The Differences Between Attending and Resident Physicians

Attending and resident physicians both have medical degrees, but there are differences in the extent of their training and ability to provide care independently. A resident has graduated from medical school and is completing a post-graduate training program. An attending physician is a board-certified physician who has completed their residency training.

Residents are supervised by attending physicians. When you receive care from a resident, you are also receiving care from their attending. This means you’ll benefit from the experience and knowledge of both.

This article discusses what makes an attending and a resident. It also offers a breakdown of the other people who comprise a hospital care team who are either board-certified physicians or on track to become one.

Doctors and Levels of Seniority

To better understand what a resident and an attending physician are, it’s helpful to know more about all levels of physician practice and how they compare.

In the United States, the hierarchy of doctors you may encounter in a hospital is as follows:

1. Attending physician: A doctor who has finished post-graduate training
2. Fellow: A doctor who pursues optional additional training before becoming an attending
3. Resident: A doctor who has finished their first year of post-graduate training
4. Intern: Medical school graduates who are first-year residents

In order to become an intern, one must go to medical school and then embark on further training at a teaching hospital.

Attending Physicians

An attending physician is a medical doctor who has completed all residency training. They are board-certified or eligible to practice independently in a particular specialty.

An attending physician typically supervises fellows, residents, and medical students and may also be a professor at an affiliated medical school. Attending physicians have final responsibility for all patient care—even if a subordinate provides the care. (They may or may not have legal liability, depending on the circumstances.)

An attending physician is considered an expert in their particular field of medicine or surgery. Attending physicians are also called staff physicians, supervising physicians, or simply “attendings.”

Depending on the field of medicine, the route from medical student to attending can take seven years or more. Some specialties can take 14 years or more of post-undergraduate studies and training before credentials are fully obtained.

• Provides direct care to patients without supervision
• No limits on services they are able to deliver
  
• Holds all responsibility for care given by them or subordinates

• Can provide direct care to patients with supervision and guidance of an attending
• Allowed to do more as they gain experience
• Does not hold ultimate responsibility for care provided

Fellows

A fellow is someone who has completed their residency and elects to pursue further training. A fellowship is optional but is required to practice certain subspecialties.

An example is a general surgeon who wants to pursue a career in pediatric brain (neuro) surgery or heart/lung (cardiothoracic) surgery.

There are fellowships in many fields of medicine, including:

• Cardiology (cardiovascular system)
• Neurology (brain and nervous system)
• Obstetrics/gynecology (female reproductive health)
• Ophthalmology (eyes)
• Orthopedics (muscles/bones/joints)
• Pediatrics
• Psychiatry
• Radiology
• Surgery

Interns and Residents

Medical school graduates enter a residency program in a hospital, clinic, or doctor’s office.

The goal of residency—also referred to as a graduate medical education (GME) program—is to continue training in a specialized field of medicine. A medical residency can last anywhere from two to three years for a family doctor and seven or more years for a surgeon.

First-year residents are referred to as interns. After that, they are known as resident doctors, resident physicians, or simply “residents.”

Residents provide direct care under the supervision of an attending physician or senior resident.

Can Residents Prescribe Medication?

Residents generally are restricted to writing prescriptions for only those under their care as part of their training. The American Medical Association notes legal cases, dating back decades, that establish residents' ability to prescribe drugs. The University of Nevada and other medical schools note, though, that residents practice medicine under supervision on a restricted basis (unlike fellows) and cannot prescribe drugs outside the scope of their clinical rotations.

Residency Specializations

Residents can choose different specialties to train in after graduation. Some potential specialties include:

• Emergency medicine
• General surgery
• Family practice
• Pediatrics
• Anesthesiology
• Diagnostic radiology

Chief Residents

Chief residents are selected to lead a group of residents. They are residents who are elevated to a level that puts them senior to the rest of the residents and junior to the program’s management.

The duties of chief residents may vary but can include patient care; mentoring, training, and advocating for team members; and carrying out some administrative duties.

Chief residents are chosen by hospital leadership during their residency program.

Medical Students

Medical students are those who have obtained a bachelor’s degree and have been accepted to medical school after meeting certain requirements, including passing the Medical College Aptitude Test (MCAT).

The first two years of their four-year program are devoted to classroom studies. During the latter two years, time is largely spent in a hospital- or clinic-based setting.

Upon completion of medical school, medical students graduate with either a doctor of medicine (MD) or a doctor of osteopathic medicine (DO) degree.

It is only at this point that they are referred to as physicians, even though their training is not yet complete.

How Can You Tell Who’s a Resident vs. an Attending?

You can sometimes tell where a person fits in the hierarchy based on the length of their lab coats. The shortest white coats are worn by medical students, while residents typically wear longer coats and attending physicians wear full-length coats.

Even so, a lab coat is not an absolute indication of a person’s status as other health professionals also wear them, including nurse practitioners and phlebotomists (technicians who draw blood).

Today, many health professionals of all ranks also wear scrubs.

When in doubt, look at a staff member’s ID badge or just ask what their role is. It is your right to know each person's role and which member of the hospital staff is ultimately in charge.

Summary

People training to become medical doctors are given different titles as they progress through training. They begin as medical students and then progress to interns, residents, and fellows. Once residency and fellowship trainings are complete, a person can become a board-certified attending physician.

From the time of enrollment in medical school to board certification, it can take anywhere from seven to 14 years (or more) to become an attending physician.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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3. Weggemans MM, van Dijk B, van Dooijeweert B, Veenendaal AG, ten Cate O. The postgraduate medical education pathway: an international comparison. GMS J Med Educ. 2017;34(5):Doc63. doi:10.3205/zma001140
4. Teo WZW, Brenner LH, Bal BS. Medicolegal sidebar: resident physician liability. Clin Orthop Relat Res. 2017;475(8):1963-1965. doi:10.1007/s11999-017-5402-x
5. Medical School Headquarters. Important details about (almost) every medical specialty.
6. AMA Journal of Ethics. When Are Residents Treated as Doctors Under the Law?
7. University of Nevada Reno School of Medicine. Resident Prescription Writing/Medical Treatment Policy.

By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.

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