Intern, Resident, Fellow, or Attending? Decoding Who’s Actually in Charge of Your Care

This October 2026 issue of The Foglight is reprinted with permission from its author, Gerda Maissel, MD, BCPA. Subscribe to her Substack here.

A Fever, an ER, and Two Doctors

Not long ago, the son of a client had symptoms of a urinary tract infection. He had been deep-sea diving, wearing a condom catheter underwater, which malfunctioned. A few days later, he developed a high fever and had urinary symptoms. He went to urgent care, and they were worried enough that they told him to go to the emergency room to make sure he wasn’t experiencing early sepsis.

In the ER, he was seen by a series of people. He didn’t quite know who anybody was. He guessed who the nurse was — as it happened, she was indeed a nurse. But then two doctors saw him, both male, and he didn’t know why each was seeing him. And he didn’t ask.

He was discharged by the first doctor and ultimately left with a prescription for antibiotics for 5 days. Later, that prescription was changed to 14 days. What the heck happened?

Well, the first doctor who saw him was a resident. And the second doctor was the attending.

From Five Days to Fourteen

Clinically, it can be hard to tell a kidney infection from a bladder infection at the beginning. The resident gave him a prescription for five days of antibiotics, which would be adequate for UTI coverage. But later on, when the attending physician reviewed the case to sign off on the notes, he changed the plan to 14 days of antibiotics. Since my client’s son had some signs of kidney infection, the attending decided to give him 14 days of antibiotics for full coverage and did an override of the resident’s order.

Two doctors, both qualified and legally able to prescribe medication, but one had the intuition that a longer course of antibiotics was called for. Why did the attending know more than the resident? Because he had more years of experience. And that’s something most people wouldn’t be able to tell from the title of “doctor.”

In the age of medical dramas on television, this kind of confusion afflicts all of us. No matter how many times you’ve watched Grey’s Anatomy or The Pitt, it can still be confusing to know the difference between an intern and a resident, not to mention an “attending.” Yet when one becomes a patient, it is crucial to be able to tell them apart. There are many levels in the physician hierarchy, and it helps to know who you’re actually talking to.

So let me break it down for you, working from the bottom to the top.

Who’s Who on the Medical Team

At the very bottom of the physician totem pole is the medical student. Not all hospitals have med students running around, but the bigger ones do, and it’s easy to confuse them for fully qualified doctors. Sometimes they’re even addressed as “doctor.”

But there may actually be an easy way to spot a med student: they wear short white coats. If you’re in a hospital and you see somebody in a short white coat, they are a medical student, or perhaps another type of student, such as a pharmacy student. Medical students know some stuff, but they are not qualified as physicians. (And to be clear, some med schools have abandoned the short white coat—but boy, was it a useful cue!)

After medical students, you get into the post-graduate hierarchy, the doctors just out of medical school. Depending on how many years out they are, they may be called “PGY1,” for post-grad year 1, then PGY2, and so forth.

After medical school, doctors begin their residencies. They are not fully qualified during their residencies. They are in training. Yet they are called “doctor” and are able to prescribe.

A first-year resident, or PGY1, is an intern; this is a doctor in their first year after graduating from medical school.

Every other doctor who is still in training, except for fellows, is simply called a resident. On occasion, depending on their specialty, a PGY1 may be called a resident, but in general “resident” means a PGY2 or later, a doctor in their second postgraduate year after medical school.

Then come the fellows. These are doctors who have finished their residencies and now want extra training in a specialty. For example, if you were to become a cardiologist, you would do three years of internal medicine residency, then several years of cardiology fellowship (often at a different hospital). A cardiac surgeon might do five years of general surgery residency, followed by a couple of years as a “cardiac surgery fellow,” learning the subspecialty of operating on hearts.

And then there is the attending physician: a doctor who has completed an internship, residency, perhaps a fellowship, and is now supervising interns and residents. Attending physicians are the grown-ups. They are in charge of your case. They have finished their training and are now “practicing.”

Yep, the doctors who are “practicing” are the ones who have finished training and are fully autonomous!

When Seniority Gets Tricky

And just to confuse you further, you can’t tell exactly what someone’s rank is by asking how long it’s been since they graduated medical school. Internal medicine residents finish and become fellows as PGY4s, but a general surgery residency is 5 years long, so they don’t become fellows until PGY6.

Here’s where it gets a little weirder. If your hospitalist trained in internal medicine and did not add on a fellowship (most don’t), a brand-new attending hospitalist will be 4 years out of medical school and considered autonomous and capable of supervising trainees (and you!). Yet someone who graduated from medical school that same year could be a PGY-4 surgical resident, below surgical fellows and all attendings in the hierarchy. The hospitalist would be considered a fully grown-up attending, and the other would not have even become a fellow yet.

What This Means for You

Let’s stop here to ask, “What does all this matter to me, the patient?” Well, it’s useful to know that a fellow, if you happen to see one, probably knows quite a bit. Residents are more variable. And interns really are just kids; they may be very smart, but they are young and inexperienced.

If you are sitting in the hospital, and somebody says “I’m Dr. So-and-So,” and you want to know if they are a medical student, intern, resident, fellow, or an attending, ask them. I’m not saying you shouldn’t talk to residents or fellows. Just know who you are dealing with.

Many times, the doctor who has time to spend with you is actually the resident, and sometimes the fellow. Another clue: the attending is the one who comes in last after a parade of others have seen you.

And in some hospitals without a teaching program, the only doctor you see is the attending. And sometimes in hospitals with teaching programs, you may not be on a “teaching service.” In that case, you will not see the parade of medical students, residents, and fellows.

But we’re not done yet. Usually, in a hospital, there is a primary or “hospitalist” service—think of them as the first line of defense—but then there are also consultants. If you are admitted to the hospital with pneumonia, you might see only the hospitalist and various trainees. But if you are also sick enough (let’s say you have a complex lung condition), the hospitalists might request a pulmonary consult. And the pulmonary attending may themselves send their resident or fellow. If your kidneys are not behaving, you might get a renal consult. And so forth.

My tip is to ask everyone who they are and if they have a card. Take pictures of badges with their permission. Keep a log of which doctors came by. Know what level of person you’re talking to.

Keep in mind that many times, you can explore issues and get a lot of information from residents and fellows. This is a reminder that the level of training isn’t a matter of “best” and “worst.” Rather, it’s good to know where in the hierarchy the doctor you’re talking to sits, because it speaks to their experience and, thus, how much they know.

It’s in your best interest to understand how much the person giving you advice knows and whether they have the experience needed. Otherwise, you might end up in a situation much more confusing than having your antibiotic prescription extended from 5 to 14 days.

Wishing you peace and understanding in your healthcare journey,  

Gerda Maissel, MD, BCPA

Dr. Gerda Maissel is a Board-Certified Physical Medicine and Rehabilitation physician and a Board-Certified Patient Advocate. Visit her website here.