PGY1-PGY2: The Residency Progression Guide

What is PGY1?

PGY1 is an acronym for post-graduate year 1. PGY2 is post-graduate year 2; and the subsequent years of a residency program follow the same format – PGY3, PGY4, etc. PGY1 is the first stage of any residency program in the US or Canada. If you get into a PGY1 position, you might also be referred to as a “PGY1”, which is interchangeable with “intern”, another term to describe first-year entrants into a residency program; you only become a “resident” when you get to PGY2. There are close to 40,000 PGY1 residency positions in the US, so they are the most common entryway for anyone who wants to complete a residency program in the US.

What is PGY2?

PGY2 is the designation you receive after you’ve completed your first year of a categorical program. But it can also refer to a program that requires you to first complete a preliminary residency year as a PGY1, which is often a requirement for more specialized medical specialties, such as dermatology, radiology, and ophthalmology.

There are much fewer PGY2 positions in the US (2,671) than PGY1 positions, but there are many types of applicants that are best served by them depending on their background, especially if they are international medical graduates. Currently, there are only 11 medical specialties that require you to go through preliminary training before you apply, which for this article, we’ll refer to as “advanced PGY2 programs”.

This article will focus only on how these terms relate to medical residencies, even though you’ll also find these acronyms being used to describe interns, and residents in pharmacy, dental, or veterinary residencies. All these disciplines have their own residency training requirements and systems, so we’ll tamp down on the confusion by only talking about PGY1 and PGY2 as they relate to medicine.

Want to know how to avoid residency application red flags? Watch this video:

PGY1-PGY2: Applicant Types

Even though the definition of PGY1 and PGY2 are simple, they only skim the surface of the much-more complicated system of matching into a residency program in the US and Canada and the various types of residencies offered. The reason that the system is so complicated is because there are so many different applicant types recognized by the matching services in both countries.

The National Resident Matching Program (NRMP) in the US lists eight types of applicants who are differentiated by several categories from their citizenship, where they went to medical school, and what type of medical school they went to (MD vs. DO), a few examples of applicant types include:

• US MD Senior – someone in their fourth year of an allopathic medical school accredited by the Liaison Committee on Medical Education (LCME).
• US DO Senior – someone in their fourth year of an osteopathic medical school accredited by the Commission on Osteopathic College Accreditation (COCA).
• Graduate of Canadian Medical School – a Canadian citizen who has graduated from a Canadian medical school
• U.S. IMG – a US citizen who has graduated from a foreign medical school
• Non-US IMG – a non-US or Canadian citizen who has graduate from a foreign medical school

In Canada, the Canadian Residency Matching Service (CaRMS) has only four applicant categories, which are also divided between citizenship (Canadian, US, or international) and type of medical school (allopathic; osteopathic). Depending on which category you fall into in either country, you may have a different path to getting into a PGY1 position or residency program.

PGY1-PGY2: Program Types

The type of medical specialty you’re pursuing also affects whether you will enter a PGY1 program or a PGY2 program. Out of the 160 different medical specialties that you can enter in the US, each one of them has different residency training requirements that have been set by that specialty's licensing board. This means that you can take various paths within that specialty to complete your residency training.

To avoid any more confusion, we’ll list the types of residencies that you can enter depending on the specialty you are pursuing. While the NRMP lists 5 types of residencies, we will only include the four below that relate to PY1 and PGY2 (the fifth type is for professional physicians):

• Categorical – residency programs that are direct-entry from medical school and give you all the training you need to become certified in that specialty, so you do not have to enter a separate residency program beforehand.
• Preliminary or transitional – residency programs that are also direct-entry from medical school but only last for one year (PGY1), meaning you have to enter another, separate residency program after to complete your training in your preferred specialty.
• Primary – categorical residency programs in primary care that start with PGY1 and give you all the training you need to become certified in that specialty.
• Advanced – residency programs that start only in PGY2 after you have completed a preliminary PGY1 residency.

These definitions are important to keep in mind, as we’ll use them to distinguish between all the different ways that you can enter a residency program and how they are related to the terms PGY1 and PGY2.

What is the Difference between PGY1 and PGY2?

The most obvious difference between PGY1 and PGY2 is that the latter is the more advanced stage of your residency. In PGY1 you are still an “intern” and some often think of PGY1 as a continuation of your medical school clinical rotations, as you are immersed into hospital or clinical settings, while still attending lectures and other didactic courses. In your first year of a categorical residency, you are expected to both begin applying your medical school training in direct-patient interactions, but also acquire general competency within various medical specialties.

But being a PGY2 can mean two different things. You can be a PGY2 within a categorical program. But PGY2 means something different if you are in an advanced PGY2 program, if you recall the definition above. Being a PGY2 in an advanced PGY2 program means that you have completed a separate year outside of your specialty to satisfy the admission requirements of the advanced PGY2 program. Think of it as a preparatory year. 

As a PGY2 in a PGY2 program, your training will start to focus solely on your chosen specialty. You won’t have a general curriculum as you did during your preliminary or transitional PGY1. You will start to explore the sub-specialties within that specialty, start research projects, participate in grand rounds and much more. The reason for this type of divide between PGY1 and PGY2 is because not all of the 160 different medical specialties can fit into the two years you spend on rotation in medical school.

