In the United States, medical residency is the final step between you and your formal clinical practice as a trained doctor. If you thought you were done with your student phase after medical school, take a deep breath and hold yourself tight because medical residency is the next step, and its length varies between 3 to 7 years. That's right! But life in both medical school and residency is much different. If you are in medical school, do read this article until the end to know the difference between both programs as well as between your life as a student and a resident.
When you are in the final year of a 4-year medical school program, your peers and professors will ask you to start applying to medical residencies. So, what exactly does it refer to?
A medical student is simply an individual enrolled in a medical school to pursue a graduate degree in medicine. After fulfilling all the requirements for their graduate program, medical students receive a Doctor of Osteopathy/DO or a Doctor of Medicine/MD degree at the end of the fourth year. Undergraduate medical students get to engage with patients during their pre-clinical years and have direct exposure to patient care during their 1st and 2nd years of medical school. This was once considered an innovative way of keeping the undergraduate students engaged during their pre-clinical years. However, today, it has become more like a selling point, at least within the medical school across the USA.
Around one-quarter of medical students in the USA train at osteopathic medical schools, and this number has significantly increased in the past five tears. The American Association of Colleges of Osteopathic Medicine reported that over 40% increase had been noted over the past decade. This spike could be attributed to additional DO-granting schools of medicine opening up in the country. As far as the requirements to apply to DO and MD programs are concerned, the criteria are the same. Both Allopathic and Osteopathic programs weigh Medical College Admission Test (MCAT) and grade-point scores heavily. The curriculum is usually the same structure, and students in both programs generally spend most of their first and second years in the classroom. In contrast, most of their training afterwards is conducted in a clinical setting.
Medical students graduate when the fourth year of medical school ends, but they still aren't ready to practice medicine despite becoming physicians. That's why they need to apply for medical residencies. For your information, residency medicine is a post-graduate program designed to train freshly graduated physicians with a DO or MO degree. By the time students in medical school reach their fourth year of medical studies, they have determined which specialty they want to explore later on. Hence, they start applying to the feasible medical residency programs offering training in that specialty. Students who receive a positive response to their applications by their preferred institutes, they have to appear for residency interviews. If this phase is successfully completed, students create a Rank-Order List to rank their preferred residency programs. The students are then matched against a similar list, which is created by the programs.
The matching occurs in late March when the students are in their final semester. This is called the Match Day. The students are duly informed if they are matched with a residency program. If they do, they are selected to fill the available post-graduate training position at the institution. This program is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Usually, students match with any of their top three preferences in residency programs. However, students who apply for more competitive medical specialties may get matched with programs ranked lower on their Rank-Order List.
Residency training is typically followed by sub-specialty or fellowship training. In most US jurisdictions, successfully completing this training is necessary to obtain a license to practice medicine, especially to get an unrestricted license to practice their preferred specialty. Depending on the jurisdiction, an individual enrolled in a residency program is called a resident, trainee or registrar.
Simply put, the medical school provides students with an extensive array of medical knowledge, and clinical skills, and ensure a supervised experience practicing medicine in numerous fields. Residency, in contract, offers in-depth training within a particular branch or specialty of medical science.
However, the main difference is that you are a student in medical school, and you'll be paying tuition to get your graduate degree. On the other hand, you have a working job as a new doctor in residency. The reason you need to enroll in a residency program is that you must hone your craft prior to receiving the license, board certification, and becoming eligible to practice on your own without anyone's supervision.
During the first 2 years of medical school, students primarily learn via didactics in the classrooms, usually divided into small groups. In the final two years, they are on clinical rotations where they learn to apply their knowledge and medical science principles to patient care to improve their ability to work in teams and practice their bedside manner.
However, the residency program is different because you aren't a student now but a doctor with many responsibilities on your shoulders. You have to take ownership of patients and would be held accountable for their health outcomes eventually. You have to be responsible for their care. Residents are not alone altogether as certified and experienced physicians supervise them to check on them and ensure quality care. As time passes, residents are expected to become more independent and rely less on attending supervision. By the end of your residency program, you would be ready to care for patients independently and start practicing as a certified doctor.
As mentioned above, the medical school offers a graduate program that lasts for about 4 years. Students may opt to study for an additional year to earn a master's degree or conduct research. In contrast, residency length depends on your specialty, and therefore, the time you spend as a resident is highly variable. Generally, the length of surgical specialties is longer than non-surgical specialties. For instance, neurosurgery residency is the longest at seven years, and some programs may be 8 years as the resident may be required to conduct research.
Plastic surgery is the second-longest program at 6 years, and some programs require mandatory research, which makes the program length longer at 7 years. Pediatrics and internal medicine are shorter programs, each not taking more than 3 years. So, almost all residencies last between 3 and 7 years. But keep in mind that some subspecialties need the student to undergo additional training in a fellowship program. You can consider fellowship as the next stage of residency.
Though most medical schools transition to a pass/fail grading system during the first two years, they are still much competitive to get into your preferred specialties. Plastic surgery, for example, has the highest Step 1 score hovering around the low 250s while gaining the 90th percentile on Step 1 would make you an average plastic surgery applicant. The subsequent 2 years can be regarded as your clerkship stage, where you are graded on the Honors/Pass/Fail system. There might be some variation, but the general grading criterion remains the same. If you have opted for a highly competitive specialty such as orthopedic surgery, plastic surgery, or dermatology, you will have to work really hard to get an Honors grade. Remember that clinical grades are generally based on a curve. This means a small percentage of students in a class can earn them, so you have to outshine your classmates at all costs for the Honors.
