What is a resident doctor? Residency is an important and exciting phase of development for new medical professionals, but it’s easy to get caught up in the day-to-day complexity and not appreciate the significance of residency. You may have a good sense of your answer to the classic residency interview question “tell me about yourself”, but perhaps you are less certain of what awaits you as you become a resident doctor. In this blog, we’ll go over the basics of what a resident doctor is and does, and discuss the process by which residency programs admit new students.
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What is a Resident Doctor?
Residency in the contemporary sense began in the late 19th century, when informal specialty training programs for novice doctors became more integrated within medical institutions. By the middle of the 20th century, residency was a common part of in-hospital medical education, and resident doctors literally resided—hence the term “residency”—at the hospitals in which they were undergoing further training. These early programs were spartan, with resident doctors being paid very little beyond being provided room and board and working extremely grueling hours. Part of this was an emphasis on encouraging these usually young people to focus all their attention on their continued training, after which they would go on to function as unsupervised medical practitioners. In essence, residency emerged as a response to the need of newer doctors to undergo a kind of advanced practical education before working wholly independently, and this often came with the ability to develop in more specialized ways.
Today, residency serves much the same function as graduate medical education (GME) and specialized training while under the supervision of a team of highly experienced physicians. Residents are recent medical school graduates who have begun the challenging and lengthy process of developing specialized knowledge and skills, and residency programs are designed to train new specialists by putting them under the supervision of experts within their chosen specialties. In a way, residency can be considered a kind of apprenticeship, though not in the traditional 1-on-1 master-pupil sense. Rather, resident doctors are apprentices within a specialty in their given institution, and as such, are a kind of collective responsibility of both the individual department and overall institution.
What Do Resident Doctors Do?
The short answer is that resident doctors provide medical services to patients while undergoing specialized training, all under greater supervision of other fully independent doctors. But to understand the day-to-day of a resident doctor, we should explain the overall structure of residency.
Residency: Terminology
To better understand the structure of residency, let’s define the relevant categories of doctors involved in residency programs.
What’s the Day to Day Life of a Resident Doctor?
Confining our answer to the category of Resident Doctor as defined above, Resident Doctors do quite a lot, and their daily workload can be substantial. Once past the initial generalized block of work in the first and/or second year, Resident Doctors are responsible for performing a specific amount of clinical rotation hours and research (or “reading”) hours per week.
Let’s take Plastic Surgery as our example. A 3rd year Plastic Surgery resident at the UBC medical school is responsible for 55 clinic hours per week, and 5 reading hours per week. Additionally, those clinic hours will include 1:4 on-call periods, meaning that a given resident doctor is 1 of 4 resident doctors staffed during a clinical rotation, and is thus responsible for approximately 25% of the requests for their specialized services, which may include specialized plastic surgeries relating to, say, hand trauma or cleft lip repair.
These numbers not only vary by institution, but widely by program as well. An Internal Medicine resident at McGill may work 80 clinical hours per week, with almost no research time, and so on. In general, though, the day to day is geared toward providing specialty-specific medical services to patients and undertaking at least some research relevant to their specialty. In later years, a Resident Doctor may be selected to serve as a Chief Resident as well, in which case their daily workload then includes administrative duties for their department.
In nearly all cases, Resident Doctors work with an Attending Physician who oversees their rotations, and acts as an additional point of contact between patients and residents. In order to fulfill research requirements, residency programs also utilize mentors or research directors to oversee ongoing research projects by residents as well. In both cases, the idea is that Resident Doctors are almost always working under the supervision of a senior physician, whether in clinical work or research.
Lastly, it’s relevant to note that while many residencies prepare new doctors for incredibly high-paying careers, almost all Resident Doctors make about $60k during their first year, with fairly conservative pay increases each year as they progress. The financial realities of a Resident Doctor are nowhere near as stressful as those of a medical student, but they’re not much better, especially if their residency program is located in a city with high costs of living.
