A hospital intern is a doctor in their very first year of training after graduating from medical school. They hold a medical degree and have earned the title “doctor,” but they practice under the supervision of more experienced physicians. This year, formally called PGY-1 (postgraduate year one), is the most intensive learning period in a physician’s career and the entry point into the hospital hierarchy.
How Interns Fit Into the Hospital Hierarchy
Teaching hospitals operate with a clear chain of command. At the top is the attending physician, a fully licensed doctor who has completed all training and bears ultimate responsibility for patient care. Below the attending are residents, doctors in their second year of training or beyond who have increasing independence. The intern sits at the beginning of this ladder.
Interns are sometimes called first-year residents, and the terms are essentially interchangeable. The key distinction from a medical student is legal: an intern has graduated from medical school and holds a medical degree, which means they can write orders, make clinical decisions, and carry their own patient panel. But every significant decision they make is reviewed by a senior resident or attending. They never practice independently.
What an Intern Actually Does All Day
A typical intern’s day at a teaching hospital starts early, often around 5:30 a.m., with pre-rounding. This means checking in on each assigned patient before the rest of the team arrives: reviewing overnight lab results, examining the patient, and preparing a brief update on how they’re doing. By 8:00 a.m., the intern joins the attending physician for formal rounds, walking from room to room as a team to discuss each patient’s diagnosis, test results, and treatment plan.
Late morning and afternoon are filled with the work that rounds generate. Interns place orders for medications and tests, call specialists for consultations, coordinate with social workers about discharge planning, and write detailed progress notes documenting every patient’s status. They also handle new admissions, which means evaluating patients who arrive on the floor, taking a full medical history, performing a physical exam, and developing an initial plan. On busy services, an intern might manage eight to twelve patients at once while fielding pages and phone calls throughout the day. The workday typically wraps around 5:30 p.m., though it can stretch much longer on call days.
How Doctors Get Placed as Interns
Medical students don’t simply apply and get hired for internship positions. They go through a centralized system called the Match, run by the National Resident Matching Program (NRMP). Fourth-year medical students interview at residency programs across the country, then submit a ranked list of their preferred programs. Simultaneously, programs rank the applicants they interviewed. An algorithm pairs students with programs based on both parties’ preferences, and the results are announced on a single day each March known as Match Day.
The algorithm is designed to favor the applicant. Economists David Gale and Lloyd Shapley proved that the system guarantees students the best available program given everyone’s preferences. The practical advice that flows from this: students should rank programs based purely on their own preferences, not on where they think they’re most likely to be accepted. No other strategy produces a better outcome.
This system exists because the old way was chaotic. When residencies first appeared around 1900, hospitals competed to lock in top candidates as early as possible. By the 1940s, offers were going out to third-year medical students who hadn’t finished their training, and by 1949 some offers expired within 12 hours. The NRMP was created in 1952 to fix the mess.
Categorical, Preliminary, and Transitional Years
Not all internships are the same. A categorical position means the intern is accepted into a full residency program from day one. They complete intern year and automatically continue into their second year in the same specialty, whether that’s internal medicine, surgery, or family medicine. This is the most common path.
A preliminary position offers only one to two years of training, typically as a stepping stone before entering an advanced specialty program like dermatology or radiology. An intern doing a preliminary year in surgery, for example, might then move to a different hospital for an ophthalmology residency. Transitional year programs are similar: they’re standalone one-year programs that blend rotations across multiple specialties, giving broad clinical experience before the doctor begins specialty training elsewhere.
How Long the Intern Year Lasts
The intern year is exactly one year. What comes after depends entirely on the specialty. Family medicine residency runs three to four years total (including intern year). Internal medicine takes three years. General surgery requires five or more years. For specialties like dermatology, the intern completes a preliminary or transitional year, then enters a three-year dermatology program starting at PGY-2.
After completing intern year, the doctor is no longer called an intern. They become a second-year resident (PGY-2) and typically gain more autonomy: supervising interns, making more independent clinical decisions, and taking on greater procedural responsibility.
Work Hours and Regulations
Intern year is notoriously demanding. The Accreditation Council for Graduate Medical Education (ACGME) caps all residents, including interns, at 80 hours per week, averaged over a four-week period. That average matters because some weeks will exceed 80 hours while others fall below it. Interns must get at least one day off per seven days (averaged over four weeks) and should have eight hours off between scheduled shifts. After a 24-hour in-house call shift, they must have at least 14 hours free.
Unlike more senior residents, interns are not allowed to moonlight, meaning they cannot pick up extra shifts at other hospitals or clinics for additional pay. The restriction exists because the workload and learning curve of intern year are already at capacity.
What Interns Earn
Interns are paid a salary, not a stipend, though it’s modest relative to their education level and hours. Pay varies significantly by hospital, city, and specialty. At many academic medical centers, PGY-1 salaries fall in the range of $55,000 to $70,000 per year. When you divide that by 70 to 80 working hours per week, the effective hourly rate can dip below minimum wage in some cities, a point of ongoing debate in medicine. Compensation increases modestly with each year of training.