Everything You Need to Know About Medical Residency and Fellowship

Becoming a doctor involves more than completing undergraduate studies and passing a few exams. It requires a long-term commitment to academics, clinical training and continuous development. For scale, 167,083 residents and fellows were training in programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) in the 2024-2025 academic year, spread across 13,762 accredited programs. Understanding how residency and fellowship work, including what medical residency salary looks like at each stage, is essential for anyone on the path to becoming a physician.

Here is a simple breakdown of the process:

1. Take the MCAT
2. Apply to Medical School
3. Interview and Get Accepted
4. Attend Medical School
5. Get Matched to a Residency Program
6. Complete Residency (and Fellowship if you subspecialize)
7. Practice Medicine Independently

The final stages, residency and fellowship, are often the least understood. Yet they are among the most important, because they decide what kind of doctor you become, where you train and how many more years you spend in supervised practice before you work on your own.

If you are still building the foundation for your medical career, it helps to understand pre-med requirements before thinking about what comes after medical school. And if you want to gauge how competitive your current profile is for medical school admission, the IMA Pathfinder admissions calculator can give you a useful starting point.

Key Takeaways

• Residency is the required training step after medical school. Most specialty programs last three or four years, and neurological surgery is the longest at seven years.
• Fellowship is optional subspecialty training after residency. Just over half of ACGME subspecialty programs (52.7%) last one year; the rest take two years or more.
• The Match pairs applicants with programs. You apply through an application service such as ERAS, interview and rank your programs, and an applicant-proposing algorithm run by the NRMP makes the placements.
• The 2027 ERAS season is underway. Residency applicants could submit applications from September 2, 2026, and programs could begin reviewing them on September 23, 2026.
• Residents are paid a stipend. The average first-year stipend was $68,166 as of July 1, 2025, rising to $94,215 in the eighth program year.
• Work hours are capped. Residents and fellows may work no more than 80 hours a week, averaged over four weeks.
• Borrowing rules changed on July 1, 2026. New professional students can borrow up to $50,000 a year in federal Direct Unsubsidized Loans, and Grad PLUS loans ended for borrowers without an exception.

Residency and Fellowship at a Glance

What Residency and Fellowship Really Look Like for Doctors

Once you have completed medical school, you are not done with your training. Before you can practice medicine independently, you must complete a residency. In some cases, you will go on to a fellowship to further specialize. Both phases are essential parts of your clinical education and shape how you will function as a physician.

The ACGME describes graduate medical education as “the crucial step of professional development between medical school and autonomous clinical practice.” Residency is where you refine your ability to make clinical decisions, manage patients and work within the systems and teams that define modern health care. Fellowship, if you pursue one, offers even more focused training in a specific subspecialty. The ACGME defines fellowship as “advanced graduate medical education beyond a core residency program for physicians who desire to enter more specialized practice.”

Let’s break down what each stage involves.

What Is Residency?

Residency is a structured period of on-the-job training that begins after medical school. During residency, you apply what you learned in classrooms and labs to real patients under the supervision of licensed physicians. A core idea in the ACGME requirements is “graded authority and responsibility for patient care”: you start with close supervision and earn more independence as you show you are ready.

Residency is graduate medical training that takes place after medical school, and it is the step that leads to board certification. The American Board of Medical Specialties (ABMS) requirements for board certification include three to seven years of full-time training in an ACGME-accredited residency program and an unrestricted medical license in the United States or Canada. State medical boards set their own minimum amount of accredited training for a full license, and those minimums differ from state to state, especially for graduates of international medical schools.

The structure, length and intensity of residency vary by specialty. Length of training for the majority of specialty programs is three or four years. For example, internal medicine requires 36 months, while general surgery requires 60 months. During this time, you take on increasing levels of responsibility for patient care under the supervision of attending physicians. You are also expected to keep learning through structured lectures, hands-on training and conferences.

Residency is demanding. You will often work long shifts, including overnight call. ACGME rules cap clinical and educational work at 80 hours a week, averaged over four weeks, and limit continuous scheduled clinical assignments to 24 hours, with up to four more hours allowed for handoffs and education. Despite the workload, this is the stage where your confidence and competence grow.

What Is PGY-1?

Your first year of residency is known as PGY-1, which stands for Post-Graduate Year 1. This is often referred to as the intern year. The ACGME uses PGY-1 for any graduate medical education position available to physicians immediately after they finish medical school, which is why these are also called entry-level positions. It serves as a transition from the academic setting of medical school to the clinical responsibilities of practicing physicians.

During PGY-1, your schedule will be intense and fast-paced. You will work under close supervision while rotating through several key areas of medicine. ACGME rules require PGY-1 residents to be supervised directly at first, and PGY-1 residents are not permitted to moonlight (take paid clinical work outside the program). These rotations are designed to build core competencies. Common departments include internal medicine, emergency medicine, general surgery, critical care and sometimes outpatient clinics. The specific rotations you complete depend on the structure of your program and your chosen specialty.

Some specialties start after a separate first year. Dermatology residents, for example, must finish a broad-based clinical year (PGY-1) in another specialty before they begin 36 months of dermatology training. Anesthesiology and diagnostic radiology programs come in two formats: one that includes the 12-month clinical year and one that expects you to complete it elsewhere first.

