While undergoing the long hours of study, clerkships, retracting in the OR, and building a stellar resume for residency applications, it’s sometimes difficult to truly understand what it means to be an “attending physician.” Basically, they’re the “big kahuna” of the medical team who’s completed their training and now teaches, has patients under their direct care, and makes the final decisions. 

But it’s important to understand the exact nature of their role. As important as they are, attendings don’t operate in a vacuum. They’re part of a team, which consists of many members, all of whom have a particular role to play. 

As medical students, it can be difficult to understand how medical teams work, who’s a part of them, and the professional hierarchy they exist in. This blog is to help clarify those roles and the differences between resident vs attending to give you a better understanding of what to expect as you progress through your career.

Here’s who’s who on a medical team, and how they work together to produce positive patient outcomes.

Resident vs Attending: What’s the Difference?

Medical Team Members and Their Assigned Duties 

The Interns

On a day-to-day basis, you as medical students will be interacting with residents the most. This is where the first-year resident comes into play, aka “the intern.”

An intern is, very simply, a physician fresh out of medical school and just starting their medical career. They’re often described as “the low person on the totem pole.” When you become an intern, you’ll be responsible for the bulk of the “floorwork.” This includes seeing consults, writing progress notes, responding to pages, and answering questions such as “can this patient have Tylenol?” It’s an intern’s responsibility to see new patients and discuss them with a higher-level resident prior to talking to the attending, who will make the final decisions. 

Intern year is the time to begin working on vital skills such as efficiency, critical thinking, and identifying when a patient is “sick or not sick.” Being flexible, resilient, and responsive to feedback will set an intern up to become a higher-level resident. 

While most decisions aren’t made by interns, they’re the hub of information and often the first contact that a patient has with the medical team. In terms of hours, interns are often the first to arrive, to start seeing patients on the service, and they update the team on any overnight events.

The Chief Resident 

As you progress through residency, there are levels of graduated responsibility (that come with salary increases). The chief resident is the most senior resident on the team and the one with the most experience. 

Once you’re at this level, you’ll start practicing to be the leader of the team. Chiefs get information from junior residents and help form full plans that they’ll discuss with the attending. They can make simple decisions independently and are major sources of learning for the rest of the team, including the medical students. 

They often have a more flexible schedule and can come into the hospital a little later and leave if they’re able to trust the remaining responsibilities of the day to a junior resident. Additionally, as you advance in training, every subsequent level comes with a salary increase. 

After residency and prior to taking a position as an attending, some physicians will choose to complete a fellowship. Fellows usually sub-specialize in things such as gastroenterology, vascular surgery, or spine surgery. They tend to operate independently and may not work with residents at all depending on your individual institution. They are still, however, working under an attending physician.

The Attending Physician 

Finally, we can discuss what it means to be an attending. Attending physicians have completed a residency and possibly a fellowship. It’s often said that “the buck stops” with them. They make all final decisions on patient care and take full responsibility for their team. 

Since they’re the final decision makers, attendings take on a much greater amount of the risk when it comes to being a caregiver. If a patient has a poor outcome, it’s the attending who must answer for it. Attendings also must maintain continuing education to stay up to date with the most current treatment recommendations. This allows them to always give optimal care to patients. They also may be needed for certain administrative roles in the hospital, such as educating residents or helping design hospital protocols. 

Being an attending requires excellent communication and leadership skills, a great deal of confidence, and a full understanding of one’s own abilities. The perks of reaching this level include having much greater control of your schedule and a much higher salary. All the risk and responsibility come with a salary that can be 5-10 times (or higher) than that of residents, and is specialty and contract dependent. 

How Members of the Medical Team Work Together 

So, how exactly does the medical team function? How do resident-attending interactions take place? First and foremost, residents should learn from their faculty mentors. But on a medical team, learning is a two-way street—attendings can (and should) also learn from their residents. Every person has a role to play, and all of them help the team deliver care to the patients. Sometimes a resident may have an idea that no one else thought of, and that can be the difference between a patient recovering or not.

An Example of Teamwork 

Once information on a patient is collected, the story is told, and the consultation note is written, the team starts to discuss full plans for a patient and their likely clinical course. 

For example, when I was on one of our general surgery services, we had a patient present to the ED with an elevated white count, abdominal pain, nausea, and vomiting. I, as the intern, saw the patient first, got the full story of the patient’s symptoms, the timeline, prior history, performed a physical exam, and relayed that information to my senior resident. 

I was particularly concerned because the patient had rebound tenderness and rigidity. The senior resident, being more experienced and having more independence, had me place initial orders for the patient and called the attending to discuss the situation. 

The attending reviewed the story, labs, history, and imaging, then decided to come into the hospital from home and perform an exploratory laparotomy. During that procedure, I saw the next patient in the ED and the cycle began again. 

Further Reading

In total, the medical team is a complex organism. There are many parts, and you will experience being each part until you reach attending-hood and have the most responsibility and oversight of the team as a whole. Understanding how each part works and your place in it will help you be the best teammate and physician you can be, no matter your responsibilities. 

Best of luck on your journey, and remember, medicine is a team sport!

Looking for more (free!) content from Blueprint tutors? Check out these other posts on the Med School blog:

• Soft Skills in Medicine: Communication, Empathy, and Teamwork
• 7 Secrets to Success I Learned from My Greatest Med School Mentor
• The Best Piece of Medical School Advice I’ve Ever Received