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Everything You Need to Know About Medical Residency and Fellowship
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Everything You Need to Know About Medical Residency and Fellowship

Written by
International Medical AID
on April 5th, 2026

READING TIME
24 minutes

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 context, the 2026 Main Residency Match was the largest in NRMP history, with over 53,000 registered applicants competing for more than 44,000 positions. Understanding how residency and fellowship work is essential for anyone on the path to becoming a physician. Here’s 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. 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.

What Is Residency?

Residency is a structured period of on-the-job training that begins after medical school. During residency, you’ll apply what you learned in classrooms and labs to real patients under the supervision of licensed physicians. Most programs last three to five years depending on your specialty. For example, internal medicine typically lasts three years, while general surgery often takes five.

The first year of residency is known as PGY-1 (Post-Graduate Year 1), often called the intern year. Residents rotate through various departments, gaining broad exposure before focusing more narrowly on their specialty. A typical day includes morning rounds, patient assessments, documentation, treatment planning, and didactic sessions.

Residency is demanding. You’ll often work long shifts, including overnight on-call hours, which may last 24 hours or longer. The ACGME caps weekly clinical hours at 80 (averaged over four weeks) and limits continuous clinical assignments to 24 hours. Despite the workload, this is the stage where your confidence and competence grow.

What Is “The Match”?

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

In the 2026 Main Residency Match, 48,050 applicants submitted rank order lists. A record 38,345 applicants matched to PGY-1 positions, and 93.5% of the 44,344 positions offered were filled. U.S. MD seniors matched at a rate of 93.5%, while U.S. DO seniors matched at 93.2%.

If you don’t match initially, there’s a secondary process called the Supplemental Offer and Acceptance Program (SOAP), which helps students secure unfilled positions. In 2026, 2,862 positions across 941 programs remained unfilled after the initial algorithm was processed, an increase of 389 positions from the prior year. Of those, 2,581 positions were offered through SOAP.

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 specialty, ranging from one to three years. During this time, fellows are licensed physicians who work closely with experts in their chosen area, often balancing clinical responsibilities with research or teaching.

Fellowship offers more independence than residency, with schedules and duties that are typically structured around the goals of the specific program. The 2026 Specialties Matching Service (SMS), which manages fellowship matching, was the largest in its 42-year history. It included 81 subspecialties across 23 separate Matches, with 15,358 fellowship positions offered and an 84.4% fill rate.

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’re unsure whether to pursue fellowship, you don’t need to decide right away. Most residents make that decision during the course of their residency training.

How International Medical Aid Can Help

Residency and fellowship are complex parts of your medical career. If you’re uncertain about which path to follow or how to approach The Match, International Medical Aid (IMA) offers personalized residency admissions consulting.

Whether you’re 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: What It Is and How It Shapes Your Medical Career

Even if you’re early in your medical education, chances are you’ve 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’ll 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’ve 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.

How The Match Works in 2026

The Match refers to the National Resident Matching Program (NRMP), the centralized process used to match graduating medical students with residency programs across the United States. It happens during the final year of medical school and is a structured, algorithm-driven system designed to align student preferences with program needs.

Here’s how it works:

  • During the fall and winter of your final year, you’ll submit applications to residency programs in your chosen specialty.
  • If selected, you’ll be invited to interview at various programs.
  • After completing interviews, you’ll submit a ranked list of your preferred programs, from most desired to least.
  • Simultaneously, residency programs rank the applicants they’ve interviewed.
  • The NRMP algorithm then matches applicants to programs based on both sets of rankings.

You’ll find out where you’ve matched during the much-anticipated Match Week. In 2026, Match Week ran from March 16 to March 20. On Monday, March 16, applicants learned whether they had matched. On Friday, March 20, Match Day, applicants found out where they would train.

To participate in this process, you must register through the NRMP’s official website.

2026 Match Results: Key Numbers to Know

The 2026 Main Residency Match set several records. Here are the most important data points, all from the NRMP:

  • Total positions offered: 44,344 across 6,809 certified program tracks (an increase of 183 tracks from 2025)
  • Overall fill rate: 93.5% (41,482 positions filled)
  • Record PGY-1 matches: 38,345 applicants matched to first-year positions
  • U.S. MD seniors: 20,934 active applicants, a 93.5% match rate
  • U.S. DO seniors: 8,503 active applicants, a 93.2% match rate (up 0.6% from 2025)
  • U.S. citizen IMGs: 70% matched, up 2.2% from 2025
  • Non-U.S. citizen IMGs: 56.4% matched, down 1.6% from 2025

These numbers matter because they give you a realistic picture of how competitive the matching process is. For international medical graduates (IMGs) who require visa sponsorship, the PGY-1 match rate dropped to 54.4% in 2026, a five-year low. By contrast, non-citizen permanent legal U.S. residents (who did not require sponsorship) matched at 67.9%, a five-year high.

Specialty Trends: Where Positions Filled and Where They Didn’t

Not all specialties fill at the same rate, and these trends are worth watching if you’re thinking about which field to enter.