PGY-1 is a year of rapid growth. It is your first real experience managing patients on a daily basis, writing orders, interpreting test results and performing procedures. It is also the year when you learn to function as part of a health care team, balancing your role among nurses, pharmacists, social workers and fellow residents.

As of July 1, 2025, the average PGY-1 stipend was $68,166.

What Does a Typical Day in Residency Look Like?

The structure of your day as a resident can vary depending on your program and rotation, but most follow a consistent rhythm. You will work as part of a team that includes other interns, upper-level residents and an attending physician. This group is responsible for a panel of hospitalized patients.

Each morning begins with rounds, where you visit patients, review overnight developments and update care plans. You will present your findings, discuss changes with the team and help make clinical decisions. This is followed by time spent ordering labs and imaging, writing progress notes, coordinating discharges and responding to patient needs throughout the day.

You will also attend educational lectures and teaching sessions, typically scheduled around noon or in the afternoon. These sessions cover a wide range of medical topics and are an essential part of residency training.

New patient admissions are common in the afternoon and evening. When a new patient arrives, you will perform a full history and physical examination, formulate a differential diagnosis and write admission orders. You will then create a care plan that is reviewed and co-signed by the supervising physician.

At the end of your shift, you will “sign out” your patients to the on-call team. This ensures continuity of care overnight and allows your colleagues to manage any issues that arise while you are off duty. Handoffs matter enough that the ACGME lets residents stay up to four hours beyond a 24-hour assignment specifically for transitions of care and education, as long as they take on no new patient care during that time.

What Does It Mean to Be On-Call?

Being on call is one of the most demanding aspects of residency. It means that you are responsible for patient care outside of regular working hours. This includes managing emergencies, writing new orders, responding to pages from nursing staff and admitting new patients to the hospital.

Call shifts can run up to 24 hours of continuous scheduled clinical assignments, which is the maximum allowed under current ACGME work-hour requirements. The current Common Program Requirements, effective July 1, 2026, set these limits for residents:

• 80 hours a week, averaged over four weeks, including in-house work, clinical work done from home and all moonlighting.
• 24 hours of continuous scheduled clinical assignments, plus up to four hours for handoffs and education.
• At least 14 hours free of clinical work and education after 24 hours of in-house call.
• One day in seven free of clinical work and required education, averaged over four weeks. At-home call cannot be assigned on these free days.
• In-house call no more often than every third night, averaged over four weeks.

During on-call hours in the hospital, you remain on site and are available to handle any urgent issues. Most hospitals provide on-call rooms where residents can rest when things are quiet, but you need to be prepared to get up and work at any time. Time spent on patient care while on at-home call also counts toward the 80-hour limit.

The frequency of call varies by specialty and by institution. In some programs, you may be on call every third night; in others, you might work a night-float system where overnight shifts are assigned in blocks.

Being on call is a challenging part of the training process, but it is also where many residents develop resilience, confidence and problem-solving skills. Learning how to care for patients during high-pressure situations is a critical part of becoming a capable physician.

How Long Is Residency? Training Length by Specialty

Most residencies last three to five years, depending on your specialty. The ACGME program requirements for each specialty set the required length. These are the lengths in the requirements effective July 1, 2026:

Emergency medicine is worth a closer look if you are considering it. Programs are already configured in 36-month and 48-month formats, and the ACGME’s major revision of the emergency medicine requirements, effective July 1, 2028, keeps both formats and requires a minimum of 36 months of clinical education. If you are interested, read our guide on how to become an emergency room doctor, and for surgery, our overview of the types of surgeons and surgical specialties and how to become a general surgeon.

What Is “The Match”?

The process of securing a residency is referred to as The Match. The Main Residency Match is run by the National Resident Matching Program (NRMP). During the final year of medical school, students apply to programs, interview, and submit a ranked list of preferences. Residency programs also rank candidates. A computer algorithm then matches applicants to programs.

If you do not match initially, there is a secondary process called the Supplemental Offer and Acceptance Program (SOAP), which offers positions left unfilled after the algorithm runs to eligible unmatched and partially matched applicants. Both are covered in detail below.

The Match: What It Is and How It Shapes Your Medical Career

Even if you are early in your medical education, chances are you have heard of “The Match.” This process is one of the most significant steps in your transition from student to practicing physician. It determines where you will complete your residency, the years of hands-on training that follow medical school and prepare you to care for patients independently.

Understanding how the Match works, what happens after you have matched, and how residency and fellowship connect can help you feel more prepared and confident as you progress through your fourth year of medical school. For a closer look at the day results arrive, read our Medical School Match Day 2026: The Definitive Guide.

How The Match Works in 2026 and 2027

The Match is a centralized, algorithm-driven process used to place graduating medical students in residency programs across the United States. It happens during the final year of medical school.

