Before you can be licensed as a physician, you must transition from medical school, through the National Residency Matching Program (NRMP), into an internship and a medical residency program - a sort of on-the-job training for doctors. Depending on your specialty, medical residency can last from a minimum of 2 years to 6 or more. After accumulating debt over the previous 8 years, you will finally be drawing a small paycheck. The pay starts at about $32,000 for the first year and tops out around $48,000 for 6th year residents. The first year of training after medical school is called internship, or PGY-1 (post graduate year #1), the second year is PGY-2, and so on.

During your clinical rotations you will have gotten a pretty good idea in which area you might want to specialize. Competition for medical residency in some specialties can be fierce, however in 1999 "80.5 percent of graduating seniors matched into one of their first three choices for first and second-year programs... 57 percent matched to their first choice, 15 percent to their second choice, and 8 percent to their third choice" (UT Southwestern). As with your application to medical school, there is a centralized service used to compile your information and place you into a medical residency program.

ERAS, NRMP, the Residency Match, and the "Scramble"

The Electronic Residency Application System (ERAS) is designed to compile your information and submit it to your selected medical residency programs in a standardized format. Completion and submission of the application is similar to using AMCAS to apply for medical school.

What takes place next is the "Match". Using the ERAS applications, the National Residency Matching Program (NRMP) helps recent graduates find residency positions and helps hospitals find residents to fill their slots. As with the AMCAS process, students must start applying early to the programs that interest them, travel to interviews if invited, and await a decision from the admissions committee. If a graduate doesn't get a slot in this way, they must suffer through the "scramble". Those that do not match are notified two days before the official results and can participate in the scramble, where unmatched graduates telephone unmatched residency programs in an attempt to find jobs. Visit the Association of American Medical Colleges (AAMC) and learn about the NRMP for more information.

The Role of Medical Residency Programs and the Medical Resident in the Healthcare System

The residency program is a fundamental part of our healthcare system and the use of low-paid interns and residents help control costs. Residents work long hours and can be "on call" every 2 to 4 days. Historically they often spent 30 to 36 hours at a time in the hospital, often with little or no sleep. In recent years, though, there has been an outcry about the harsh working conditions to which new doctors are submitted. Organizations like the American Medical Student Association (AMSA) made substantial progress toward limiting the hours worked by student doctors, including limiting residents to a maximum of an 80-hour work week, with a maximum of 36 hours on-site, and required naps for long shifts. For some residency programs that means that residents are effectively limited to 60-hour work weeks. While these are still long hours, the situation is much improved compared to that 10 years ago.

The following statistics were recently compiled by the AMSA:

• The Institute of Medicine released a report revealing nearly 100,000 annual deaths resulting from medical errors.
• Before work-hour changes resident physicians work up to 120 hours a week, including 36 hour shifts for several weeks at a time.
• After 24 hours of wakefulness, cognitive function deteriorates to a level equivalent to having a 0.1% blood alcohol level. These doctors would be considered too unsafe to drive; yet they could still treat patients for 12 more hours.
• Forty-one percent of resident physicians attribute their most serious mistake in the previous year to exhaustion. (AMSA)

That said, resident work hour caps haven't been implemented without some complaints. Older doctors believe that the more experience you have treating patients and their diseases the better you will be as a physician. An old saying in medicine goes "the only thing wrong with being on call every other night is that you only get to see half the patients." Beside being the hardest worked member of the medical team, an intern is at the bottom of the food chain at a teaching hospital. Any unpleasant, menial task (called scut work) is the intern's job.

After the intern year, residents spend more and more time focusing on their area of specialty. Beginning with relatively simple procedures, they learn progressively more complex tasks. Medicine is taught on the premise "see one, do one, teach one." In other words; watch a procedure performed, do the procedure yourself, then teach someone else how to do it.

Medical residency training is without a doubt a grueling experience, but the US consistently turns out the best doctors in the world, so despite it's drawbacks, it is a highly effective form of education for new physicians.

For support during medical residency try the medical residents forum and connect with other residents. More medical resident resources at MomMD.

Articles in this series:

• Becoming a Doctor Are you trying to decide whether becoming a doctor is right for you? Take a realistic look at what it takes to get there.
• Steps to Become a Doctor Premed Planning - The timeline and steps to become a doctor, including undergraduate studies, gaining experience in the medical industry and taking the MCAT.
• Applying to Medical School Ready to apply to medical school? Be prepared for the application process and for medical school interviews.
• How to Become a Doctor What to Expect in Medical School - Medical school curriculum, USMLE, and the cost of medical school
• NRMP and Medical Residency What is residency for doctors? Medical Residency, ERAS, NRMP, the Residency Match and the Scramble - The process of getting matched with a medical residency position, and the medical resident's role.
• Being a Doctor What It's Like to be a Doctor

Visit all the pre-med resources for becoming a doctor.