This makes it apparent that medical school is more stressful than residency but don't think residency is any easier. The pressure is always there whether you are in a medical school or residency. In residency, you are expected to outperform your peers even though there aren't any grades. You will have to take an annual in-service exam based on your specialty, and as a resident you'll be evaluated by your attitude and attendings in a real-world clinical setting.
The primary purpose of residency is to help improve a resident's clinical skills and judgment ability. In medical school, you will be given tests frequently while in residency. Such evaluations are more informal. Such as, an intern may conduct surgery and the attending reasonably well, and the supervisor tells them that the job was well done but also adds a reminder that the next time they should not pick the needle with the forceps. Attendings train residents on medication choices, postoperative measures/guidelines and many other aspects of patient care.
Also, residency doesn't have those standardized tests as you get in a medical school. Step 1, Step 2 CK, and Step 2 CS are standardized tests students must undertake in medical school. On the other hand, as a resident, they will only take the Step 3 test, and an annual exam called the in-service test. At the end of their residency, all residents will appear in a formal licensing exam called the boards exam.
As we told you before, the main difference between medical school and residency is that you are a student in school. In contrast, in the residency program, you are a working professional. On average, as per the latest figures, medical school graduate has debt at around $190,000. This means one must pay approximately $200,000 to become a doctor, including college and medical school loans.
In residency, however, the situation is different because you will be earning a salary and can start paying off your loans. And, you will probably be making minimum payments and accumulating interest as residents, on average, earn around $50,000 to $60,000 annually. However, remember that residents' salaries vary according to their geographic location, years of experience, and specialty.
The Association of American Medical Colleges (AAMC) revealed in their 2018-19 survey report that first-year residents received an average salary of $56,126 and $63,014 in their 4th year of residency. They also receive certain benefits depending on the type of program. Such as, some receive insurance while some may get paid days off or parking and meal allowances. As far as first-year residents are concerned, they earn around $58,000 to $59,000 a year.
According to the AAMC's 2020 survey of Resident/Fellow stipends and benefits, here's a breakdown of medical residency salaries.
Residency Year Average Salary
are the top five highest-paid medical specialties per the same survey.
However, it is worth noting that despite being real doctors, medical residents do not receive as much salary as their senior physicians get, and the income mentioned above is comparatively low. That's mainly due to fierce competition between residents. As long as the residents are continuing at the hospitals, they will have to compete with others, and that's why physicians prefer to engage in general practice. It must be noted that the US government funds the salary of residents. These funds come from Congressional hearings that occurred when Medicare was established in 1965.
There's a vast difference between your life and responsibilities in medical school and medical residency. A medical school is all about gaining knowledge; residency is about applying what you have learned in the practical world. During the first 2 years of your medical school, the classroom will be where you will spend most of your time, and in the final two years, clinical settings will be where you will learn to apply the knowledge and improve skills. So, mostly you will be on your own, and all you will have to do is focus on what you are being taught. But, in the residency program, you are responsible for your own performance and the patient. You are a doctor and have to take care of the patients while knowing that you are being evaluated and supervised.
So, understandably, there are salient differences between the way you will schedule your time and efforts. In medical school, you have the option of skipping the class and watching it online later or acquiring notes from your colleagues. In clinical rotations, you can take a day off or leave early as there are no specific limitations to which students must adhere. However, as a resident, you will hardly get any free time, and things may not fully be under your control. You will be provided with a schedule that you will religiously follow. You could be allotted a daytime or nighttime shift or even a 24-hour shift, and you MUST be there on time. Then you have the extra burden of being responsible for patient care and ensuring their wellbeing. You will discover that your shift doesn't always end when it is supposed to. Such as, if you are part of an operation team for an emergency trauma patient and your shift is over, you cannot leave the operating room until the surgery is finished and care has been transitioned. So, this brings us to the all-important question- Is residency easier or harder than medical school?
It is difficult to rate the complexity of residency from one to ten (where ten signifies the hardest) because it is variable. Your life will definitely be different in residency compared to medical school, mainly because of the strict guidelines and being held accountable for your patients' wellbeing as a real doctor. In residency, you cannot make mistakes as it may endanger someone's life. But, on the flip side, residency training is a challenging and exciting job. The best thing about it is that you gain practical experience and learn to apply your knowledge. The working hours may get tough, particularly during your beginning years as a resident, but you will gradually learn to adjust.
They both are challenging in their own specific ways. Medical school will appear more challenging for the first two years as you adjust to the environment and studies. Your study habits will change and so will your lifestyle. There will be lesser time for non-academic activities. The only challenge you will have to deal with in medical school is getting high grades to ensure you don't face any difficulties when you apply for your residency.
You should realize that life in medical school and residency has its fair share of challenges and rewards at the end of the day. What makes residency different from med school is that you'll become a doctor to real patients as a resident. It will be frustrating and stressful almost always, but it is the most rewarding aspect of a residency program. Residency is the program that will make your dream of becoming a doctor and serving humanity come true in the real sense.