Attending and resident physicians both have medical degrees, but there are differences in the extent of their training and ability to provide care independently.
A resident has graduated from medical school and is completing a post-graduate training program. An attending is a board-certified physician who has completed their residency training. Residents are supervised by attending physicians.
Levels of Doctor Seniority
Upon completion of four years of medical school, medical students graduate with either a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO) degree. At this point, they are referred to as physicians, even though they must embark on further training as an intern at a teaching hospital.
In the United States, the hierarchy of doctors (from lowest to highest level of seniority) is as follows:
- Intern: medical school graduate who is a first-year resident
- Resident: a doctor who has finished their first year of post-graduate training
- Fellow: a doctor who pursues optional additional training before becoming an attending
- Attending physician: a doctor who has finished post-graduate training
Attending Physicians
An attending physician is a medical doctor who has completed all residency training. Attending physicians are also called staff physicians, supervising physicians, or simply “attendings.” Not all doctors become attendings, as some take different career paths or do not complete their training.
Attending physicians are board-certified and/or eligible to practice independently in a particular specialty. They are considered experts in their particular field of medicine or surgery. Depending on the field of medicine, the route from medical student to attending can take seven years or more.
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 for all patient care—even if a subordinate provides the care. (They may or may not have legal liability, depending on the circumstances.)
Why Are Physicians Called Attendings?
The term "attending" may have originated from the fact that physicians are associated with a specific hospital—like a student "attending" a certain school—or the idea that they "attend" rounds (daily visits to each patient under a medical team's care).
Resident Physicians
Medical school graduates enter a residency program in a hospital or clinic. 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 three to four years for a family doctor and 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.” These physicians provide direct care under the supervision of an attending physician or senior resident.
Can Residents Prescribe Medication?
Residents are generally restricted to writing prescriptions for only those under their care as part of their training. The American Medical Association notes legal cases, dating back decades, that establish residents' ability to prescribe drugs. Residents practice medicine under supervision on a restricted basis (unlike fellows) and cannot prescribe drugs outside the scope of their clinical rotations.
Residency Specializations
Residents can choose different specialties to train in after graduation. These include:
- Emergency medicine
- General surgery
- Family practice
- Pediatrics
- Anesthesiology
- Diagnostic radiology
Chief Residents
Chief residents are elevated to a level that puts them senior to the rest of the residents and junior to the program’s management. They are chosen by hospital leadership during their residency program.
The duties of chief residents may vary but can include patient care; mentoring, training, and advocating for team members; and carrying out some administrative duties.
Attending vs. Resident
Provides direct care to patients without supervision
No limits on services they are able to deliver
Holds all responsibility for care given by them or subordinates
Can provide direct care to patients with supervision and guidance of an attending
Allowed to do more as they gain experience
Does not hold ultimate responsibility for care provided
How Can You Tell Who’s a Resident vs. an Attending?
You can sometimes tell where a physician fits in the hierarchy based on the length of their lab coat. Medical students wear the shortest white coats; residents typically wear longer ones; and attending physicians wear full-length coats.
However, nurse practitioners and phlebotomists (technicians who draw blood) may also wear lab coats. In addition, many health professionals of all ranks now wear scrubs.
The best way to tell who is a resident versus an attending physician is to look at a staff member’s ID badge or ask what their role is. It is your right to know each person's role and which member of a hospital staff is ultimately in charge.
Summary
People training to become medical doctors are given different titles as they progress through training. These titles denote their level of experience as well as their ability to provide care without supervision.
After medical students graduate, they become interns and then progress to residents and fellows. Attending doctors are the highest in level of seniority. They are fully licensed and can practice independently.