Here is how it works:

1. Apply. During the fall of your final year, you submit applications to residency programs in your chosen specialty. Most specialties use the AAMC’s Electronic Residency Application Service (ERAS). For the 2027 ERAS season, which covers residency starting in 2027, the season opened June 4, 2026; applicants could begin submitting MyERAS applications to programs on September 2, 2026; and programs could begin reviewing applications and Medical Student Performance Evaluations (MSPEs) on September 23, 2026. Emergency medicine, emergency medicine combined specialties and obstetrics and gynecology programs used a different service, ResidencyCAS, in the 2026 cycle. Our ERAS residency application guide walks through each section.
2. Signal and interview. In the 2027 MyERAS application, applicants can send program signals to participating programs at the time of application to show interest; the number of signals varies by specialty. If selected, you will be invited to interview. Brush up with our list of medical school interview questions, since many of the same skills carry into residency interviews.
3. Rank. After completing interviews, you submit a ranked list of your preferred programs, from most desired to least. Programs rank the applicants they have interviewed. Some applicants also send a residency letter of intent to their top program.
4. Match. The algorithm starts with the applicant’s rank order list rather than a program’s. It tries to place you at your first choice; if it cannot, it moves to your second choice, and so on. Placements are “tentative” until the end, and an applicant can be displaced by another applicant whom the program ranked higher. Because of that design, ranking a less preferred program higher does not change your overall chance of matching. It only changes where you are likely to land, so rank programs in your true order of preference.

The 2027 MyERAS application also has some changes worth knowing. The Publications section is now called Scholarly Work, with no limit on the number of entries and the option to mark up to three entries as Most Meaningful. Letters of recommendation now go through the AAMC Letter Writer Portal, and FSMB began processing USMLE transcript requests for the season in June 2026. If you are preparing for licensing exams, see our guides to USMLE Step 1 and USMLE Step 2 CK.

You will find out where you have matched during Match Week in March. In 2026, Match Week began on Monday, March 16, when applicants learned whether they had matched. To participate in this process, you must register with the NRMP through its official website.

Match policies can change from one season to the next. Participation is governed by the NRMP’s Match Participation Agreement, and SOAP commitments are enforced through it, so read the current agreement and the rules for your specialty before interview season and ask programs directly about any policy that affects how they rank.

Match Results: Where to Find the Numbers

Match results matter because they give you a realistic picture of how competitive the process is. The NRMP publishes the official Main Residency Match and Specialties Matching Service results each spring on its own website. Our Match Day 2026 results guide also covers this year’s outcomes.

The ACGME’s annual count of residents shows the size of the pipeline those Match results feed. In academic year 2024-2025:

• 38,967 residents entered the pipeline, meaning they began entry-level positions.
• 53.3% (20,777) were graduates of U.S. LCME-accredited medical schools, 25.5% (9,929) were international medical graduates (IMGs) and 21.1% (8,241) were osteopathic medical school graduates. Fewer than one percent (16) came from Canadian schools.
• Since 2015-2016, residents entering the pipeline increased 36.9%, with growth of 12.9% among U.S. allopathic graduates, 48.3% among IMGs and 146.2% among osteopathic graduates.

For international medical graduates, the ACGME rule is that you must hold a currently valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) before appointment, or a full and unrestricted license in the state where the program is located. Our IMG guide to U.S. residency, ECFMG and the Match explains each step.

Specialty Trends: Where Programs Are Growing

Not all specialties grow at the same rate, and these trends are worth watching if you are thinking about which field to enter. A total of 457 programs were newly accredited during the 2024-2025 academic year. The specialties with the most new programs were:

• Family medicine (47)
• Internal medicine (41)
• Psychiatry (20)
• Anesthesiology (16)
• Emergency medicine (9)

Among subspecialties, interventional pulmonology (24), pulmonary disease and critical care medicine (15), cardiovascular disease (14), neurocritical care (13) and critical care medicine (12) added the most new programs. Over five years, family medicine (107), internal medicine (102) and psychiatry (66) had the highest growth in total programs.

Psychiatry stands out among the fastest-growing specialties by number of new programs, and it is a 48-month residency. If you are drawn to mental health, IMA’s mental health internships abroad can show you what behavioral health care looks like in practice before you apply to medical school.

These specialty-level trends help students understand where demand is strong, where opportunities exist and where the physician pipeline needs the most support. According to the AAMC’s workforce projections (published March 2024, the most recent available), the United States faces a projected shortage of between 13,500 and 86,000 physicians by 2036, including a shortage of 20,200 to 40,400 primary care physicians and 10,100 to 19,900 in surgical specialties. For a field-by-field look at applicant demand, see our ranking of the 10 most competitive medical specialties, and for a different angle, the happiest medical specialties.

What Happens If You Don’t Match?

Not matching can be disappointing, but it is far from the end of your journey. The Supplemental Offer and Acceptance Program (SOAP) is designed to help unmatched students quickly find available positions in residency programs that still have open slots.

Here is how SOAP worked in the 2026 cycle:

• Eligibility. You must be registered for the Main Residency Match, eligible to start graduate medical education on July 1 (verified by your medical school or by ECFMG), and unmatched or partially matched on the Monday of Match Week. There is no separate registration, and you do not submit a rank order list.
• Applications. You see the list of unfilled programs you are eligible for in the NRMP’s R3 system and apply through the application service each program uses, either ERAS or ResidencyCAS. You get up to 45 applications in each service, and you cannot withdraw an application once it is sent.
• Offers. Programs build preference lists, and positions are offered during four SOAP offer rounds. Each round lasts two hours, you can receive more than one offer in a round, and offers you do not answer expire. In 2026 the offer rounds ran on Thursday, March 19.
• Commitment. A position accepted during SOAP is a binding commitment.

