What Comes After Residency for Physicians?

TLDR; What comes after residency for physicians is application for a medical license, board certification, a fellowship in some cases, and career exploration (including locum tenens roles).

You’ve done it – congratulations! Completing your medical residency is cause for celebration. And rest.

But what's next? The transition from residency to the "real world" can feel overwhelming. Suddenly, you're faced with crucial career decisions and student loan repayments. Should you work within a hospital system? Try a locum tenens role? And just as importantly, what kind of life do you want outside of work? 

Here's everything you need to know about the first steps to take after residency to help you feel great about your path forward.

What happens after residency?

• 6 Things to do after residency
  • Rest and recharge
  • Apply for a medical license
  • Board certification
  • Consider a fellowing
  • Become an attending physician
  • Fine-tune your financials
• What is the difference between a resident and attending physician?
• Trying a locum tenens role

6 Things to do after residency

As you'll soon discover, some of the steps you have to take after residency are universal, whereas others offer some flexibility and choice. In our experience, here's how many physicians set themselves up for post-residency success:

1. Rest and recharge

This is probably the most overlooked piece of advice for post-residency doctors, but countless doctors years into their practices tell us they wish they had done just this. So we’re going to challenge you to really think about this one. 

Feeling a bit anxious about what comes after residency is totally normal. It's a big transition. But jumping straight into the next phase without pausing can lead to deep burnout. Give yourself some time to unwind and reevaluate your priorities. Remembering what it’s like to have more free time and fewer responsibilities is a good thing for decision-making – and your mental health.

Self-Care is non-negotiable

Ultimately, self-care for physicians is essential for good health and well-being. You can't effectively care for others unless you're taking care of yourself. This means eating right, getting enough sleep, and exercising regularly. Prioritize your future work-life balance by focusing on your mental, emotional, and physical needs.

It’s also time to ease yourself back into better habits. You may have been cornered into less-than-ideal ones with the hectic pace and long hours of residency, but after residency it's time to get back on track. No more skipping workouts or eating on-the-go.

2. Apply for a medical license

Once you've completed your residency, you can begin practicing independently by applying for a medical license. This process varies by state or country, but typically involves submitting an application to the local medical board, providing proof of education and training, and passing licensing exams. In the U.S., for example, physicians must pass the United States Medical Licensing Examination (USMLE) steps, if not already completed, and meet specific state requirements.

The timeline for obtaining a medical license can differ depending on the region, but expect the process to take several months. Once approved, your license grants you the legal authority to practice medicine and prescribe medications within the state or country. Maintaining your license usually involves ongoing education, regular renewals, and adherence to professional ethical standards.

3. Board certification

Board certification is an important milestone after you've completed your residency training. Obtaining board certification in a medical specialty demonstrates your expertise and commitment to maintaining high standards in patient care. To become board certified, you must pass a rigorous exam administered by one of the specialty boards recognized by the American Board of Medical Specialties (ABMS) or an equivalent certifying body. The certification process typically includes both written and oral exams that test the physician’s knowledge and practical skills within their chosen specialty, such as internal medicine, surgery, or pediatrics.

Keep in mind that certification is not a one-time event; most specialties require periodic recertification through continuing education and re-examination, ensuring that you stay current with advancements in your field.

4. Consider a fellowship

After completing residency, but before becoming an attending physician, you may choose to pursue a fellowship to gain advanced training and specialize further in a particular area of medicine. Fellowships are typically offered in subspecialties (for instance cardiology, oncology, or pediatric surgery), and they allow physicians to deepen their expertise and focus on specific aspects of patient care.

Fellowships usually last between one and three years, depending on the specialty, and involve a combination of clinical work, research, and hands-on procedures. During this time, you will work closely with experienced specialists, learning advanced techniques and enhancing their diagnostic and treatment skills in their chosen subspecialty.Understand your career options

Whether you've already mapped out your next move or are still weighing your options, you're not alone. Some residents stay on at their training hospital, while others look for other opportunities, but it’s always great to know your future options.

Explore subspecialties by shadowing

Thinking about a subspecialty but unsure if it's the right fit? Consider shadowing a doctor in that field. Shadowing provides:

• Hands-on experience with seasoned professionals
• Insight into daily routines and responsibilities
• A real-life perspective on what it's like to work in that specialty

This firsthand experience can be invaluable as you decide on your next steps.

5. Becoming an attending physician

An attending physician is a doctor who has completed all required medical training (including medical school, residency, and often a fellowship) and now practices medicine independently. They have earned a full medical license and are typically board-certified in their chosen specialty, signifying they have met the highest standards of expertise. The title "attending" refers to the fact that they are the primary doctor legally responsible for "attending to" or overseeing a patient's medical care.

This role represents the culmination of a physician's formal training and the beginning of their autonomous career. Attending physicians are ultimately responsible for making final diagnoses, approving treatment plans, and guiding the entire medical team, including residents, medical students, nurses, and physician assistants. Becoming an attending physician is the goal of residency, marking the transition from a trainee to an expert practitioner and leader.

Taking permanent roles

For most physicians, the first step after residency or fellowship is accepting a permanent position, typically within a hospital/health system or a private group practice. In a hospital or health system, you become an employee, often with a title like Hospitalist, Staff Surgeon, or Medical Specialist. You'll have a defined salary, benefits package, and a set schedule or call rotation. In a small private practice, you may be brought on as an associate with the potential to eventually become a partner, sharing in both the practice's profits and its operational responsibilities and risks.

