What’s the difference between an intern, a resident, a fellow, and an attending in the hospital setting?

Many patients do not know the difference between the medical student or the attending that visits them. In teaching hospitals, there is a hierarchy to the ranks and roles of the doctors or students involved in patient care that present confusion to most people. Hospitals are now attempting to create different techniques for each person to introduce themselves in order to minimize confusion. 

(Source: FutureDocs)

  • Interns – This is probably one of the most confusing terms in a teaching hospital.  Interns are doctors who have graduated medical school and are in their first year of a residency training program.  Of course, ‘intern’ is also the universal term for all those college students trying to get a short term experience on their resume by ‘interning’ there first.  So, why would a patient think an intern is a doctor?   After all, you would never put your faith in the legal ‘intern’ at the law firm to defend you in a lawsuit.   To make matters worse, there is the opposite problem.  Intern is often mistaken for ‘internist’, who is actually a doctor who has completed their internal medicine residency and otherwise a ‘doctor for adults.’  (Patients are more familiar with their “PCP” or ‘primary care physician,’ which could refer to either an internist or a family physician).    
  • Residents – Residents can refer to any doctor who has graduated from medical school and is in a residency training program (including interns). The term “residents” originates from William Osler’s era when residents did live in the hospital.  Of course, they don’t live there anymore  which would violate worker’s rights not to mention their regulated duty hours… but we still call them residents.  The other name residents are often referred to is as “PGY1” (post graduate year) which is certainly not an improvement.  
  • Housestaff – One of our premed college students just asked me what this term was this week.  I explained that while this does sound like the butler, maid, or cook a fancy estate, this term actually refers to the hospital as the “house” that the residents live in as the staff.  So all residents (including interns) are part of the ‘housestaff’. 
  • Fellow – This is perhaps one of the most disconcerting names for a physician as it may sound like it refers only to male doctors (and conjure up images of young man from England with excellent manners i.e. he’s a fine ‘fellow’).  In fact, a fellow is a doctor who has completed residency and is getting advanced training in a certain subspecialty. 
  • Attending- Attending to what you may wonder?  The attending physician is actually the doctor who has completed training and is legally responsible for the care provided by residents.  In other words, this is the ‘boss’ doctor as my residents sometimes introduce me to the patients on our team. 
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