Remember that you will take your USMLE Step 3 exam during residency. Check out our tips below:
Becoming a Resident Doctor
As noted above, residency programs admit medical school graduates who have completed their mid-training licensing exams like the USMLE Step 2, COMLEX Level 2, and/or MCCQE Part 2 exam. However, passing these qualifying exams is only one part of the application process.
In both the U.S. and Canada, residency application services provide a vital administrative role in matching suitable applicants to their desired residency programs. Canada uses the Canadian Residency Matching System (CaRMS) and the U.S. utilizes the Electronic Residency Application System (ERAS). Though there are variations between these two systems, they both operate along similar timelines. In general, the last two years of a student’s medical program should involve exploring various specialties, preparing their residency CV, residency personal statements, and MSPE/MSPR documents, and procuring letters of recommendation from faculty and supervisors.
Are you wondering how to enter your letters of recommendation into ERAS? Check out our step-by-step guide:
“Application season” refers to the point in early summer (usually June) each year when 4th year MD and DO students begin finalizing these materials for submission into their respective matching services. Students spend the months prior to this period contacting their desired residency programs to find out more about their specific requirements and deadlines, and take preference assessments like the AAMC’s RPE to make sure they’re attempting to enter into the right residency program and specialty.
Students begin submitting their application materials by late August or early September, although some residency programs—such as plastic surgery or urology—are referred to as “early match” programs, meaning their application process begins and ends a bit sooner than most others. If it weren’t obvious by now, specific dates and requirements must always be checked with individual programs, as no two are totally identical.
In October, residency programs begin reviewing applications, and the following period from late October to mid-February is referred to as “interview season.” This is exactly as it sounds—the window in which residency programs conduct interviews with potential admittees. During this time, students also write letters of intent to their top choice program, which is submitted as part of the matching process.
Mid-March is the finish line, as the National Resident Matching Program (in the U.S.) and CaRMS Match (in Canada) begin “Match Week,” in which applicants to residency programs are notified of their having been matched to residency programs (though this is not the final decision). Some applicants are not matched during this period, following which they can participate in SOAP, or the Supplemental Offer and Acceptance Program to try to obtain an unfilled residency position. The last day of Match Week is Match Day, in which all matched applicants are given an envelope which lists the program they’ll attend for residency.
For a fuller overview of the residency application and matching process, check out our video on the MATCH:
If that all sounds a bit dizzying, you’re not alone. Compared to applying to medical schools, residency matching seems like another level of complexity. But there’s good reason for this: residency programs are, as we’ve shown, incredibly competitive, demanding and specialized, and the utmost care goes into selecting the right candidate for each available residency slot. Furthermore, while medical schools are making decisions based on more generalized information like MCAT scores and GPA, residency programs need to dig deeply into a candidate’s performance throughout medical school to ensure they can handle the unique demands of not only a given specialty but their specific residency program in that specialty. It’s a lot of work and deliberation, but the result is entry into the final phase of graduate medical education, after which residents emerge as fully functional physicians, capable of the full breadth of independent medical practice.
If you are preparing for residency interview, check out the most important questions you should know.
Conclusion: Residency From the Patient’s Perspective
It’s worth considering the patient perspective on all this as we conclude our discussion. After all, a common question asked in regard to residency is “Should I see a resident doctor?” The short answer to this is, simply, “absolutely.”
Resident Doctors do not exist in a vacuum, nor do they partake in the application of medical treatment without supervision. In effect, working with a Resident Doctor ensures that a patient is engaging with an entire system of supervision and medical input, from attending physicians to senior residents to other resident doctors on-call. There’s a system and structure around residents that ensures they’re never truly alone, and can easily seek additional input from the other people in this “constellation,” so to speak.
