A medical residency is the next stage of training for individuals who've earned a medical degree. It’s a form of post-graduate instruction supervised by a fully licensed physician practicing in a specific branch of medicine within a hospital or clinic. The requirements for practicing medicine vary from country to country and within each country from state to state or province to province. While those requirements have evolved over time, currently in the U.S., most doctors, including those going into general practice and virtually all specialties, are required to complete a minimum of one and more typically two or three years of postgraduate training for medical licensure. Depending on the specialty or sub-specialty chosen by the medical school graduate and the jurisdiction where they’ll be practicing, three to seven years of a combined residency and fellowship may be required.
The distinction between what’s learned in medical school and what’s learned in a medical residency is important to understand. Medical school teaches physicians a broad range of medical knowledge and basic clinical skills. A residency provides more in-depth knowledge within a specific branch of medicine or specialty, Internal Medicine for example. Most important, a residency provides the medical school graduate with extensive experience applying that knowledge by practicing medicine within that area of specialization. Practicing in what is considered a sub-specialty such as Cardiovascular Disease, which is a sub-specialty of Internal Medicine, typically requires additional years of post-graduate training in the form of a fellowship following completion of the residency.
Many people have heard the term internship, which refers to the first year of post-graduate training. The title “intern” is gradually being replaced for most specialties by the title “first year resident” as internships are increasingly considered part of the residency program. There are some exceptions, however. Certain specialties, like Anesthesiology, Dermatology, Ophthalmology and Radiology, still require prospective residents to complete an internship year prior to starting their residency.
Given the annual number of medical school graduates in 2012 (31,000), the number of residency positions available (26,000), and the number of medical specialties (48), securing the residency preferred by the applicant can be a complex and competitive challenge. Simply deciding which residency programs to apply to requires consideration of a number of factors which must be identified and then ranked based on what’s most important to the applicant. It’s similar to selecting a medical school, only more complex. Nevertheless, securing the best possible residency is important. Depending on the kind of medicine the applicant seeks to practice and where he/she prefers to locate, the residency program they participate in can have a profound influence on their career. Those factors, not necessarily in this order, often include but are not limited to the following:
- the medical specialty/sub-specialty the applicant seeks to focus upon
- the location of the residency programs
- the reputation of the programs within the area of specialization
- the applicant’s potential of qualifying for acceptance into the programs
- living/working conditions for residents participating in the programs
- the applicant’s financial capacity to pursue the interview process for the programs selected
- financial considerations related to participation in the programs
Fortunately, the complexity of this selection process, for both the applicants and the institutions offering the residency programs, has been recognized and addressed by an organization known as the National Resident Matching Program (NRMP). The NRMP is a private, not-for-profit corporation. NRMP’s Main Residency Match (MRM) provides an impartial venue for matching applicants’ preferences for residency positions with program directors’ preferences for applicants.
The objective of MRM is to match the applicant’s highest preference for a residency program with the residency program’s highest preference for applicants based on the applicant’s and the program’s rankings of each other. NRMP through their MRM essentially acts as a clearinghouse for matching approximately 16,000 seniors in U.S. allopathic medical schools and approximately 15,000 seniors in osteopathic, Canadian or foreign medical schools, as they compete for approximately 26,000 residency positions. NRMP identifies the available residency programs and provides a system for ranking the preferences of both the applicants and the programs. It is not an application or job placement service. Applicants must apply directly to residency programs in addition to registering with NRMP. However, most programs participate in the Electronic Residency Application Service (ERAS) which transmits residency applications to program directors via the internet.
The registration fee for the MRM is $50.00 for an individual senior and includes up to 20 different program ranks. Additional programs beyond 20 are $30.00 per program. The fee is due at registration. Applicants who complete their registration after November 30th must pay an additional $50.00 late registration fee. In recognition of the additional challenge facing a couple seeking a match in the same location, institution and possibly the same program, the NRMP allows each partner of a couple to rank up to 30 different programs for an additional registration fee of $15.00 per partner. More specific information about the National Resident Matching Program and the Main Residency Match is available at www.nrmp.org
The registration fee for the ERAS is $92.00 for up to 10 programs in the same specialty, $9.00 each for programs 11-20, $15.00 each for programs 21-30, and $25.00 each for programs 31 or more. The fee for the requisite USMLE or COMLEX Transcript is $70.00 per season. More specific information about the Electronic Residency Application Service is available at the Association of American Medical Colleges website, www.aamc.org
Annual compensation for a resident averages about $45,000 for a work week which, even after recently mandated restrictions, still averages 80 hours based on recent studies. Obviously, given the academic qualifications of the residents and the number of hours worked, such compensation is far below the fair market value of the services provided. This often adds to the financial investment required of prospective candidates seeking to become licensed physicians.
Hopefully, this primer has provided a broad overview of the key elements in the process for initiating the next stage of training following graduation from medical school – medical residency. Given the subject matter, it seems appropriate to mention that Medelita, which sponsored this article, has for years maintained a special tie to medical residencies. William Osler, MD was the Canadian physician responsible for establishing the medical residency system in the U.S. Medelita chose to honor his contribution to the practice of medicine by naming what has become one of the company’s most popular men’s lab coats “The Osler
”, as part of its broader commitment to recognizing pioneers of the medical profession. The Osler, along with the complete collection of the best fitting, most fashionable and functional men’s and women’s lab coats and scrubs available, can be viewed at www.medelita.com/index.html