structure of residencies vary by specialty. Some residencies are intended for students just leaving medical school, while others require one or more post-graduate preparatory years (PGY) in a general field before launching into the specialty fully. While we’ve done our best to give you a solid overview of residency lengths by type, there are differences from program to program, as well as dual-specialization residencies and sub-specialty fellowships that may extend timelines for those chosen to participate. As with all matters regarding medical education, you must consult the handbooks and guidelines of each specific program to gain a full understanding of their residency offerings.
As a specialty that incorporates many other fields like pharmacology, emergency medicine, and physiology, Anesthesiology requires significant time and preparation. The result, though, is a specialty that combines flexibility with tremendous general knowledge, and can lead to many different subspecialty certifications throughout a practitioner’s career.
Anesthesiology residencies in the United States run around 4 years and utilize PGY1 for a transitional or preliminary year, followed by 3 years of residency. Subspecialty fellowships are numerous in the U.S., ranging from Palliative Medicine to Patient Safety and Quality Improvement.
In Canada, Anesthesiology programs utilize the first post-graduate year (PGY1) for basic clinical training in a wide range of applications. The remaining 4 years build competency in specific subspecialties including Clinical Anesthesia, Internal Medicine, Critical Care, and a six-month block of electives. Anesthesiology programs in Canada therefore last 5 years on average. There are also dozens of in addition to general residency programs.
Like most surgical specialties, Cardiac Surgery residencies are extremely long, demanding, and technical.
In the United States, Cardiac Surgery residents typically complete a basic surgical residency usually lasting 5 years, followed by approximately 3 years of specialized Cardiac Surgery training. There are tremendous variations in various “tracks” of residency here as well, ranging from 6-year integrated programs to dual-focus surgical residencies in cardiac and thoracic surgery. In general though, the total length of any of these permutations is about 6 years, with additional years for subspecialties and academic enrichment if so desired.
In Canada, this takes 6 years, though there are opportunities for additional subspecialty fellowships and certifications. Canadian Cardiac Surgery residents undertake a core block in PGY1-2 focusing on clinical work in a broad base of specialties including general medicine, cardiology, and various surgical subspecialties. Late PGY2 and early PGY3 focus on developing surgical competency and taking as well as the Principals of Surgery Examination. Finally, the remaining years of the program (PGY3-6) are structured around 6-month blocks of surgical subspecialty training, a 1-year senior residency in adult cardiac surgery, and 1 year of academic enrichment.
Community Medicine/Public Health and Preventative Medicine
Community Medicine, in contrast to surgical specialties, is a broader specialty that includes a range of medical contexts like Public Health, Occupational Medicine, and Preventative Medicine. Residencies in Community or Public Health may commonly lead to careers outside of traditional clinical settings, including governmental and academic positions.
U.S. Community Health residencies are fairly short, with Public and Preventative Health residency programs usually lasting about 2 years, though preceded by a 1-year preliminary clinical block (PGY1). So, about 3 years total.
Canadian Community Health programs run approximately 5 years total. 1-2 years of this is in clinical training that usually focuses on Family Medicine, followed at least 1 year in Community Medicine, followed by at least 1 year of Community Medicine field placements. The aforementioned total of 5 years is based on the RCPSC requirement of at least 5 years of post-MD/PGY training, meaning that those 1-year minimums in specialty usually last at least 2.
Dermatology residency programs in both Canada and the U.S. utilize an initial block of basic clinical training in related fields like Internal Medicine or Pediatrics, followed by specialty-specific training in Dermatology. In both countries, residency programs last 4-5 years.
Residencies in the U.S. typically run 4 years, with an initial 1-2 years of basic clinical work and the remaining years spent in dermatology-specific rotations and work. Additional subspecialty certifications like Dermatopathology or Dermatologic Oncology usually add another 1-2 years to this 4-5 year average.
Canadian residencies utilize a similar structure, although the initial clinical block is always 2 years long, followed by 2 years of specialty-specific work. Additionally, Canadian residencies in Ophthalmology add a year for enrichment following this initial 2+2 structure, which may include teaching, research, or additional courses in complementary fields.
As with many diagnostic specialties, residency in Diagnostic Radiology encompasses a wide array of skills in order to equip the trainee physician to navigate this highly complex field. Residents develop strong interpretive skills that utilize an extensive and varied base of knowledge, including many subspecialties like Neuroradiology, Ultrasound/MRI/CT Imaging, Mammography, and even Interventional Radiology, which trains physicians to perform minimally invasive procedures like insertion of central lines, drainage of abscesses, and more.
