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Your graduation from medical school does not mark the end of your education.
After earning an MD, you will spend several years as a resident in a teaching hospital. During this time, you'll learn to practice in a specific area of medicine under the guidance of experienced physicians.
Residency can be a grueling experience. When it comes to the hospital environment, you're at the bottom of the pecking order. You'll face a massive workload, an unrelenting schedule and heavy scrutiny from supervising doctors. To top it off, you won't make much money.
On the flip side, you will work directly with patients and gain mastery of a specific specialty.
Applying for a residency
Clinical rotations should have given you a taste of the various areas of medicine. In your final year of med school, you'll need to pick one and apply for residency programs in that specialty. This process is known as "the Match".
There are many things to consider when choosing a specialty—the type of medicine you'd like to practice, the career opportunities available, as well as compensation and lifestyle issues. If you choose a competitive specialty such as dermatology, neurology or neurosurgery, you'll have to work harder to get into a residency program. Some students apply for residencies in more than one specialty.
To apply for a residency, you submit an application that includes your USMLE scores, grades, CV, recommendations and a personal statement. Residency programs then invite you to an on-site interview. Once the interview process is over, you submit a ranked list of programs to the National Residency Matching Program (NRMP). Each program also submits a ranked list of students they're interested in, and NRMP uses an algorithm to match applicants to schools.
Some applicants – particularly those applying for competitive specialties – do not find a match through the NRMP. If you are one of these students, you will be notified just as others are receiving their matches. You must then call around to programs with vacant spots, which may not be in your intended specialty. This process is called "the Scramble".
Learning on the job
The residency can last anywhere from three to eight years, depending on your specialty. You'll learn almost everything you need to know about your area of specialty during this time. You will work directly with patients, but a more senior physician will generally be required to approve your decision making, at least for the first few years.
Expect exhaustion to be a constant factor. Typical work weeks range from 50 to 80 hours, and residents spend several nights a week on-call. Specialties that deal with the unexpected, such as trauma and transplant surgery, require particularly demanding hours.
The first three to five months of residency will be the hardest, as your body adjusts to the lack of sleep, surplus of work, and constant reprimanding that comes with the territory. You must be able to leave it behind when you leave work. It also helps to have a strong support system of friends and family to keep you sane.
As the residency progresses, you will be given more responsibility and make more decisions independently of your attending physician. You will also apply for a medical license from the state licensing board.
Once your residency is over, you'll finally have the knowledge and experience to practice medicine on your own. Some doctors pursue a fellowship or additional research after their residency. Others join a hospital, clinic, HMO or start their own private practice