Additionally, Resident Doctors are often quite fresh, but this doesn’t usually mean inexperienced. Rather, Residents are in the midst of mastering their specialty, and are incredibly engaged in its study and theory as well as practice, meaning they’re far less likely to evince the kind of jadedness or inflexibility people may associate with longtime physicians. Resident Doctors are also usually the on-call options at odd times, meaning that declining to work with a Resident may mean a longer wait for an attending or other non-resident.
Turning this back to the side of the Resident Doctor, then, you should feel emboldened by working in residency, and that you’re a vital and unique part of your medical environment. It’s hard, exhausting, and often times thankless work, but think of it as sort of the trench warfare period of your career before your get to enjoy the fruits of your labor as a fully credentialed and independent physician. Enjoy the privilege of working in the specialty you’ve chosen and feel passionately about dedicating your life to perfecting.
FAQs
1. How much do Resident Doctors get paid?
The exact amount varies slightly by program, but most first-year residents make around $60k, with this increasing slightly with each year of seniority. Residency is decidedly not the period in which you’ll start chipping away at your med school debt, but you won’t starve either.
2. Are Resident Doctors assessed throughout their program?
Yes, but not with traditional exams or tests. Rather, programs use competency milestones and Entrustable Professional Activities or EPAs to measure resident performance within a program. Residency programs have their own assessment protocols to measure these milestones or competencies, but their criteria are largely dictated by governing bodies like the AAMC/ACGME and RCPSC.
3. Do Resident Doctors take board exams?
Yes, accreditation in a given specialty is conferred via specialty-specific board exams, typically after the 3rd year of residency, though this timing varies. This is decidedly not an assessment to determine performance in the residency program, but rather a final accreditation that will allow the resident to operate as an independent and certified specialist once out of the residency program.
4. Do Resident Doctors take coursework?
No, but that doesn’t mean scholarship isn’t a part of residency. Rather, research and research projects are a part of almost all residency programs. Residency is, after all, Graduate Medical Education, so much like non-medical graduate studies, Resident Doctors are expected to contribute findings and novel research to the study and scholarship of their specialty.
5. What are the longest residencies? What are the shortest?
Family medicine residency programs are usually among the shortest, and run between 2-3 years. Surgical residencies, especially highly specialized ones like Neurosurgery, can last up to 8 years though, with even more time if subspecialty fellowship is pursued.
6. What happens if a medical school graduate doesn’t get matched into a residency?
After the initial disappointment, medical graduates can do a lot to get matched in a second attempt. The AMA recommends 3 things following a no-match match day: staying in touch/reaching out to your medical school to gain advice from mentors; finding a job in a clinical setting that helps you maintain your knowledge and clinical skills; and, lastly, trying a new approach to interviewing and applying. On this third point, working with a residency interview prep company can help a lot to strengthen your weaknesses and help you reformulate your approach.
7. What’s the most important part of a residency application?
There isn’t a single monolithic answer to this, but there are some criteria that can get your application binned without any attention paid to the rest. The first is your USMLE, COMLEX, or MCCQE scores. Poor scores on these comprehensive exams will absolutely overshadow virtually everything else on your application, so do everything you can to maximize your scores when you take them. Second in importance are the Letters of Recommendation, and for obvious reason—it’s a communication from one faculty body to another, and so carries the weight of their prestige and experience, not to mention shared vested interest in ensuring good quality candidates entering into residency programs. Talk to your letter writers early and regularly to make sure your Recommendation Letters are as strong as possible.
8. When should I start my residency application materials?
In a sense, at the very beginning of medical school. Choosing the right medical specialty is a process you should begin potentially even before med school, but it should be a continuous part of your experience throughout your MD program. Additionally, forming solid positive relationships with faculty is crucial to ensuring great letters of recommendation, and a big part of this is performing well in classes and rotations. Midway through your third year is when these preparatory processes begin shifting into constructing specific application materials, but the point is to view residency and specialization as the step you’re building toward from the very beginning of medical school, even the beginning of your undergraduate education. Be curious, adventurous, and really take the time to contemplate your motivations and feelings toward the many medical specialties available in residency programs.
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