Residents in the U.S. spend PGY1 in a clinical internship focusing on a non-radiology field (usually internal medicine or general surgery), followed by 4 years of Radiology residency. As with Canadian D.R. residencies, there are numerous options for subspecialty fellowships following these first five years, including Neuroradiology, Neurointerventional Radiology, and Pediatric Radiology.
In Canada, Diagnostic Radiology residencies also last 5 years. PGY1 is a basic but broad clinical block, while PGY 2-5 develop highly specialized knowledge in nearly a dozen subspecialties. There are also, typically, strong research components throughout these 5 years.
One of the most intense specialties, Emergency Medicine residencies focus on developing the ability to make high-pressure decisions that utilize knowledge from a vast array of specialties. Emergency Medicine is also incredibly emotionally demanding, and requires a high level of adaptability in both resident and seasoned practitioners.
In both Canada and the U.S., Emergency Medicine residencies utilize PGY for basic clinical training and subsequent years for training in the emergency aspects of Anesthesia, Critical Care, Internal Medicine, General Surgery, and more. At least one of the later years is dedicated to elective assignments and research. The total residency length for Emergency Medicine programs in both countries is therefore 3-5 years, with 4 being the average and 5 typically only needed for pursuing fellowships in subspecialties like Disaster Medicine or Medical Toxicology.
Family Medicine residencies are traditionally among the shortest and most generalized, but this doesn’t mean they’re easy. To be most effective in their positions, Family Medicine specialists need to sustain a high degree of familiarity with patients, developing long-term relationships with continuous communication.
Continuity of care and relationship is in fact one of the hallmarks of the specialty and residents must therefore develop a deep sense of their place in the community they treat. Family Medicine is therefore among the most socially and psychologically involved specialties, despite relatively short residency lengths. Given the importance of this social or relational aspect of Family Medicine, you’ll want to be sure to discuss these ideas in your .
U.S. Family Medicine programs typically run 3 years, with a basic clinical block in PGY1 and a possible fourth year for subspecialty fellowship or certification.
In Canada, Family Medicine residencies also dedicate PGY1 to basic clinical training in Family Medicine, as well as General Surgery, Internal Medicine, and more. PGY2 focuses entirely on Family Medicine. Additional fellowship subspecialties (undertaken in PGY3) include Palliative Care, Addictions, Gerontology, Psychotherapies, and more.
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Rural Family Medicine
Much of the same structure applies to Family Medicine residencies in rural settings, but with the added emphasis on non-urban communities. One of the central differences in Rural residencies lies in the decreased prevalence of sophisticated diagnostic technology and specialists, and so residents are required to exercise even greater discipline and clinical responsibility. Rural Family Medicine is an emergent specialty with growing interest, and those wishing to explore this option in the U.S. should consult the for detailed listings of schools offering Rural Health specialization. As with Family Medicine generally, RFM residencies are organized around 2 years of clinical development with optional 3rd years in subspecialty.
General Surgical Residencies are immensely popular and competitive, not only because they’re fitting stepping-stones to more specialized surgical residencies but because general surgeons are perennially in-demand, focusing largely on gastrointestinal, colorectal, trauma, transplantation, and pediatric surgeries. As such, the knowledge and experience gained in a General Surgery residency is extremely useful and marketable.
General Surgery residencies last at least 5 years in both Canada and the U.S., with subspecialty work extending from PGY5 well into PGY7 or even 8. The first 2 years are “core” development years that focus on both surgical and non-surgical fields. PGY3-5 are therefore spent almost entirely in General Surgery rotations, with at least one year as a senior or Chief Resident.
Internists, like Family Medicine specialists, focus largely on diagnosis and treatment of a wide range of both common and complex diseases affecting organ systems. Residencies therefore stress the importance of community awareness, with many Internists participating in teaching, health advocacy, and research.
Internal Medicine residents in the U.S. complete a 3-year core block of highly varied work with the option to extend into subspecialty work. Fellowships after this core block are diverse and numerous, including treatment of various immunological and chronic diseases, Gastroenterology, Endocrinology, Geriatric medicine, Nephrology, and many more.
In Canada, Internal Medicine residency lengths are instead 4 years at minimum. Residencies for students choosing to subspecialize within Internal Medicine may spend 5 or even 6 years however. Internists, like Family Medicine specialists, are required to complete clinical training in a wide variety of related specialties including Critical Care, Cardiology, Infectious Diseases, Respiratory Medicine, and many others. Internal Medicine programs therefore limit the time residents spend in any one specialty or subspecialty to 6 months during the core 4 years to maximize breadth of knowledge.
