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Residency is a stage of postgraduate medical training in North America and leads to eligibility for board certification in a primary care or referral specialty. It is filled by a resident physician who has received a medical degree (M.D. or D.O.) and is composed almost entirely of the care of hospitalized or clinic patients, mostly with direct supervision by more senior physicians. A residency may follow the internship year or include the internship year as the first year of residency.

Whereas medical school gives doctors a broad range of medical knowledge, basic clinical skills, and limited experience practicing medicine, medical residency gives in-depth training within a specific branch of medicine, such as anesthesiology, dermatology, emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, pathology, pediatric medicine, psychiatry.

Changes in postgraduate medical training

Many changes have occurred in postgraduate medical training in the last fifty years:

1. Nearly all doctors now serve a residency after graduation from medical school. In many states, full licensure for unrestricted practice is not available until graduation from a residency program. Residency is now considered desirable preparation for primary care (what used to be called “general practice”).
2. The internship has been subsumed into residency for most physicians. It is now uncommon for a physician to take a year of internship before entering a residency, and the first year of residency training is now considered equivalent to an internship for most legal purposes. Certain specialties, such as ophthalmology, radiology, anesthesiology, and dermatology, still require prospective residents to complete a separate internship year, prior to starting their residency program training. Physicians who graduate from osteopathic medical schools (receiving the D.O. instead of M.D. degree) are still encouraged (and in five states required) to take an internship before applying for residency.
3. The number of separate residencies has proliferated and there are now dozens. For many years the principal traditional residencies included internal medicine, gynecology, pediatrics, general surgery, ophthalmology, orthopaedics, neurosurgery, otolaryngology, urology, physical medicine and rehabilitation, and psychiatry. Family practice and emergency medicine residencies have been available for many years.
4. Pay has increased, but few residents make a wage which can support a family. Few residents live in hospital-supplied housing anymore, but unlike most attending physicians (that is, those who are not residents), they do not take call from home; they are usually expected to remain in the hospital for the entire shift.
5. Call hours have been greatly restricted. In July of 2003, strict rules went into effect for all residency programs in the US, known to residents as the “work hours rules”. Among other things, these rules limited a resident to no more than 80 hours of work in a week, no more than 30 hours at a stretch (with no new patients in the last six), and call no more often than every third night. In-house call for most residents these days is typically one night in four; surgery and obstetrics residents are more likely to have one in three call. A few decades ago, in-house call every third night or every other night was the standard.
6. For many specialties an increasing proportion of the training time is spent in outpatient clinics rather than on inpatient care. Since in-house call is usually greatly reduced or absent on these outpatient rotations, this also contributes to the overall decrease in the total number of on-call hours.

See also

This page has the following sub pages.

• Physician Shortages
• Requirements for a State Training License needed to start Residency
• Severe doctors' shortage predicted in Canada