You’ve completed medical school and earned your MD or MBBS. Can you start practicing in the US?
Not just yet. In the US, a medical degree is the beginning. You must complete a medical residency. During residency, you are trained and closely supervised for a number of years by various specialties. Each year you become more responsible and practiced for independent practice until you are ready to practice independently in your chosen specialty.
We will cover the various aspects of residency including how long it lasts, who is eligible for residency (including international medical graduates), and what you can expect afterwards.
Medical residency is the period of postgraduate medical training, typically between four to eight years in duration, during which a physician who has completed medical school training and is deemed by a certifying board to be ready to practice medicine, refines clinical skills, learns methods of clinical reasoning, and makes clinical judgments in the context of a chosen specialty in medicine.
There are various forms of training after graduating from medical school. The next step in one’s medical education is residency. Residency shapes the kind of doctor you become, like a surgeon or a pediatrician.
Three key terms describe resident physicians. An attending physician is a fully trained doctor that is supervising resident physicians and is in charge of directing and overseeing care provided to a patient. Graduate medical education (GME) encompasses all post-medical school education, training and fellowship.
Resident physicians are licensed doctors. They have the authority to examine, diagnose and treat patients. However, their license is different from a conventional doctor’s license and does not give them unsupervised autonomy. They work under supervision, and in some instances, may only practice under strict state laws that limit their practice to a particular faculty member.
Different activities comprise resident physician’s work week. Clinical evaluation and case conferences are important in improving medical knowledge. Most U.S. residency programs are accredited by the ACGME (Accreditation Council for Graduate Medical Education).
A medical student can take a history, examine a patient, and suggest a diagnosis. What they rarely do is make the final call. Residency is where that changes.
Over the course of training, residents learn to:
There is a reason for this as well. The majority of state medical boards require at least 1 year of accredited postgraduate training before awarding a full license, and many of them ask international graduates to complete additional years of training.
Residency happens in teaching hospitals, and outpatient clinics, as well as the surrounding healthcare facilities. Whichever hospital or medical school is sponsoring the program, is the sponsoring institution.
Training occurs in blocks called rotations, and each of those blocks usually lasts 2 to 4 weeks. During your first year as an internal medicine resident, you may spend a month in cardiology, a month in the ICU, and the emergency department, and clinic.
You are supervised by attendings throughout your training. In your first year, your notes and orders may get checked. By your final year, you may be running the team, and teaching interns and medical students.
Each year of residency has a label, PGY, short for postgraduate year:
| Term | Meaning |
| PGY-1 | First postgraduate year |
| PGY-2 | Second postgraduate year |
| PGY-3 | Third postgraduate year |
| PGY-4 | Fourth postgraduate year |
You’ll often hear PGY-1 called the intern year, and first-year residents called interns. Internship isn’t a separate stage. It’s just the first year of residency.
Programs don’t all start in the same place. Many begin at PGY-1, while some begin at PGY-2 and expect you to finish a first year somewhere else. Fellowship is something else again: optional subspecialty training that comes after residency ends.
What a medical resident does all day depends on the specialty, the year of training, and the setting. Here’s a typical weekday for an internal medicine resident on the wards:
Yes, the hours are long. But they’re capped. ACGME-accredited programs can’t schedule residents for more than 80 hours a week, averaged over four weeks, and residents must get at least one day in seven off, also averaged over four weeks.
Specialty makes a big difference here. A surgery resident will usually work longer weeks than someone training in psychiatry or family medicine.
Most medical residency programs in the US last three to seven years. Specialty is the biggest factor: primary care fields sit at the shorter end, and surgical fields take the longest.
| Specialty | Typical residency duration |
| Internal Medicine | 3 years |
| Family Medicine | 3 years |
| Pediatrics | 3 years |
| Emergency Medicine | 3 to 4 years |
| Psychiatry | 4 years |
| Neurology | 4 years |
| Obstetrics and Gynecology | 4 years |
| General Surgery | 5 years |
| Orthopedic Surgery | 5 years |
| Urology | 5 years |
| Plastic Surgery | 6 years (integrated) |
| Neurosurgery | 7 years |
The table shows how long the residency itself lasts. That isn’t always the full picture:
So if you are adding up the years for your medical residency, you will need to add up three things: any first year required, the residency, and a fellowship.
You will see various program labels like “categorical” and “preliminary” in residency program listings. The NRMP recognizes five different residency program types:
An example helps to explain this better. Let’s say you want to be a diagnostic radiologist. You would need to apply to the advanced radiology programs for training beyond PGY-1. You would also need to apply to either preliminary or transitional programs for your PGY-1. The Match could give you both programs and align the two years of training.
The requirements look a little different depending on where you went to medical school.
If you graduated from a US school (MD or DO), you’ll generally need to:
If you’re an international medical graduate, you’ll generally need to:
Two things catch a lot of IMGs off guard. ECFMG certification makes you eligible to apply, but it doesn’t promise you a position. And training you completed back home, even full specialist training, usually doesn’t count toward US residency. Most IMGs start over at PGY-1.
The IMG path has more moving parts than most guides admit. We help you line up exams, ECFMG, USCE, and visa so nothing stalls your application.
The road to a residency in the USA looks something like this:
From a strong ERAS portfolio and personal statement to a program list built for your scores, grad year, and visa, we help IMGs get each step right.
People mix up ERAS and NRMP all the time, but they do different jobs:
A few specialties, urology among them, run their own match, and some programs fill spots outside the Match. Check how each program on your list recruits.
They do. Residents are employees of their sponsoring institution, so they draw a salary and usually get health insurance, paid leave, and other benefits.
There’s no national pay scale, though. Resident pay depends on:
Pay is well below what attendings earn, since residents are still training. Programs usually post current salaries on their websites, which is the best place to check.
Once residency is over, most physicians go one of two ways.
The first is independent practice. With a full state medical license, you can practice on your own. Most physicians also take their specialty’s board exam to become board certified, and many hospitals and insurers expect it.
The second is fellowship, which means more training in a subspecialty. Some common routes:
Fellowships usually run one to three years, and they’re optional. Plenty of internists, pediatricians, and family physicians go straight into practice after residency.
It’s a period of supervised clinical training that doctors complete after medical school. By the end of it, they’re ready to practice independently in one specialty.
For the standard route to independent practice in the US, yes. State medical boards require accredited postgraduate training for a full license. A handful of states now offer alternative licensing routes for experienced international physicians, but the rules differ by state and are still changing.
Usually three to seven years. Internal medicine, family medicine, and pediatrics take three, while neurosurgery takes seven.
Yes. Once you’ve passed the required USMLE exams and met ECFMG’s requirements, you can apply. You’ll need ECFMG certification before training starts and, if you aren’t a US citizen or permanent resident, a visa.
Yes. Residents have finished medical school and hold a medical degree. They treat patients every day, under the supervision of attending physicians.
Residency trains you in a specialty, such as internal medicine. Fellowship is optional training after residency that narrows your focus to a subspecialty, such as cardiology or nephrology.
Residency is the stretch between medical school and independent practice, where a new graduate becomes a specialist through years of supervised, hands-on work. If you’re heading that way, compare specialties early and read each program’s requirements carefully.
Residency is the stretch between medical school and independent practice, and for IMGs, getting in is a journey of its own. We guide you through all of it:
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