Doctors, Residents, and Attendings: What's the Difference?

If you are being treated in a hospital, you may be confused by the different titles used by the people treating you. Some may be physicians who are fully licensed to practice, while others may be doctors-in-training who work under someone else's supervision.

This article offers a breakdown of the people in your hospital care team who are either board-certified physicians or those on track to becoming them.

Hospital Hierarchy

In the United States, a person who decides to become a doctor will undergo training at a medical school before embarking on further training at a teaching hospital.

As they pass certain educational goalposts, these doctors-in-training will rise through the ranks from medical student to intern to resident, finally becoming an attending physician. Some may pursue additional training as a fellow before becoming 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. Residents typically wear longer coats, while attending physicians will 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.

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 is 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.

Interns and Residents

Medical school graduates then 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 to 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.

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:

• Internal medicine
• Neurology (nerves)
• Obstetrics/gynecology (female reproductive health)
• Ophthalmology (eyes)
• Orthopedics (muscles/bones/joints)

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, legally or otherwise, for all patient care—even if the care is given by a subordinate.

An attending physician is considered an expert in their field of medicine or surgery. Attendings are also referred to as staff physicians, supervising physicians, rendering doctors, 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.

Summary

People training to be a medical doctor are given different titles as they progress through the ranks. They begin as medical students, 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.

A Word From Verywell

It can be confusing to keep all of the different types of doctors straight when you're in a hospital.

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