Many students successfully enter residency through this process and go on to thrive in their training and careers. If you are not placed through SOAP either, talk with your dean’s office about strengthening your application for the next season.

Couples Match: What Partners Should Know

For applicants who are in a relationship with another Match participant, the NRMP offers a Couples Match option. This allows two applicants to link their rank order lists so that the algorithm places both partners together.

Here is how it works:

• Partners submit the same number of ranked programs and agree on how to pair and rank them.
• The couple is matched to the most preferred pair of programs on their lists that can take both of them.
• Both partners must be matched to a pair they listed together; if the couple does not match together, their lists are not processed separately.
• Partners can apply to different specialties, programs or institutions.

The Couples Match adds complexity to the ranking process, since each pairing of programs for both partners counts as a single rank. If you are considering the Couples Match, start planning your list strategy early and seek advice from advisors who have experience with paired ranking.

After You Match: Starting Residency

Once you have matched and graduated from medical school, you will begin your residency training. Residency usually starts on July 1, and SOAP eligibility is tied to being able to begin graduate medical education on that date. It marks your official entry into clinical practice, albeit in a supervised capacity.

Residency is where you will hone your skills, deepen your medical knowledge and develop the confidence to manage real-world patient care. It is both rigorous and rewarding, and it is a required step on the path to independent medical practice.

Most residencies last three to five years, depending on your specialty. For example:

• Internal Medicine: 3 years (36 months)
• Pediatrics: 3 years (36 months)
• General Surgery: 5 years (60 months)
• Psychiatry: 4 years (48 months)
• Emergency Medicine: 3 to 4 years (36-month and 48-month formats; both continue under revised requirements effective July 1, 2028)
• Anesthesiology: 4 years including the clinical year (36 months of clinical anesthesia)
• Dermatology: 4 years including the separate clinical year (36 months of dermatology)
• Neurology: 4 years (48 months)
• OB/GYN: 4 years (48 months)
• Radiology: 4 to 5 years (48-month and 60-month formats)
• Pathology: 4 years for combined anatomic and clinical pathology (48 months)

During residency, you will progress from structured supervision to greater autonomy. You will rotate through different settings, see a wide range of patients and begin to specialize in your chosen area of medicine. The Bureau of Labor Statistics sums up the range across all fields: residencies typically last from 3 to 9 years, depending on the specialty.

What Residents Earn: Medical Residency Salary in 2026

Resident physicians are paid a stipend during training, though it is significantly less than what attending physicians earn. According to the 2025 AAMC survey (the most recent data available, with stipends as of July 1, 2025), average resident stipends by training year are:

• PGY-1: $68,166
• PGY-2: $70,499
• PGY-3: $73,301
• PGY-4: $77,593
• PGY-5: $81,807
• PGY-6: $84,744
• PGY-7: $89,187
• PGY-8: $94,215

These are unweighted means, meaning each institution counts equally regardless of how many residents it trains. Weighted by the number of residents, the first-year average was $70,684.

Stipend growth slowed. The average first-year stipend rose 2.2% ($1,453) from 2024 to 2025, compared with 4.6% the year before and 4.7% the year before that. After adjusting for the Consumer Price Index, the first-year stipend actually fell slightly: in constant 1969 dollars it dropped $36, from $7,368 to $7,332.

Stipends also vary by institution type and region. Medical schools averaged $67,899 to $90,855 (PGY-1 through PGY-8), while general and specialty hospitals averaged $68,308 to $96,112 across the same range. Regionally, weighted averages for PGY-1 through PGY-8 ranged from $65,076 to $86,768 in the South, up to $77,649 to $107,587 in the West. The Northeast ranged from $74,994 to $107,287 and the Central region from $68,580 to $91,134. Cost of living in the highest-paying regions often offsets much of the difference.

These numbers are important to weigh against the cost of medical education. Among 2026 MD graduates, 67.8% reported education debt, and the median total education debt for those with debt was $230,000, up $10,000 from 2025. For the 2025-2026 academic year, median first-year tuition, fees and health insurance were $43,648 at public schools (state residents) and $74,661 at private schools. You can learn more about how these costs have changed in our guide to medical school tuition trends.

Resident and Fellow Stipends in 2026

Residents and fellows are paid on a single program-year scale, and most institutions do not pay more for one specialty than another: 96.9% of responding institutions reported paying the same base stipend at each level across all specialties. Pay rises with each training year. Understanding the medical residency salary structure is important for financial planning, especially when balancing loan repayment, cost of living and long-term career goals.

The 2026 survey results are typically released by mid-November, so check for updated figures if you are reading this later in the season.

After completing training, physicians typically see a substantial pay increase as attendings. The gap between a medical residency salary range of about $68,000 to $94,000 and attending pay is why financial planning during the training years is so important.

Managing Student Loan Repayment During Residency

With a median education debt of $230,000 among indebted 2026 graduates and a medical residency salary that starts around $68,000, loan repayment is a practical concern that affects most residents. The gap between what you owe and what you earn during training is real, and having a plan matters.