The specialties that are usually left out of your required rotations are often the same specialties that require you to take a preliminary or transitional year. It’s because you may not have any knowledge or training in that specialty (radiology or dermatology, for example) so they want to make sure you enter the advanced PGY2 program with some foundation so you are not completely overwhelmed by the new subject matter.

PGY1-PGY2: Salary

Another important difference between PGY1 and PGY2 is compensation. Unlike medical school, residencies are paid positions, but how much do residents make depends on the program, the host institution and, in Canada, which province you are doing your residency. As in any other field, entry-level interns make less than those who are PGY2 residents or who have made it to chief resident status in either PGY4, PGY5, or PGY6. 

The average starting salary of a PGY1 intern can range between $50,000-$60,000. For PGY2, you can expect a raise of about $1,000 to $5,000 making the salary range for residents between $57,000 and $67,000. But, again, your exact salary is determined by several factors, including the specialty you are in. However, as you progress through your entire residency, your salary will increase, which is applicable to all programs, and specialties.

PGY1-PGY2: Medical Specialties

We’ve established all the applicant and program types, so now we can begin going into more depth by describing what these definitions mean in relation to PGY1 and PGY2. We’ll start off by saying that your medical specialty is what determines whether you are able to enter a program right out of medical school as a PGY1 or whether you have to take a transitional year residency to ascend into a more advanced residency program as a PGY2. 

But a lot also depends on the host institution that you are applying to, whether it be hospital-based, community-based or academic-based, as they might offer variations on the types of residencies we talked about above (categorical, preliminary, or advanced). For example, according to NRMP, dermatology has more PGY2 positions (almost 500) than PGY1 positions (29).

This means some institutions have opted to offer a categorical dermatology residency so, you can enter as a PGY1 and do not need to complete a separate residency program beforehand. However, other institutions have mandated that you complete a preliminary or transitional residency before applying to dermatology, which means you enter as a PGY2. There are variations on this in all of the medical specialties you can enter in the US.

Some of the other specialties that may require you to complete a preliminary year as a PGY1 are:

• Radiation-Oncology
• Physical Medicine and Rehabilitation
• Radiology-Diagnostic 
• Anesthesiology
• General Surgery

But you might also have to enter as a PGY2 to get into an ophthalmology residency, which does not even use the NRMP, but the San Francisco Match, a residency match service in the US for niche residencies, practicing physicians, and residencies within military medical schools.

Structure of PGY1 Programs

The most popular medical residencies by number of applicants are a family medicine residency or an internal medicine residency. These specialties are in the realm of primary care. They are also categorical and you can enter them as a PGY1. They typically last for three years and you do not need to enter any other residency program before or after to earn certification. You can choose to pursue a medical fellowship afterward, but that’s another topic for another article.

However, if you want to enter a discipline outside of primary care, such as a surgical specialty or secondary or tertiary care, you usually have to do a preliminary, one-year, PGY1 residency in an unrelated field to the one you want to enter, or not, it can also be in the same field. For example, the following specialties are offered as both preliminary and categorical:

• Emergency medicine
• Preventative medicine
• Psychiatry
• Pediatrics

Meaning, you can choose to enter a PGY1-only residency in the above specialties to fulfill the entrance requirements of a PGY2 program. But you can also choose them as your sole specialty and complete them as a categorical residency. If you do one of these preliminary residency programs, it’s most likely because the specialty you truly want to enter requires it.

This is true for most of the programs we mentioned above, such as dermatology, radiology, and several surgical specialties like vascular or thoracic surgery. The purpose of all one-year, preliminary residencies is to bolster your medical school training so that you can enter a specialty that is completely new to you since it was not a required rotation in medical school.

PGY1-PGY2: Preliminary vs. Transistional

The structure of preliminary or transitional PGY1 residencies can differ depending on the specialty. Some say that there is a difference between a “preliminary” and “transitional” residency, but we would argue that there is little to no difference, because they both achieve the same goals (expanding your knowledge base and preparing you for an advanced PGY2 program) with only slight differences.

The structure of a PGY1 preliminary or transitional residency is a combination of electives, where you decide your rotation schedule, and primary care specialties such as emergency, family, internal or pediatric medicine. For example, you can take the preliminary PGY1 residency in internal medicine at the University of Pittsburgh, which consists of a curriculum balanced between electives, required rotations in the intensive care unit, and rotating through various inpatient departments such as oncology and hematology.

Some say that a preliminary residency involves more focus on primary care, while a “transitional” residency combines primary care and surgery. But we’d argue that is not a significant difference. If you want to enter an advanced surgical PGY2 program, a supposed, primary-care-focused preliminary residency would be as beneficial as a combined transitional program. Ultimately, you have to decide which PGY1 preliminary or transitional residency best suits your goals, and there is a tremendous amount of autonomy in taking either.

