What is "Residency"?

When you start your journey as a doctor in the U.S., you will start as a "resident". When you complete your "Residency" which is about 3-5 years, you are regarded as a "specialist". You can work as an independent specialist, and can choose to stay in an academic setting (generally means university hospitals) or go to private practice.
In order to help you understand better, allow me to use the analogy of Grey's Anatomy.

As you can see here. This is the ranking system in the hospital. When you apply for a residency position, you need to determine which specialty you would want to train for. In the case of Meredith Grey, she decided to pursue a residency in General Surgery. Immediately upon graduation from medical school, she enters a general surgery residency. She has few big bosses, who are her Attendings. The biggest boss is the Chief of Surgery. She also has a small boss, who is the Chief Resident. The Chief Resident is a 5th year surgical resident. Meredith Grey will become a Chief Resident 4 years later, and she will become an Attending 5 years later. She may stay on to work as an Attending and perhaps one day she will get to become the Chief of Surgery.

In order to put this into a Malaysian perspective, here is what the ranking system will be like if we use our terms into Seattle Grace Hospital.

A few questions which may be in your mind right now:

Question: What about housemanship in the U.S.?

In the U.S. system, there is no housemanship when you graduate (and no compulsory service as well). They have the "Residency" system. Singapore is currently also adopting a similar system. There is also no "medical officer" or "compulsory service". Upon graduation, you enter into a training program in your field of choice. That training program is known as "RESIDENCY". The duration of a residency program ranges from 3 to 5 years, depending on the specialty. General surgery is 5 years. Internal medicine and Pediatrics is 3 years.

Question: Isn't the intern = houseman?

No. The intern is a first year resident. For example in a general surgery residency, interns (or 1st year residents) train only in the surgical department. The last time Meredith Grey delivered a baby was in medical school during her OBGYN rotation. There are certain residency programs like ophtalmology which requires the 1st year resident to rotate in the medical department for 1 year before entering ophtalmology.

Question: What happens immediately after you complete residency?

There are a two general pathways:

• Work as an Attending
• If you complete ENT residency, you work as an ENT surgeon. You can choose to work in a few settings
• Academic: which are places with residents. Here, your job is not only to provide service to patients, but also to teach residents and medical students. A good comparison would be a specialist working in University Malaya Medical Center.
• Private: where it is mainly providing service to patients. But of course this is where the money is. A good comparison would be a specialist working in Gleneagles. However, you lose the satisfaction of teaching and mentoring, unlike if you remain in the academic setting.
•  Continue with a Fellowship (subspecialization)
• Fellowships is where one goes after completing residency. If Christina Yang completes general surgery residency, she can opt to continue her training to subspecialize in cardiothoracic surgery. If one completes a pediatric residency, one can opt to continue with a fellowship in pediatric nephrology.
• If you are interested in a fellowship, you will need to apply for it in your final year as a resident. If you get a spot for fellowship, you will begin fellowship training immediately after completion of residency training.

The reason I used "Masters trainee" instead of medical officer or housemanship, is because I can't find an equivalent term for a resident in the U.S. Another equal term may be "Postgraduate trainee" or "Registrar".

 I hope I have outlined the general pathways well. These are the things which I was not clear about before I embarked on my USMLE journey, and in the same way others have enlightened me, I hope I make it clear to you as well.

- Jamie -
Tags : what is residency, work as doctor in usa, USMLE, Kuala Lumpur, Malaysia, kuala lumpur, specialization