Many residents use income-driven repayment during training, where payments are based on income rather than on the loan balance alone. The 2025 federal law known as the One Big Beautiful Bill Act (OBBBA) created a new income-driven option, the Repayment Assistance Plan (RAP), which was to be in effect no later than July 1, 2026. Payments made under RAP count toward Public Service Loan Forgiveness (PSLF) if all other eligibility criteria are met.

If you work at a qualifying nonprofit or government employer during residency, those years can count toward PSLF. Check your hospital’s status before you assume it qualifies. Among the 64.9% of 2026 medical graduates who planned to enter a loan-forgiveness program, 88.9% planned to use PSLF.

Some residents also consider refinancing federal loans through a private lender to lock in a lower interest rate. This can reduce total interest paid over time, but it comes with trade-offs, because a private loan is no longer part of the federal loan system and its federal repayment and forgiveness options.

For residents planning to work in private practice after training, refinancing may make financial sense. For those headed toward academic medicine, government employment or nonprofit health systems, keeping federal loans and pursuing PSLF is often the stronger long-term strategy.

There is no single right answer. The best approach depends on your total debt load, your expected medical residency salary trajectory, where you plan to practice and how long your training will last. If you want to model different repayment scenarios based on your specific numbers, IMA’s Student Loan Repayment Calculator can help you compare monthly payments, total interest and forgiveness timelines side by side.

A Major Student Loan Change Taking Effect in 2026

Medical students planning to borrow federal loans should be aware of a significant policy change. As of July 1, 2026, graduate and professional borrowers who do not qualify for an exception can no longer receive Grad PLUS loans (Direct PLUS Loans for graduate and professional students) under the One Big Beautiful Bill Act.

The new federal limits work like this:

• Annual limit: students in professional programs, which include medical school, can borrow up to $50,000 a year in Direct Unsubsidized Loans, compared with $20,500 for other graduate programs.
• Aggregate limit: $200,000 for professional study (the graduate limit is $100,000).
• Lifetime limit: $257,500 across undergraduate, graduate and professional loans. Once you reach it, you cannot get more federal student loans, even if earlier loans were repaid or forgiven.
• Exceptions: borrowers who qualify for an exception keep the earlier limits during the exception period.

Schools may also set lower program-level limits than these caps. With median first-year tuition, fees and health insurance of $74,661 at private schools in 2025-2026, before living costs, many students will need institutional grants, scholarships, private loans or personal savings to cover the gap. Students who are still building their pre-med profiles and have not yet applied should factor this into their financial planning early.

PSLF remains available to physicians who work at qualifying nonprofit or government employers during residency and beyond, and payments under the new RAP count toward it.

What Is Fellowship?

After completing residency, some physicians pursue additional training in a subspecialty through a fellowship. Fellowship is optional and intended for those who want to become experts in a narrower field, such as cardiology, pediatric endocrinology or vascular surgery.

The length of a fellowship varies by subspecialty. Most last one to three years: 52.7% of ACGME subspecialty programs (7,733) are one year long, and the rest require two or more years. Some highly specialized fellowships, such as interventional cardiology or clinical cardiac electrophysiology, also require completing another fellowship first.

During this time, fellows are licensed physicians who work closely with experts in their chosen area, often balancing clinical responsibilities with research or teaching. As the ACGME puts it, fellows who have completed residency “are able to practice autonomously in their core specialty,” which is what sets them apart from residents. Fellowship offers more independence than residency, with schedules and duties that are typically structured around the goals of the specific program.

Fellowships are a large part of graduate medical education. In 2024-2025, 29,651 of the 167,083 trainees in ACGME programs were in subspecialty programs.

What Comes After Residency? Understanding Fellowship

Once you complete residency, you may choose to enter clinical practice or pursue a fellowship in a subspecialty. Fellowship is not required for all physicians, but it is essential for those who want to work in more specialized areas of medicine.

Unlike residency, which provides broad training within a specialty, fellowship focuses narrowly on a particular field. For example, if you completed a residency in internal medicine and want to specialize in cardiology or gastroenterology, you would apply for a fellowship in that subspecialty.

As a fellow, you are a fully trained physician in your core specialty and often take on more complex cases. You will work closely with experts in your field, perform advanced procedures and may engage in research, teaching or academic presentations.

A Look at Fellowships

Fellowship is an optional but often essential phase of training that takes place after residency. It allows you to subspecialize in a narrower area of your specialty. Fellowship is typically pursued by those who want to become experts in a particular field or work in academic medicine.

Unlike residency, fellowship is not required unless your desired career path involves subspecialization. However, it is common in many fields: of the 12,404 programs with Continued Accreditation in 2024-2025, 7,024 were subspecialty programs and 5,380 were specialty programs, and the subspecialties of pulmonary disease and critical care medicine, cardiovascular disease and critical care medicine were among those adding the most new programs in 2024-2025.

Here are some examples of specialties and their related subspecialties (fellowships), with ACGME-required lengths where they apply:

Internal Medicine (3 years)

• Cardiology (cardiovascular disease, 36 months)
• Endocrinology (24 months)
• Gastroenterology (36 months)
• Hematology (24 months)
• Infectious Diseases (24 months)
• Nephrology (24 months)
• Oncology (hematology and medical oncology combined, 36 months)
• Pulmonary Medicine (24 months; 36 months when combined with critical care medicine)
• Rheumatology (24 months)

General Surgery (5 years)

• Cardiothoracic Surgery
• Vascular Surgery (independent program, 24 months)
• Pediatric Surgery (24 months)
• Colon and Rectal Surgery
• Plastic Surgery
• Surgical Oncology (complex general surgical oncology, at least 24 months)
• Transplant Surgery

Vascular surgery and plastic surgery can also be entered directly from medical school through integrated residencies; integrated vascular surgery is 60 months.