Laboratory Medicine is an umbrella term for various subspecialties within Pathology. These include Anatomical Pathology, General Pathology, Hematological Pathology, Medical Biochemistry, Medical Microbiology, and Neuropathology among many others. Each school offering residencies in one or more of these subspecialties will structure their residency programs slightly differently, with significant variations in the and application processes as well.
The vast majority of Pathology Residents in the U.S. (95%) seek out fellowship training following their core residency, so while the minimum residency length for Pathology in the U.S. is only 3 years, most residents spend 4 or more years in residence/fellowship before moving on to full practice. Surgical Pathology is the most popular of these subspecialties, with Cytopathology, Hematopathology, Hepatic Pathology, and Anatomic Pathology comprising the other most popular options.
Canadian Laboratory Medicine residents all complete two years of General Medicine training, followed by two years of more specialized laboratory training, and an additional year for electives, although not all programs require this. Average program length is therefore 5 years with the exception being Hematological Pathology, which in some programs is covered in 4 years.
A recap of residency lengths:
Geneticists are frequently part of multidisciplinary teams focusing on diagnosis of a broad range of genetic diseases affecting the full variety of bodily systems. It is therefore an especially academically demanding specialty, with residency lengths ranging from a minimum of 2 years in the U.S. to 5 years in Canada.
The central reason for variance in these numbers is that Medical Genetics is structured as an independent program in Canada, while in the U.S. it’s a subspecialty pursued after initial residency in a more basic field like Internal Medicine. That is, Canadian residencies will block the first few years for core clinical development, while this is considered anterior to Medical Genetics in the U.S.
Ultimately, the total length of residency is around 5 years in both countries but can extend beyond this for further subspecialty fellowships in fields including Biochemical Genetics, Molecular Genetics, Cytogenetics, Neurogenetics, Cancer or Oncological Genetics, and Skeletal Dysplasias.
Although largely focused on the brain, spinal cord, and peripheral nerves, Neurology involves the assessment, diagnosis, and treatment of many forms of illness targeting this system at all stages of life. As such, the work of the Neurology resident focuses on many extremely complex forms of disease, including chronic, debilitating, and painful conditions that significantly impact patients’ lives. Mastery in this field affords Neurologists a great deal of flexibility though, with many serving largely consultative roles in hospitals and private practice settings.
Neurology residencies in the U.S. are usually 4 years long, with PGY1 reserved for general clinical proficiency in Internal Medicine, and PGY2-4 spent in-specialty. Subspecialty fellowships are extensive and numerous, including both specialized contexts in Neurology as well as the treatment of specific Neurological disorders like Epilepsy.
Canadian Neurology residents complete a similar but longer 5-year program. Like U.S. residencies, Canadian programs use PGY1 for general clinical proficiency in Internal Medicine, while PGY2-4 focus on various Neurological subspecialties including Adult, Pediatric, and Clinical Neurology. PGY5 is dedicated to research or additional subspecialty training.
Neurosurgical residencies rank among the longest and most demanding in all of medicine—and for very good reason. The complexity and sensitivity of Neurosurgery demands incredible focus, breadth of knowledge, and technical mastery from practitioners. As such, Neurosurgeons are among the .
In the U.S., Neurosurgery residents follow a 6-7 year track, with a general surgery block in PGY1-2, with numerous specialized rotations throughout PGY 3-6. There is significant variation from program to program on how the core/specialization years are organized however. For instance, Neurosurgery residents at work in 2-month rotations throughout PGY2-3, and spend a 7th year as Chief Residents overseeing the large operative volume at Hopkins Hospital. As always, consult the specific programs to which you’re applying to determine exactly how your time will be spent.
In Canada, PGY1-2 are also dedicated to core training in surgery, followed by 4 years of specialized training in Neurosurgery and 1 year of Senior Residency. Additionally, this 4-year block of specialized training is structured around gaining experience in both Adult and Pediatric Neurosurgery, as well as Neuropathology. Most programs also require at least some time—usually 6 months to 1 year—dedicated to research.
Obstetrics and Gynecology
The OB/GYN specialization is among the oldest and most fundamental in medicine. It combines both diagnostic and surgical skills to address the reproductive needs of women’s health throughout all phases of life. Additionally, OB/GYN specialists require extensive knowledge of the social, cultural, and environmental factors that affect women’s health, making this specialization and its residency programs inherently multidisciplinary and holistic.
OB/GYN residencies in the U.S. last 4 years, with PGY1 broken into 6 months of general and 6 months specialized practice, rather than the Canadian model of an entire year of general work.