Primary care specialties collectively offered 20,712 positions in 2026 (an increase of 412 from 2025) but achieved only a 92.1% fill rate, a 1.4% decrease from the prior year. Within primary care:

  • Internal Medicine offered 11,632 categorical and primary positions and filled 95.2% of them.
  • Family Medicine offered 5,491 positions but filled only 83.6%, leaving 899 positions unfilled. This represents a continuing decline worth noting for workforce planning.
  • Pediatrics offered 3,185 positions and filled 94.4%.

Emergency Medicine continued its recovery after a difficult 2023 cycle (when 81.8% of positions filled). In 2026, the specialty offered 3,198 positions and achieved a 95.6% fill rate.

Psychiatry remains one of the fastest-growing specialties. It offered 2,516 positions with a 97.4% fill rate and added 30 new programs in 2026.

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, 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.

What Happens If You Don’t Match?

Not matching can be disappointing, but it’s 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.

SOAP starts immediately after the initial match results are released and offers several rounds where students can apply and receive offers. In 2026, 2,581 positions were offered through SOAP. Many students successfully enter residency through this process and go on to thrive in their training and careers.

After You Match: Starting Residency

Once you’ve matched and graduated from medical school, you’ll begin your residency training. This period usually starts in July and marks your official entry into clinical practice, albeit in a supervised capacity.

Residency is where you’ll 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
  • Pediatrics: 3 years
  • General Surgery: 5 years
  • Psychiatry: 4 years
  • Emergency Medicine: 3 to 4 years (note: the ACGME has proposed extending all EM programs to 48 months; this change is not yet finalized as of 2026)
  • Anesthesiology: 4 years
  • Dermatology: 4 years
  • Neurology: 4 years
  • OB/GYN: 4 years
  • Radiology: 4 to 5 years
  • Pathology: 4 years

During residency, you’ll progress from structured supervision to greater autonomy. You’ll rotate through different settings, see a wide range of patients, and begin to specialize in your chosen area of medicine.

What Residents Earn: 2026 Salary Data

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 effective 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

Medscape’s 2025 Resident Salary and Debt Report put the average resident salary at approximately $75,000 annually, reflecting a 6.5% increase from the prior year. However, AAMC data showed that overall stipend growth slowed to 2.2% from 2024 to 2025, the slowest rate in four years. Stipends vary slightly by institution type: 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.

These numbers are important to weigh against the cost of medical education. According to the AAMC (October 2025 report), average education debt among medical graduates is $223,130, with 70% of all graduates carrying some education debt. Students at public medical schools averaged $210,147 in total education debt (a 3% increase from the prior year), while private school graduates averaged $244,964 (an 8% increase). For the 2025-2026 academic year, median tuition and fees were $42,648 at public schools (in-state) and $74,661 at private schools. You can learn more about how these costs have changed in our guide to medical school tuition trends.

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, the Grad PLUS Loan will be eliminated for new borrowers. Going forward, the only federal student loan available to medical students will be the Direct Unsubsidized Loan. This change was part of the domestic policy bill signed in July 2025.

This shift could affect how students finance the gap between their Direct Unsubsidized Loan limits and their total cost of attendance. Students who are still building their pre-med profiles and haven’t yet applied should factor this into their financial planning early. Among the 65.1% of 2025 medical graduates who intended to pursue student loan forgiveness, most (88.5%) planned to apply for federal Public Service Loan Forgiveness (PSLF), which remains available to physicians who work at qualifying nonprofit or government employers during residency and beyond.

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 increasingly common in competitive fields.

The 2026 Specialties Matching Service (SMS) was the largest in its 42-year history, with 15,846 active applicants competing for 15,358 fellowship positions across 6,606 programs. Of those positions, 84.4% were filled. Four new subspecialties joined the SMS for the 2026 appointment year: Bone and Soft Tissue Pathology, Hematopathology, and Molecular Genetic Pathology (all within the Pathology Fellowship Match), along with a new single-specialty Match for Forensic Psychiatry. Across the 81 subspecialties participating, 26 filled 90% or more of their positions, and 49 filled 75% or more.

Here are some examples of specialties and their related subspecialties (fellowships):

Internal Medicine (3 years)

  • Cardiology
  • Endocrinology
  • Gastroenterology
  • Hematology
  • Infectious Diseases
  • Nephrology
  • Oncology
  • Pulmonary Medicine
  • Rheumatology

General Surgery (5 years)

  • Cardiothoracic Surgery
  • Vascular Surgery
  • Pediatric Surgery
  • Colon and Rectal Surgery
  • Plastic Surgery
  • Surgical Oncology
  • Transplant Surgery

Pediatrics (3 years)

  • Pediatric Cardiology
  • Pediatric Gastroenterology
  • Pediatric Infectious Diseases
  • Neonatology
  • Pediatric Pulmonology
  • Pediatric Endocrinology

Radiology (4 to 5 years)

  • Neuroradiology
  • Pediatric Radiology
  • Vascular and Interventional Radiology

Fellowship lengths vary, generally lasting 1 to 3 years, depending on the subspecialty. For instance, cardiology fellowships often take 3 years after internal medicine residency, while pediatric subspecialties can take 1 to 2 additional years. Fellows are typically compensated at PGY-4 through PGY-7 stipend levels, depending on their prior training, which translates to roughly $77,000 to $89,000 per year based on 2025 AAMC data.

