Doctors, Residents, Interns, and Attendings: What's the Difference?

surgeon in mask image
Physician At Work. Photo: © Christopher Furlong/Getty Images

If you are being treated in a hospital you may be confused by all of the different titles that are used for physicians. This quick guide should help clarify the roles and education levels of the different students and physicians you may see during a hospitalization.

In the United States, an individual must complete high school and obtain a bachelor's degree prior to beginning medical school. In order to apply to medical school, the student must complete a bachelor's degree and coursework in biology, physics and chemistry.

In some cases, a school may combine the bachelor's program with the medical school program, but these programs are less common than the traditional bachelor's degree followed by medical school program of study.

A teaching facility is traditionally a hospital that offers training to doctors after they complete medical school. University based hospitals are typically teaching facilities, but smaller hospitals and hospitals not affiliated with a school may also be teaching facilities.

Physician Versus Doctor

A physician is a medical doctor, either an M.D. or D.O., who has completed graduate training to provide health care. A physician may be referred to as a doctor. However, not all doctors are physicians. An individual with a PhD, such as a doctoral degree in economics, is referred to as a doctor. So while all physicians are doctors, not all doctors are physicians.

Medical Students

Individuals who are in medical school are referred to as medical students.

They are not referred to as a doctor or physician until they graduate from medical school. Once they graduate, they are a physician even though their training is not complete.

Interns

After completing medical school, the doctor completes their first year of post-medical school training. This year is referred to as the intern year.

The intern does not have the right to practice unsupervised medicine, and must practice within the confines of the training program in which they are enrolled.

Residents

Residency follows the intern year. At this point, when the internship year has been completed and a third level exam has been passed, the physician may practice as a general practitioner. While practicing independently is possible, the vast majority of physicians choose to pursue a residency for further training. Residency can range from an additional two years of education to an additional seven years of training, depending on the specialty. For example, a family practice residency would be two years of residency while a surgery residency may last five to seven years.

Fellows

A fellow is a physician who has completed their residency and elects to complete further training in a specialty. For example, a cardiothoracic surgeon would complete an intern year and a residency in general surgery. After residency, they would complete a fellowship in cardiothoracic surgery, which would provide more specific training in heart and lung procedures.

The fellow is a fully credentialed physician who chooses to pursue additional training, the fellowship is optional and is not required to practice medicine, but is necessary for training in a subspecialty. To be clear, after a general surgery residency a physician is fully qualified to perform general surgery independently. The fellowship is necessary for more specific training, such as pediatric neurosurgery.

Attendings

An attending is a physician who has completed their training and is working independently in their specialty. This individual is typically board certified in their area of expertise; however, board certification is not required to practice in a specialty. In a teaching facility, such as a university hospital,  the attending is often directing the education of medical students, interns, residents, and fellows.  They typically play an active role as a teacher to those who have not completed their education. 

Short Coats and Long Coats

While it is generally true that the shorter the coat the less training an individual has received, the short coat versus long coat rule is not absolute. The shortest white coats are worn by medical students, who are not physicians. Interns also wear short coats, but not quite as short as those worn by students. Residents typically wear longer coats and attendings wear a full length coat. While this general rule holds true, personal preference often dictates the length of the coats worn (if one is worn at all) by an attending, so coat length is not an absolute indication of what level of training a physician has completed.

Sources:

Physician Training. Health Guide USA. http://www.healthguideusa.org/careers/physician_training.htm"

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