The primary advantage of a permanent role is stability. It provides a predictable income, comprehensive benefits (like health insurance, retirement plans, and malpractice coverage), and the opportunity to build a lasting patient panel and reputation within a community. You become deeply integrated into a team and can develop strong referral networks.

However, this stability can come with a trade-off in autonomy. Hospital employees must adhere to system-wide protocols and electronic health record systems, while private practice partners often face significant administrative burdens related to managing a business. Earning potential may also be capped by a salary or be dependent on the practice's overall financial performance.

Test the waters with locum tenens

If you’re not fully committed to everything about the permanent roles you’re finding, locum tenens allows you to dip your toes into life as an attending physician without committing to a full-time position. Locum tenens means "holding a position" in Latin, and it often denotes short-term positions held by physicians in order to meet temporary staffing shortages. It's a popular and exciting way that new physicians discover what they truly enjoy in their medical careers while trying out different work settings and living situations. To find locums roles, you can work with trusted locum tenens agencies that have relationships with facilities looking for temporary staff.

These roles offer:

• Flexibility to design your schedule
• High compensation that rewards your hard work
• Travel opportunities to explore different care settings and locations

And hey, if you’re interested in seeing what’s out there, Era Locums is here to help you connect with amazing opportunities. Click here to see our open roles, or pair up with one of our expert recruiters.

6. Fine-tune your financials

And finally, let’s not forget about those student loans hanging over your head. But there's good news—tackling debt doesn't have to be overwhelming! 

A realistic budget is going to be your secret weapon. Even after landing your first job post-residency, living below your means for a few years (re: like you’re still in residency) can make a world of difference. Plus, if you hold off on auto and home loans, you'll have the flexibility to switch jobs if you're unhappy with your current situation.

And be sure to take advantage of federal income-driven repayment plans. They tailor your monthly payments to your income, making debt more manageable and less stressful.

What is the difference between an attending and resident physician?

The journey from medical school to independent practice is a structured path of increasing responsibility. The two key roles on this path (resident and attending physician) represent fundamentally different stages, each with its own responsibilities, authority, and scope of practice. Understanding this distinction is crucial to grasping a physician's career trajectory.

In the simplest terms, a resident is a doctor-in-training, while an attending physician is a fully trained and licensed expert who supervises and leads patient care.

Here’s a breakdown of the key differences:

1. Training Status and Supervision

• Resident Physician: A resident has earned their medical degree (MD or DO) but is now completing mandatory, supervised postgraduate training in a chosen specialty, such as surgery, internal medicine, or pediatrics. This period, known as residency, lasts between three and seven years. Residents always work under the legal supervision and license of an attending physician. They are still "in training," making them the primary learners on the clinical team.
• Attending Physician: An attending has successfully completed their residency (and often a fellowship for further sub-specialization). They are board-certified or board-eligible in their specialty and hold an independent, full medical license. They are the ones who provide ultimate supervision, oversight, and final approval for medical decisions. The term "attending" comes from their role as the doctor who "attends" to or is primarily responsible for the patient.

2. Scope of Responsibility and Decision-Making

• Resident Physician: Residents are responsible for the hands-on, day-to-day care of patients. They take patient histories, perform physical exams, develop initial diagnostic and treatment plans, write orders, and perform procedures. However, their decisions and plans must be reviewed and co-signed by an attending. Their responsibility is to execute care and learn.
• Attending Physician: The attending carries the ultimate legal and ethical responsibility for patient outcomes. They verify the resident's findings, approve the care plan, and are the final authority on all major decisions. They are the ones who sign the discharge paperwork, have the final conversation with a family about a poor prognosis, and are named in any legal proceedings. Their responsibility is to direct care and teach.

3. Workload and Schedule

• Resident Physician: Residency is famously intense, with long, demanding hours often governed by duty-hour restrictions (e.g., 80-hour work weeks). Schedules are highly structured by the training program and involve frequent night shifts, 24-hour calls, and rotating through different services. The focus is on gaining broad exposure.
• Attending Physician: While attending hours can still be very demanding, they have significantly more autonomy over their schedule. They can choose practice settings that align with their desired work-life balance (e.g., outpatient clinic, hospitalist with shift work, or a busy surgical practice). The grueling, structured schedule of residency is replaced by a self-directed career.

4. Compensation and Career Stage

• Resident Physician: Residents are paid a salary, often viewed as a stipend for their training. While it has increased in recent years, it is modest compared to an attending's income, especially when considering their hours worked. They are at the beginning of their career, accumulating significant educational debt.
• Attending Physician: This is the stage where a physician's financial investment in their education pays off. Attending physicians earn a significantly higher salary commensurate with their specialty, experience, and geographic location. They have moved from being trainees to established professionals.

Trying a locum tenens role

Stepping into your role as a licensed physician is both a thrilling and pivotal moment in your career. You’ve worked tirelessly, and now you’re about to see years of hard work pay off.

Why not take the opportunity to design your own practice? Locum tenens work allows you to do just that. Locums is a chance to gain unparalleled flexibility, explore diverse practice settings without long-term commitment, and command competitive hourly rates while you do it. You can travel to new locations, supplement your income, and find the perfect environment that aligns with your personal and professional goals before settling into a permanent role.

Just know that we'll be here to support you across every era of your career. Follow us on social to stay connected, browse open positions, or send us your resume so we can always be looking out for your dream job. We got your back, doc!