Postgraduate Medical Training: Internship, Residency, and Fellowship
Graduation from medical school is an achievement of great merit but is not recognized by practicing physicians as anything more than a beginning. Before one is acknowledged as clinically competent, additional years of intensive training must be successfully undertaken as a house officer--intern, resident, and perhaps fellow.
Historically, physicians at this stage actually resided in the hospital while working full time as an intern or resident. At Massachusetts General Hospital, one of our country's first and best-known teaching hospitals, the "Little Red House," where the original house physician resided, still exists on the grounds. These original residents received no salary, only board and room. In return, they were permitted to take care of patients as apprentices to the attending physicians.
Times have changed considerably since then. Housestaff receive salaries and no longer reside in the hospital, though there are notable exceptions, such as the trauma-team rotation at San Francisco General Hospital whose Chief Resident actually lives in the hospital for a month's period. Although less of an internment than originally, current residencies still remain highly confining. Today's housestaff maintain private residences, but most of their time is still spent in the hospital, especially when "on-call." Because these schedules may require work shifts of 36 hours or more, sleep is a luxury.
The length of time required to complete residency training varies from two to seven years or more, depending on the specialty. During the first year, referred to as Post Graduate Year 1 (PGY-1) all