Pediatrics (3 years)

• Pediatric Cardiology (36 months)
• Pediatric Gastroenterology (36 months)
• Pediatric Infectious Diseases (36 months)
• Neonatology (neonatal-perinatal medicine, 36 months)
• Pediatric Pulmonology (36 months)
• Pediatric Endocrinology (36 months)

Radiology (4 to 5 years)

• Neuroradiology (12 months)
• Pediatric Radiology (at least 12 months)
• Vascular and Interventional Radiology (independent interventional radiology is 24 months; the integrated residency is 60 or 72 months)

Fellowship lengths vary, generally lasting one to three years, depending on the subspecialty. For instance, cardiology fellowships take 36 months after internal medicine residency, and the pediatric subspecialties listed above each require 36 months after pediatrics residency.

Fellows are paid on the same program-year stipend scale as residents, so a fellow who has already finished a three-year residency is typically paid at the PGY-4 level or above. Based on the 2025 AAMC data, PGY-4 through PGY-7 stipends averaged $77,593 to $89,187.

Applying to Fellowship

Many fellowships take applications through ERAS, which runs two fellowship cycles each season. For the 2027 season:

• July cycle: applicants could begin submitting applications on July 1, 2026, and programs could begin reviewing them on July 15, 2026.
• December cycle: applicants can begin submitting on November 12, 2026, and programs can begin reviewing on December 2, 2026.

Applying through ERAS and entering a fellowship match are separate steps. Check which match, if any, your subspecialty uses, and register with that organization for its own eligibility rules and deadlines.

What Does a Fellow’s Schedule Look Like?

Your day as a fellow depends heavily on the structure of your program and the type of specialty you are pursuing. You may work in hospital wards, outpatient clinics, operating rooms or diagnostic labs.

Your hours can vary, and although fellowships are generally less rigid than residency, they still demand high levels of dedication and clinical skill. Fellows work under the same 80-hour weekly limit, averaged over four weeks, as residents. Many fellows also take on teaching responsibilities, mentoring residents and medical students while continuing to deepen their own expertise.

Do You Need a Fellowship?

Fellowship is not required unless your intended career path involves subspecialization. Many physicians go directly into practice after residency. Others use the fellowship period to refine their skills, build research portfolios or position themselves for academic or leadership roles.

If you are unsure whether to pursue fellowship, you do not need to decide right away. Fellowship applications go out while you are still a resident, so most residents make that decision during the course of their residency training.

Deciding Whether to Pursue Fellowship

You are not required to make this decision at the start of residency. During residency, you will gain exposure to various fields, receive mentorship from attendings and fellows, and have opportunities to explore what fits your interests and long-term goals. Keep the timing in mind, though: ERAS fellowship cycles open in July and November, and fellowship applications are submitted while you are still in residency, so it helps to start the conversation with mentors early.

Some physicians feel ready to begin practicing independently after residency, especially in general fields like internal medicine, family medicine or pediatrics. Others feel called to focus more deeply on a subspecialty and pursue fellowship as the next step in their training.

Residency vs. Fellowship: What’s the Difference?

Residency is your core graduate medical education. It is the training that leads to board certification in your specialty, and it is where you gain broad-based training in your chosen field. You learn how to care for patients, make decisions under pressure and work in hospital and outpatient settings.

Fellowship, on the other hand, is advanced training. It is designed for doctors who want to focus deeply on a specific field, conduct research or prepare for academic or leadership roles. You will have more autonomy, potentially teach residents or medical students, and work closely with a smaller group of mentors in your field.

For example, let’s say you want to become a cardiologist. First, you must complete a 36-month residency in internal medicine. Then, you apply for a cardiovascular disease fellowship, which lasts another 36 months. After both phases, you will have completed the training required to practice as a cardiologist.

What If You’re Still Undecided?

Not everyone knows whether they want to pursue a fellowship when they start residency. That’s okay. Most doctors use residency to explore their interests, gain exposure to subspecialties and speak with mentors and faculty.

Some residents decide not to pursue a fellowship and instead begin practicing medicine immediately after completing their core training. If you find yourself on the fence, focus on excelling during residency. Subspecialty interests often emerge naturally through patient care and mentorship.

And if you are even earlier in your journey, still weighing whether medicine is the right fit, our guide on what to know before getting into medical school can help you think through the decision from the ground up.

The Physician Shortage and Why Residency Training Matters More Than Ever

The stakes of residency training extend beyond the individual physician. The United States is facing a growing physician workforce gap that makes every residency position, and every completed training program, important.

According to the AAMC’s most recent workforce projections (published March 2024), the nation could face a shortage of between 13,500 and 86,000 physicians by 2036. That includes a projected shortage of 20,200 to 40,400 primary care physicians and 10,100 to 19,900 surgical specialists. The AAMC notes that the projected shortage is smaller than in its 2021 report because the new scenarios assume continued growth in residency positions, and it warns that the shortfall will be larger if those investments do not materialize.

