What is medical residency?

Residency, also known as graduate medical education, is a period of intensive training in a specialty or specialties. Generally ranging from three to seven years, residency acts as the bridge between completing medical school and becoming a practicing physician.

Every specialty, including family medicine, has its own set of requirements for residency. They all include a set number of months of training in each area required for board certification. For example, family medicine residents must train in obstetrics, pediatrics, general surgery, emergency medicine and inpatient hospital care (including critical care).

According to the Accreditation Council for Graduate Medical Education (ACGME), which sets and monitors standards for U.S. residency programs, a “rigorous and demanding” graduate medical education should prepare residents to:

First, the good news: You’re paid for all those long hours and hard work! You’ll begin earning a resident’s salary—your first paid role as a physician. The hours will get longer and the work harder, but your medical knowledge and clinical experience will accelerate rapidly as you move into hands-on patient care.

It's a gradual process by design. As a first-year resident, most of your time will be spent on indirect patient care—most importantly, your daily teaching rounds with attending physicians. This is where key learning happens as you assist in examining a variety of patients and asking questions. First-year residents also spend considerable time on maintaining patients’ medical records and communicating with other team members about patient care. They may also do research or pursue additional education opportunities.

Direct patient care becomes a bigger part of your day as you progress through residency. See the residency timeline below for more information.

As you progress through residency, doing daily rounds and rotating through various areas of training, you gain the real-world experience needed to evaluate patients and make decisions on your own. This process is often referred to as “graduated autonomy.” The more you demonstrate your knowledge and judgment, the more autonomy you’ll be granted and the less supervision you’ll have.

The ACGME has milestones to measure residents’ development in six areas of core competency: patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills.

Based on observed behaviors, a resident’s performance level falls into one of five categories:

Three years of training are required to complete most family medicine residency programs accredited by the ACGME. Some programs offer a four-year plan that includes a year of training in fundamental clinical skills of medicine. Combined residencies, where physicians train in family medicine and one of five other specialties, require five years of training.

Here’s how family medicine compares with other specialties in terms of length of residency.

As a fourth-year medical student, you’ll most likely pursue residency through the National Resident Matching Program^® (NRMP^®), better known as the Match. (The Military Match uses its own matching service and works on a different timeline.)

Match Day happens every year on the third Friday in March. Students and graduates are paired with residency programs by an algorithm that factors in preferences from rank order lists submitted during the application process.

Most residency programs begin on July 1, with onboarding and orientation in late June. Be sure to check with your residency program for specifics.

Years in residency are referred to as PGYs, or postgraduate years. The first year—PGY-1, or the internship year—is spent building a strong foundation of clinical skills and knowledge, with a focus on your specialty. Some programs include internships in other areas during PGY-1 so you can build a broader foundation.

For family medicine residents, PGY-1 includes rotations, with time spent each week in the family medicine continuity clinic providing ongoing care to a panel of patients. During PGY-1, most residents also study for and take the final United States Medical Licensing Examination^® (USMLE^®), for future MDs, or the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA), for future DOs. Passing one or the other is the minimum requirement for licensing to practice in any state.

In PGY-2 and PGY-3, you’ll get broader experience and build more skills in your specialty and subspecialty areas, spending more time in the family medicine continuity clinic as you gain the autonomy to see and treat patients without supervision.

As a resident, you also must balance clinical work with studying for board exams. Once you’ve completed your training and met all ACGME accreditation requirements, you can take the exam to be certified by the American Board of Family Medicine or the American Osteopathic Board of Family Physicians.

First, the good news: You’re paid for all those long hours and hard work! You’ll begin earning a resident’s salary—your first paid role as a physician. The hours will get longer and the work harder, but your medical knowledge and clinical experience will accelerate rapidly as you move into hands-on patient care.

It's a gradual process by design. As a first-year resident, most of your time will be spent on indirect patient care—most importantly, your daily teaching rounds with attending physicians. This is where key learning happens as you assist in examining a variety of patients and asking questions. First-year residents also spend considerable time on maintaining patients’ medical records and communicating with other team members about patient care. They may also do research or pursue additional education opportunities.

Direct patient care becomes a bigger part of your day as you progress through residency.

The Electronic Residency Application Service^® (ERAS^®) is the centralized online system for medical students and graduates to submit applications and supporting documents to residency programs. You’ll be able to access ERAS after getting a token from your dean’s office.

Here's a look at some key pieces of documentation and strategy to improve your chances of securing the residency you want.

Beyond just good grades and test scores, residency program directors want to know about you as a physician and as a person. This is where letters of recommendation and personal statements come in.

Letters of recommendation

Here’s where your teachers and mentors can help you put your best foot forward. Most residency programs want three recommendation letters and may request that one or more come from a specific department or rotation. You can submit a maximum of four letters through ERAS to any given residency program.

Personal statements

A well-crafted personal statement is a crucial part of your application and can help you stand out among the many hundreds of people applying to a residency. This is where you get to showcase your personality, highlight your personal achievements and—most importantly—express your passion for a career in family medicine and why you’d be a good fit for a particular residency program.

If a residency program thinks you have potential, they’ll invite you for an interview. The process varies by institution, but you’ll likely be talking with various faculty and staff members, as well as the program director. It will take at least a few hours and may stretch over a couple of days. Remember, it’s a two-way conversation. While the residency staff want to get to know you better, this is also your chance to “interview” them. Do your research about the program and come prepared to ask lots of questions!

The interview process will help you compile your ranked order list—which must be submitted by early March—in advance of the Match. Putting together this list of rankings can be stressful as you try to decide which residency programs to put at the top. It is good practice to reflect on your interview experiences and weigh the pros and cons of each program, considering factors such as geographic location and faculty-student ratio.

There’s no shortage of quality graduate education programs available to aspiring medical residents. During the 2024–2025 academic year, the ACGME oversaw 13,762 accredited residency and fellowship programs across more than 900 different institutions. There are more than 167,000 full- and part-time residents working in these programs.

Most residency programs train physicians in one specialty. But in 2024, the ACGME began accrediting combined residency programs, which train physicians in two or more specialties. Residents who want to pursue a combined family medicine residency can choose from one of five other specialties:

To remain accredited, a residency program must meet and remain in compliance with ACGME standards for education and training. On its website, the organization says its standards are “designed to cultivate a team-based learning environment and culture in which residents and fellows serve as both learners and mentors in delivering high-quality patient-focused care.”

The standards are set by a volunteer committee of physicians, including a resident member. Accredited programs are monitored continuously for compliance through data collection, surveys and site visits.

The AAFP makes it easy to research any residency program you might be interested in, from A to Z, with the option to filter by location, community setting, program type, program size and more.

Other online resources, like the Association of American Medical Colleges (AAMC) Residency Explorer™ Tool, Doximity and FREIDA™, the American Medical Association Residency and Fellowship Database^®, offer breakdowns of residency programs, including application requirements and Match statistics.

Match Day, the third Friday in March, is when residents-to-be find out where they matched. But the Match actually begins on Monday of that week, when applicants find out if they matched—and not everyone does. If you don’t match right away, don’t give up! There are still paths to residency.

The Supplemental Offer and Acceptance Program (SOAP) is a system run by the NRMP that pairs unmatched applicants with unfilled residency positions. The process moves fast. Once you find out on Monday that you didn’t match, you’ll have a couple of days to submit new applications to residencies and go through interviews. Residency programs then offer positions in several rounds (usually three or four) on Thursday. Each offer has a two-hour window for you to respond.