Canadian OB/GYN residency lengths are thus 5 years in all cases, though of course additional time is required for further fellowship or subspecialty training in fields like Gynecologic Oncology, Endocrinology, and Maternal-Fetal Medicine. PGY1 is a general year of clinical work, followed by PGY2-5 spent in the specialty. PGY5 involves serving as a Chief Resident and preparing for private practice.
Like many other specialties that focus on a specific system, Ophthalmology relies on the ability to utilize aspects of many overlapping specialties like Neurology, Pathology, Dermatology, and many others. As such, training in this residency is quite varied, with blocks covering many different aspects of Ophthalmology.
Ophthalmology residencies in the U.S. run 4 years rather than 5 as in Canada. Additionally, U.S. residencies typically don’t incorporate as much elective study/practice in their later years. Fellowships include illness-specific subspecialties like Glaucoma and Corneal diseases, as well as Ocular Genetics, Ocular Oncology, and Pediatric Ophthalmology.
In Canada, Ophthalmology residents follow a 5-year program, with PGY1 focused on a broad clinical background, and PGY2-5 generally focused on exposure to each subspeciality and related clinical rotations. PGY4-5 afford most residents the opportunity for elective study and practice. However, Ophthalmology residency structures vary somewhat from program to program.
Residents in Orthopedic surgery focus on diagnosing, treating, rehabilitating, and preventing diseases of the musculoskeletal system. As a result, and similar to Ophthalmology above, it is a specialty that requires broad knowledge of the many aspects of this complex system’s functions.
Orthopedic Surgery residencies in the U.S. run about 5 years on average, with initial rotations in Internal medicine and General Surgery in PGY1. Additionally, U.S. residencies place greater emphasis on further training in fellowships following this initial 5-year block. These opportunities include subspecialty work in Arthroplasty, Arthroscopy, Extremities, Trauma, Pediatrics, and Spinal surgery.
Canadian Orthopedic Surgery residency lengths are also 5 years long, with PGY1-2 focused on Internal medicine and basic surgical rotations in General, Pediatric, Vascular, and Thoracic surgery. The remaining 3 years focus entirely on Orthopedic surgery and the development of highly specialized technical knowledge.
Otherwise known as Ear, Nose, and Throat (ENT) physicians, Otolaryngologists rely on fine motor skills, manual dexterity, critical thinking skills, and expert patient communication skills. ENTs may also subspecialize into ENT surgery, although few physicians focus on surgery entirely—most split their time between medical and surgical work.
In the U.S., Otolaryngology programs are usually 5 years long. PGY1-2 are typically spent in general development before more specialized work in PGY3-5. Additionally, these latter years typically focus quite heavily on surgical development rather than medical rotations.
Otolaryngology residencies in Canada are 5-year programs, with PGY1-2 spent developing surgical skills, and the other 3 focusing on subspecialization and research while still maintaining both medical and surgical rotations throughout. Fellowships in Otolaryngology include further specialization in facial reconstructive surgeries, trauma surgery, and various other medically-oriented specialties like Otology or Rhinology.
Among the shortest residency lengths, Pediatrics programs encompass the study of many systems that affect the health and development of infants, children, and adolescents. Residency lengths in both countries average around 4 years.
In the U.S., programs typically run 3 years with a strong emphasis on fellowships following the third year. These subspecialties include Immunology, Cardiology, Critical Care medicine, Endocrinology, and many others. Post-residency fellowships typically last 2-3 years, with most running 3.
In Canada, PGY1-3 residents focus on developing core knowledge and skill in various subfields like Child Development, Neonatology, NICU medicine, and Psychiatry among many others. PGY4 is more flexible, affording students the ability to begin subspecializing, conduct research, or simply complete one final year of general training.
Physical Medicine and Rehabilitation
Physical medicine specialists seek to improve or restore physical, psychological, social, and vocational functions of affected persons, as well as the maintenance of health and the alleviation of pain. It is a specialty that relies heavily on effective and decisive diagnosis and deals with many disabilities affecting various systems including neuromuscular and cardiopulmonary functions.
In the U.S., Physical Medicine residency programs last about 3 years, beginning with 1 year of general work and 2 years in specialty. Part of the discrepancy in length between U.S. and Canadian programs lies in less emphasis on research in later years—although this varies by program.
Physical Medicine residency lengths in Canada are typically 5 years, with PGY1 focused on comprehensive training in Internal Medicine or Surgery, and PGY2-5 in specialty-specific rotations.