The Bureau of Labor Statistics projects employment of physicians and surgeons to grow 4% from 2025 to 2035, about the average for all occupations, with about 22,100 openings each year on average over the decade.

These projections underscore two realities. First, there is strong long-term demand for physicians across nearly every specialty. Second, the training pipeline, which runs through residency and fellowship, depends on funding for training positions. Medicare supports residency positions through graduate medical education funding, and the AAMC has backed legislation to add 14,000 Medicare-supported residency positions over seven years, building on Congress’s investments in graduate medical education in 2020 and 2022. The pipeline is growing: residents entering ACGME pipeline programs increased 36.9% from 2015-2016 to 2024-2025. That means matching into residency is competitive, and that the physicians who do complete training are entering a workforce that needs them.

For pre-med students, this context reinforces the importance of building a strong foundation early. Clinical experience, research involvement, strong academic performance and a clear understanding of what AAMC core competencies actually mean for your application can all position you well for a competitive Match several years down the line. If you want to know where your MCAT score fits relative to admitted students, our guide on what MCAT score you need for medical school provides a detailed breakdown.

Building Clinical Experience Before Medical School

Everything described in this article, the Match, residency, fellowship and independent practice, builds on the foundation you create during your pre-medical years. The clinical judgment and professional instincts that residency demands do not appear overnight. They develop over time, starting with your earliest exposures to health care settings.

This is one reason why structured clinical experience matters well before you apply to medical school. Whether you are shadowing physicians, volunteering in a clinical setting or taking part in a supervised global health program, you are building the patient care and interpersonal skills that residency will later refine. If you are wondering how much clinical exposure you should have before applying, our guide on how many clinical hours you need for medical school breaks down realistic expectations, and clinical internships for pre-med students are one way to build those hours.

For students who want early, structured, hands-on clinical experience, IMA’s pre-med internships abroad place you on supervised care teams in global health settings. Under supervision, interns take vital signs, help with patient intake and triage, and assist with direct patient care, while seeing how teams assess patients and communicate medical decisions. IMA also runs medical internships abroad and offers pre-med summer internships for students planning around the academic year. You can compare all of IMA’s healthcare internships abroad in one place.

These programs are not substitutes for residency training, and IMA is not affiliated with any medical school or residency program. They are starting points that help students understand what clinical work actually looks like and whether medicine is the right path for them. Students interested in trying on different specialties early can also read about whether you can specialize during a medical internship.

How International Medical Aid Can Help

Residency and fellowship are complex parts of your medical career. If you are uncertain about which path to follow or how to approach The Match, International Medical Aid (IMA) offers personalized residency admissions consulting. Whether you are early in your pre-med journey or preparing for post-graduate training, our comprehensive guides and admissions support can help you approach each stage with clarity and confidence.

For students still considering whether additional academic preparation would strengthen their candidacy, our guide on whether grad school helps you get into medical school may be useful.

The Match is an exciting and sometimes overwhelming process, especially when paired with the demands of your final year of medical school. Whether you are preparing for your rank list or planning your long-term career path, IMA is here to support you.

Our Residency Admissions Consulting services offer one-on-one guidance through every phase of the process, from choosing a specialty and identifying programs to preparing application materials and developing a strategy for the Match. You can also read more about how admissions consulting could help you at earlier stages of your career planning.

If you are earlier in your journey and still preparing for medical school, we also offer resources on the MCAT, application prep and interviews.

Whether you are aiming to match into your dream residency or planning for a fellowship, preparation and clarity are key. Understand the system, keep your goals flexible and seek guidance when you need it. The Match is just one step, albeit a critical one, on your way to becoming a physician.

Let us know if you would like help reviewing your residency application, personal statement or specialty options. We are here to help. Consulting support does not guarantee a match or admission to any program.

Residency Admissions Consulting Services

Residency and fellowship require careful planning, strategic decision-making and often some outside support. International Medical Aid offers professional guidance for medical students and graduates who are preparing for residency, considering fellowship or seeking advice on specialty options.

Through our Residency Admissions Consulting, we help applicants build strong profiles, prepare compelling application materials and understand what programs look for in residency and fellowship candidates. If you are preparing for your next step or exploring your long-term goals in medicine, we are here to walk with you every step of the way.

Still deciding where you want to study medicine? Check out our series of definitive guides to getting into medical school. We have covered a variety of allopathic and osteopathic schools, and we add to our list all the time.

• UC Davis School of Medicine
• Harvard Medical School
• UC Riverside School of Medicine
• USC Keck School of Medicine
• UT Southwestern Medical School
• Long School of Medicine at UT Health San Antonio
• University of the Incarnate Word School of Osteopathic Medicine
• UT Austin’s Dell Medical School
• UTMB School of Medicine
• Johns Hopkins School of Medicine
• McGovern Medical School at UT Health
• The University of Texas Rio Grande Valley School of Medicine
• UNT Texas College of Osteopathic Medicine
• University of Houston College of Medicine
• Texas A&M College of Medicine
• Baylor College of Medicine
• George Washington University School of Medicine
• Vanderbilt University School of Medicine
• St. George’s University School of Medicine
• Lake Erie College of Osteopathic Medicine (in Pennsylvania)
• Sidney Kimmel Medical College at Thomas Jefferson University
• Wake Forest University School of Medicine
• Western University of Health Sciences (in California)
• Drexel University College of Medicine
• Stritch School of Medicine at Loyola University Chicago
• Georgetown University School of Medicine
• Yale School of Medicine
• Perelman School of Medicine
• UCLA Medical School
• NYU Medical School
• Washington University School of Medicine
• Brown Medical School

Frequently Asked Questions

How much do medical residents and fellows make in 2026?

