From Med Student to Attending – Understand the Difference Between Levels of Medical Training (and, Why You Just Got a New Resident!)
Every July 1st residencies rotate – interns suddenly become someone’s doctor, junior residents become seniors, etc. If your doctor is a resident, they may leave to go on to another part of training, and you’ll end up with another doctor. In teaching hospitals, July can be chaotic. Suddenly, emergency rooms across the country are flooded with many doctors who have never worked on a patient by themselves. Among doctors, “don’t get sick in July” is a well-known truth, so since it’s July I thought it would be a good time for this post!
It can be confusing to be a patient in a large hospital or medical practice, especially with the blur of healthcare professionals that may be involved in your care. Understanding the different roles occupied by people in various stages of medical training can help you pick the best doctor and hospital for your needs. Remember, it’s always okay to ask what the title of the person helping you is (“are you a resident or attending?”) and it is ALWAYS okay to ask for an attending!
- Teaching Hospital – All medical schools are affiliated with teaching, or academic, hospitals. Examples of this include Brigham and Women’s Hospital, Massachusetts General Hospital, and a few other hospitals in the Boston area, all affiliated with Harvard Medical School.
Teaching hospitals are often on the front lines of research, including the most clinical trials and the best known specialists. If you’re a patient at a teaching hospital, you may encounter many different medical students and residents in several aspects of your care. You can always ask for an attending doctor instead, but if you’re willing, you can provide a great training opportunity to the next generation of doctors.
- Med Student – Medical students have 4 years of training after undergraduate work. The first 2 years are “preclinical” and take place mostly in the classroom and lab. The last two years are the “clinical years”, which involve hands-on training with rotations through various specialties, including internal medicine, surgery, pediatrics, and emergency medicine,
among others. In teaching hospitals, they are often the first people to see patients, and usually introduce themselves as medical students or student doctors. They cannot make final decisions or order procedures.
- Resident – Upon graduating from medical school, the graduate receives a M.D. degree, but that degree alone does not entitle one to practice medicine. Now the new M.D.s must enter residency training, which ranges from three to seven years, depending on specialty.
Residency programs are intense, up to 80 hours per week. Internship is the first year of residency, followed by junior and then senior residency. Throughout the program, residents are under intense supervision from attending doctors. Once the residency in the chosen specialty is completed, residents are eligible to take exams to qualify as “Board Certified” in their specialty.
Pros – Many residents are eager to please patients and are more apt to take more time with and listen more closely to patients. They tend to be less set in their ways and more willing to think outside of the box. They also have to run everything by attending doctors, so more doctors are involved in the decision making, which can be good or bad – errors may be caught more frequently, but things may take longer.
Cons – They are not always accessible, because they are doing other parts of their training, and you are dealing with the attending doctor as well. Residents frequently leave, either because their residencies end or to continue their training at another hospital or in another specialty.
- Fellow – Some fields, including cardiology and gastroenterology, require fellowships, which is additional training for those who have completed residencies. Most residency graduates do not pursue fellowships and go right to work as attending doctors.
Pros – because they’re still in training, they are generally less set in their ways and more apt to think outside the box.
Cons – Again, you’re still dealing with more than one doctor, and the fellow will eventually leave to open their own practice.
- Attending – A doctor who has completed their residency and, if required, fellowship. Attending doctors practice on their own without oversight, often in their own practices, and sometimes take additional teaching or research duties. Attending doctors sometimes work with fellows, residents and/or med students. Many attendings, especially specialists in teaching hospitals, only see the patient for the last 10-15 minutes of the appointment.
Pros – Many years of experience, will be there long term and not leaving when finishing their training. They have the ability to make decisions on their own. Cons – Generally do not make phone calls or communicate with patients outside of office visits, sometimes are more set in their ways, don’t think “out of the box,” and are less willing to work with their patients as partners – they are often more “my way or the highway.” Although they can practice on their own, if you’re in a teaching hospital you’re still frequently dealing with more than one doctor because they often have fellows or residents working under them.
Source – When Doctors Don’t Listen by Leana Wen, M.D., and Joshua Kosowsky, M.D., p 34-38