Like many other surgical residencies, Plastic Surgery programs equip residents with a block of general surgical training, followed by 3 or more years of specialized surgical rotations. Plastic Surgery residencies in the U.S. vary between integrated 6-year programs (similar to the standard Canadian residency structure) and independent plastic surgery programs of 3 years. This latter option is suitable for residents either switching from another specialty or who have completed a basic or General Surgery residency already.
In Canada, Plastic Surgery residencies follow a 5-year track. PGY1-2 are core surgical training, and PGY3-5 are spent in plastics and related specialties like Orthopedics, Neurosurgery, Otolaryngology, Vascular Surgery, and Urology.
Focusing on the assessment, diagnosis, and treatment of mental illnesses/disorders, Psychiatry residencies are heavily holistic and encompass developing a great breadth of skills. Additionally, more so than many other specialties, Psychiatry residents are expected to take an active role in research, community programs, and even teaching. Expect interviews for Psychiatry residencies to be especially demanding of your ability to express your thoughts and feelings about the specialty, and be sure you can handle the dreaded question well.
In the U.S., Psychiatry programs are usually 4 years, the difference again being less structured emphasis on research. Additionally, Psychiatry residencies in the U.S. are not especially competitive and so can be considered a safe choice for students who have decent USMLE scores and a proven record of relevant academic accomplishments.
Canadian Psychiatry residency lengths are typically 5 years, with one year of basic clinical training and 3 years in Clinical Psychiatry. Later years are somewhat flexible, allowing the resident to explore subspecialties and research.
Fellowships in subspecialties include work in Addiction, Child and Adolescent Psychiatry, Forensic Psychiatry, and Psychosomatic Medicine.
Urology residencies train physicians in the diagnosis and treatment of ailments affecting both male and female urinary tract and male reproductive organs. Urology residents therefore focus heavily on surgical work, but are also required to develop a broad knowledge of Internal Medicine, Pediatrics, Gynecology, and other related specialties.
U.S. residency lengths in Urology average around 5 years, as nearly all programs are integrated—that is, inclusive of a 1-2 year General Surgery block at the beginning. Fellowship opportunities for subspecialization are fewer in the U.S. than in Canada, and programs in both countries are considered highly competitive.
Canadian Urology residency lengths are 5 years, utilizing the standard surgical specialty model of 2 years of core surgical training and 3 years of various urology-specific rotations. These may include Andrology, Endo-Urology, Laparoscopic Surgery, Pediatric Urology, Reconstructive Surgery, and Urologic Oncology.
The guiding principle medical graduates should never forget is to seek the path that they truly desire and feel called to follow. Many residencies are highly competitive, and some encompass a dizzying amount of work and technical mastery. But you’ll do far better, and find the work far easier, if you apply to residency programs that genuinely suit you. Carefully considering residency lengths and structures long before you begin preparing for your or can help you develop a greater sense of what lays ahead, and this in turn can help reify or clarify your feelings toward specialties to which you feel drawn.
1. What's the shortest residency?
Family Medicine residencies, which in both Canada and the U.S. run 2-3 years.
2. What's the longest residency?
Nearly all specialized surgical residencies, but both Neurosurgery and Cardiac Surgery top our list at 6-8 years.
3. Can I change specialties after my residency?
Of course, but this may require considerable sacrifices on your part, including relocation and a likely pay cut. Transferring to a different residency while still a resident is slightly less frowned-upon by medical establishments, but requires a tremendous amount of additional work for the resident while still maintaining their current residency workload. For more discussion on this, see the AMA’s article on switching.
4. Is there a central directory of residency programs in Canada or the US?
5. Why are surgical residencies so long?
The short answer is that surgical residencies involve core work in medicine and surgery, and also require extensive technical development. Surgical rotations are often not as volume-heavy as medical rotations: a medical rotation may involve seeing dozens of patients, while a surgical rotation can sometimes be limited to a single surgery. As such, repetition and refinement of residents’ abilities can take longer to accomplish in surgical residencies.
6. Are residency lengths different for D.O.s, as opposed to M.D.s?
Residency lengths don’t differ but the odds of getting into a residency can differ significantly between students. For instance, M.D. students applying for Internal Medicine residencies in New York were about 4x more likely than D.O. students to be admitted. Because of these lower match statistics, D.O. students must make sure that application materials such as the are as strong as possible.
7. Are residents paid?
8. If I apply to several kinds of residencies, do I need separate letters of recommendation for each?
Nope! Fortunately, residency selection committees do not expect program-specific letters. Letters of Recommendation should be standardized, not least of all because requesting multiple specialty-specific letters from your writers is simply not feasible. If you're concerned about your academic track record in relation to specific residencies, simply talk to your letter writers to see if they can address these in a way that doesn't overly determine the scope of the letter.