As of July 1, 2025 (the most recent AAMC survey), the average medical residency salary ranges from $68,166 for PGY-1 to $94,215 for PGY-8. Weighted by the number of residents, the first-year average was $70,684. Stipends vary modestly by institution type and region, with Western and Northeastern programs paying the most, and the AAMC usually releases new figures by mid-November.

Do fellows earn more than residents?

Slightly. Fellows are paid on the same program-year stipend scale as residents, so a fellow at PGY-5 or PGY-6 earns more than a PGY-1 or PGY-2 resident: $81,807 and $84,744 on average, compared with $68,166 and $70,499. The larger pay increase comes after training, when physicians begin practicing as attendings and their pay is set by the open market rather than a training stipend scale.

Why are resident salaries so similar across hospitals?

Most institutions pay residents on a fixed program-year scale, and 96.9% of institutions in the 2025 AAMC survey paid the same base stipend at each level across all specialties. Medicare also supports residency positions through graduate medical education funding, so pay is not set the way open-market physician salaries are. Some variation exists by region and institution type, but the differences are much smaller than what attending physicians see across practice settings.

What happens to student loans during residency?

Many residents use income-driven repayment, which bases payments on income. The Repayment Assistance Plan created by the One Big Beautiful Bill Act counts toward Public Service Loan Forgiveness (PSLF), and if you work at a qualifying nonprofit or government employer, those payments can count toward forgiveness. IMA’s Student Loan Repayment Calculator can help you model different repayment scenarios.

What is the overall match rate for U.S. medical students?

The NRMP publishes official match rates for each applicant group every spring, so check its current Main Residency Match report for the latest figures. For a sense of scale, 38,967 residents entered ACGME entry-level positions in 2024-2025, and 53.3% of them were graduates of U.S. MD schools, 21.1% were graduates of osteopathic schools and 25.5% were international medical graduates.

How long is medical residency?

It depends on the specialty. Internal medicine, pediatrics and family medicine require 36 months; psychiatry, neurology and obstetrics and gynecology require 48 months; general surgery requires 60 months; and neurological surgery is the longest at seven years. Emergency medicine, anesthesiology and diagnostic radiology each come in two formats.

What are the work-hour limits for residents?

Residents may work no more than 80 hours a week averaged over four weeks, with continuous scheduled clinical assignments capped at 24 hours plus up to four hours for handoffs and education. They must have at least one day in seven free, at least 14 hours off after 24 hours of in-house call, and in-house call no more often than every third night on average.

When do residency applications open?

For the 2027 ERAS season, residency applicants could begin submitting applications to programs on September 2, 2026, and programs could begin reviewing them on September 23, 2026. The season ends May 31, 2027. Fellowship applicants use ERAS July and December cycles; the December cycle opens to applicants on November 12, 2026.

Sources

• ACGME, Data Resource Book, Academic Year 2024-2025 (Figures A.1, C.1, C.3; program accreditation and resident characteristics summaries)
• ACGME Common Program Requirements (Residency and Fellowship), effective July 1, 2026
• ACGME specialty Program Requirements, effective July 1, 2026 (internal medicine, pediatrics, family medicine, surgery, psychiatry, emergency medicine including the 2028 revision, anesthesiology, dermatology, neurology, obstetrics and gynecology, pathology, radiology, vascular surgery and the subspecialties listed)
• AAMC, 2025 Survey of Resident/Fellow Stipends and Benefits Report (stipends as of July 1, 2025)
• AAMC, 2026 Medical School Graduation Questionnaire, All Schools Summary Report
• AAMC, Tuition and Student Fees for First-Year Students, 2025-2026
• AAMC, The Complexities of Physician Supply and Demand: Projections From 2021 to 2036 (March 2024)
• AAMC, 2027 ERAS Residency Timeline
• AAMC, 2027 ERAS Fellowship Application Timeline
• AAMC, What You Need to Know About the 2027 ERAS Application Season
• AAMC, Supplemental Offer and Acceptance Program (SOAP) 2026 Guide for Residency Applicants
• American Medical Association, How the physician residency Match algorithm favors applicants (March 5, 2025)
• American Medical Association, AMA News Wire article on matching as a couple (January 4, 2025)
• Federal Student Aid, One Big Beautiful Bill Act NSLDS eligibility processing updates (April 24, 2026)
• Federal Student Aid, Dear Colleague Letter GEN-25-05 (July 18, 2025)
• Federal Student Aid, Dear Colleague Letter on program-level loan limits (June 26, 2026)
• U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Physicians and Surgeons (2025-2035 projections)
• Federation of State Medical Boards, International Medical Graduates GME Requirements (April 2026), including ABMS board certification requirements
• National Resident Matching Program (official Match data and Match rules; not used for figures in this guide)

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