List of PGY1-Only and Preliminary Residencies

Structure of PGY2 Programs

As we mentioned, advanced PGY2-only programs are when you start to focus on your particular specialty, to the exclusion of all others. You will immediately begin on-the-job training in your first year of an advanced PGY2 program and complete rotations in that specialty and all its sub-specialties. For example, the advanced PGY2 program at the University of Utah takes this route and throws you into the deep end with a series of rotations in radiology-adjacent specialties, such as:

• Thoracic
• Musculoskeletal
• Ultrasound
• Nuclear Medicine
• Mammography/Breast Imaging

The length of advanced PGY2 programs can vary. An advanced, PGY2 radiology residency can typically last between four to five years. But other advanced PGY2 programs, such as a neurology residency or an anesthesiology residency, may last only three or four years, especially if you’ve already completed a preliminary or transitional PGY1 residency. 

List of Advanced PGY2 Programs

How to Apply to PGY1-PGY2 Programs

You apply to all PGY1 and PGY2 programs through the Match, but it gets complicated depending on your specialty. Essentially, if your ultimate goal is to enter an advanced PGY2 residency program, you must submit your top choices for those programs on your main rank order list. However, you’ll also submit a supplemental rank order list with your preferred preliminary PGY1 positions needed to enter the advanced PGY2 positions on your primary list.

You can, of course, match to programs at different institutions. But you have to think about what a logistical nightmare this will be for you, since you would have to move to two different cities or even states, if you do end up matching to both your preliminary and advanced program. To avoid this, the NRMP along with participating residency programs have created Joint Advanced and Preliminary programs – Joint A/P – that connect preliminary PGY1 programs with advanced PGY2 programs at the same institution.

With “linked” joint A/P programs, you follow the same procedure as you would without them (listing preliminary and advanced programs on two separate lists), but what this new arrangement does is that it keeps your place in the linked advance program, so long as you listed the linked preliminary program on your supplemental list. As these joint A/P programs are relatively new, you’ll be told in your residency interview whether you have the possibility to rank a joint A/P program.

What Happens if I Don’t Match?

We listed all the important NRMP information so you can see for yourself that all of these programs, PGY1 and PGY2, are very competitive and there are always more applicants than positions available. What we didn’t mention is the number of people who go unmatched, which is more prevalent in preliminary, PGY1 positions. Almost 60 applicants did not match into one-year preliminary internal medicine programs; 150 did not match into the PGY1 preliminary surgery residencies; and 45 did not match into a transitional, PGY1 residency.

This means that 34% of all unfilled positions were in preliminary, PGY1 positions, so it is very possible that you may end up being either unmatched or partially-matched (meaning you matched into either a preliminary PGY1 positions but not the PGY2 position, or vice-versa). What happens if this happens? First, if are unmatched with the preliminary program, you can submit another rank order list in the Supplemental Offer and Acceptance Program (SOAP) to try to secure a spot in a preliminary PGY1 program. If that doesn’t happen, then NRMP recommends you get a waiver to give you permission to exit your advanced PGY2 program.

How to Get into Your PGY1 or PGY2 Programs

1. Make Sure your ERAS Application is Stellar

Almost every PGY1 or PGY2 residency position uses the ERAS application system to review your application materials, including your ERAS personal statement, two or three ERAS recommendation letters, your transcripts, your MSPE, and your USMLE Step 1 or COMLEX Level 1 scores. Your ERAS application is the first view that residency program directors have of you, so you have to ensure that you give the required amount of attention for each of the above aspects. Run through various drafts of your personal statement, and try to focus on showing, not telling what you want to achieve in the program, and what you can contribute thanks to your previous achievements. You also have to ensure that you have a high GPA. Anywhere from 3.5 or higher will have a greater chance of being matched, as it has been proven as one of the key factors that make a successful residency applicant. There are various other aspects of your application that matter, but a GPA is always the best indicator of your academic achievements and potential for success.

2. Focus on Interview Prep

Once you’ve sent out your ERAS application, your next step is to interview with each program, if they’ve invited you. You should start preparing for your residency interview by doing residency mock interviews to build your confidence and put you at ease with the format.

You can hire professional a residency application consultant or residency interview prep to help you formulate bullet points to summarize your answers to common residency interview questions such as “why should we choose you?” and “tell me about yourself”.

Residency interview serve many purposes. Not only will you meet with the residency directors and faculty that you’ll be learning from for the next three or five years, they’ll also get a sense of your personality and character through the way you carry and present yourself. You many think these things don’t matter, but they do, very much so. Being a resident means that you have to interact with patients, fellow residents and faculty every day, and residency directors want to see that you have the soft skills to contribute positively to these programs.

3. Choose your Rank Order List Wisely

This applies more to after you’ve completed your initial ERAS application and have met with your interested program in a residency interview. But after you’ve met with individual programs and have started to make your rank order list, be sure that you have a clear goal of where you want to go, which programs are joint A/P or, failing that, which programs are the closest to each other so you don’t have to travel large distances in consecutive years. A lot also depends on your specialty. If you are dead-set on a particular specialty, you should rank as many programs as possible in that specialty (up to 12 or 17, even) if you want a higher chance of being matched into an advanced

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Your friends at BeMo

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