Residency vs. Fellowship: What’s the Difference?

Residency is your core graduate medical education. It is required for licensure and is where you gain broad-based training in your chosen specialty. 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’ll 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 3-year residency in internal medicine. Then, you apply for a cardiology fellowship, which typically lasts another 3 years. You will be ready to practice as a board-certified cardiologist after both phases.

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’re 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 slot, and every completed training program, critically 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 Bureau of Labor Statistics projects approximately 32,000 physician job openings per year through 2033, with an overall 4% employment growth rate for physicians during that period.

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, is the bottleneck. Even as medical school enrollment has expanded significantly over the past two decades, the number of federally funded residency positions has grown more slowly. This mismatch means that 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.

How International Medical Aid Can Help

The Match is an exciting and sometimes overwhelming process, especially when paired with the demands of your final year of medical school. Whether you’re preparing for your rank list or planning your long-term career path, International Medical Aid (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 top programs to preparing application materials and developing a strategy for Match success. You can also read more about how admissions consulting could help you at earlier stages of your career planning.

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

Whether you’re 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’d like help reviewing your residency application, personal statement, or specialty options. We’re here to help.

What Residency and Fellowship Really Look Like for Doctors

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

Residency is where you refine your ability to make clinical decisions, manage patients, and operate within the systems and teams that define modern healthcare. Fellowship, if you pursue one, offers even more focused training in a specific subspecialty. Let’s break down what each stage involves.

What Is Residency?

Residency is a graduate medical training program that takes place after medical school. It is a requirement for medical licensure and board certification in nearly every specialty. Even if you intend to become a generalist, you must complete at least one year of residency training to qualify for an unrestricted medical license in the United States.

The structure, length, and intensity of residency vary by specialty. Most residencies last three to five years. During this time, you’ll take on increasing levels of responsibility for patient care under the supervision of attending physicians. You’ll also be expected to continue learning through structured lectures, hands-on training, and conferences.

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. 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’ll work under close supervision while rotating through several key areas of medicine. 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.

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’s also the year when you learn to function as part of a healthcare team, balancing your role among nurses, pharmacists, social workers, and fellow residents. As of the 2025 AAMC survey, the average PGY-1 stipend is $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’ll 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’ll 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’ll 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’ll perform a full history and physical examination, formulate a differential diagnosis, and write admission orders. You’ll then create a care plan that is reviewed and co-signed by the supervising physician.

At the end of your shift, you’ll “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’re off-duty.

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 last anywhere from 12 to 24 hours of continuous scheduled clinical assignments, which is the maximum allowed under current ACGME duty hour regulations. The ACGME also requires that residents have at least one day off in seven (averaged over four weeks) and that in-house call occur no more often than every third night, on average. During on-call hours, you remain in the hospital 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.

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’s 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.

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.

Fellowships typically last one to three years. As a fellow, you are a fully licensed physician and often take on more complex cases. You’ll work closely with experts in your field, perform advanced procedures, and may engage in research, teaching, or academic presentations.

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’re 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 acumen.

Many fellows also take on teaching responsibilities, mentoring residents and medical students while continuing to deepen their own expertise.

Deciding Whether to Pursue Fellowship

You are not required to make this decision at the start of residency. In fact, most residents wait until their second or third year before deciding whether to subspecialize. During residency, you’ll gain exposure to various fields, receive mentorship from attendings and fellows, and have opportunities to explore what fits your interests and long-term goals.

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.

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 healthcare settings.

This is one reason why structured clinical experience matters well before you apply to medical school. Whether you’re shadowing physicians, volunteering in a clinical setting, or participating in a supervised global health program, you’re building the observational 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.

For students who want to gain early, structured exposure to clinical environments, including observing how healthcare teams function, how patients are assessed, and how medical decisions are communicated, IMA’s programs provide supervised, ethically grounded experiences in global health settings. These are not substitutes for residency training. They are starting points that help students understand what clinical work actually looks like and whether medicine is the right path for them.

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 makes a successful residency or fellowship candidate.

If you are preparing for your next step or exploring your long-term goals in medicine, we’re 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’ve covered a variety of allopathic and osteopathic schools, and we add to our list all the time. 

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About IMA

International Medical Aid provides global internship opportunities  for students and clinicians who are looking to broaden their horizons and experience healthcare on an international level. These program participants have the unique opportunity to shadow healthcare providers as they treat individuals who live in remote and underserved areas and who don’t have easy access to medical attention. International Medical Aid also provides medical school admissions consulting to individuals applying to medical school and PA school programs. We review primary and secondary applications, offer guidance for personal statements and essays, and conduct mock interviews to prepare you for the admissions committees that will interview you before accepting you into their programs. IMA is here to provide the tools you need to help further your career and expand your opportunities in healthcare.