As a child, you dreamed of becoming a doctor someday. You watch Grey’s Anatomy and Chicago Hope mesmerized by the power and intrigue that come with titles like resident, attending or medical director. Every pre-med should understand the medical hierarchy of a hospital, so you know just how high to dream.

The Hospital Medical Hierarchy Every Pre-Med Should Understand

The Hospital Medical Hierarchy Every Pre-Med Should Understand. Image by Halcyon Marine Healthcare Systems from Pixabay

Every Pre-Med Should Understand the Medical Hierarchy of Hospitals

There are multiple levels of practicing medicine. Many people exist on a physician team, each having their own responsibilities. Some are licensed to practice medicine, while others are studying and working hard to get there.

Is it your goal to someday become an attending physician? Or do you aspire to run a whole department or even an entire hospital someday? Every pre-med should understand how the hierarchy works at most hospitals to understand just how far they can go in their careers at these facilities.

The Top Heads of a Hospital Medical Hierarchy

This is the typical medical hierarchy of the top heads at hospitals and the general responsibilities of each role from the top down:

1. Medical Director

The directors of a hospital are industry leaders in charge of overseeing every single physician on the staff. Medical directors establish good practices and policies for the institution with the goal of high-quality patient care in mind.

Every aspect of outpatient and inpatient care is coordinated by these directors. Each and every physician in a hospital answers to these professionals.

2. Head of Department

When you work at a hospital, the doctor responsible for a patient’s treatment plan is the attending. There may be times when your attending is too busy or preoccupied to answer your questions.

In that case, you need to go to the head of the department associated with the issues. IE, the head of orthopedics or head of pediatrics.

3. Attending Physician

Every pre-med should understand that the senior doctors in a hospital are the attending physicians. They are responsible for the major decision-making related to a patient’s treatment.

These doctors are fully trained, with at least three years of residency training under their belts. Depending on their specialized fields, they may or may not have passed board exams related to those specialties.

Every Pre-Med Should Understand How House Staff Hierarchies Work

Hospitals use the generalized term house staff to covers all other medical staff, from med school graduates who are now interns to other doctors-in-training and fellows. At teaching hospitals, residents are a very important part of a patient’s medical care.

A hands-on approach allows them to learn to engage with and treat patients on their paths to becoming doctors. This is the general medical hierarchy of a hospital’s house staff:

4. Fellow

Right below attending physicians when it comes to responsibilities are fellows. These doctors are working on a fellowship, or advanced training in a specific medical specialty, after completing their primary residencies.

Although they are ready to practice medicine, because they are in specialty training, most have little direct contact with patients. A fellow can write orders in a patient’s chart, as well as make decisions related to the treatment plan.

Things Every Pre-Med Should Understand: What Is a Resident?

Residents working in a hospital have already graduated from medical school. They’ve also taken and passed the required national licensing exams, also known as the USMLEs.

Each resident is licensed to practice medicine as an MD (medical doctor). However, this person must have supervision when working with patients until three years of hand’s on training are completed.

These years are referred to as the primary residency. Some specialty fields require participation in specific residency programs for as long as eight years.

This is the basic medical hierarchy of residents working and training in most hospitals:

5. Chief Resident

This person works at the highest senior level for all residents. The chief resident is in charge of directing the activities of all the other residents at the hospital.

Chiefs act as the immediate “bosses” of the lower level residents. To become chiefs, they must have already completed three years of their residencies.

6. Senior Resident

Right up under the chief is the senior resident. Generally, this doctor is in the third year of residency.

7. Junior Resident

Just below the seniors are the junior residents. These doctors are generally in the second year of their residencies.

8. Intern

Once a student has graduated from medical school and started a residency, this doctor is called an intern. At some hospitals, they are referred to as first-year residents.

Although interns do have medical degrees and are referred to as doctors, they’re not licensed to practice medicine without supervision. They must be supervised by senior residents or senior MDs when working with patients.

9. Medical Student

When a person is in medical school studying to become a doctor, that person is called a medical student. This person hasn’t graduated and doesn’t have a medical degree yet.

During training, medical students follow cases of various hospitalized patients. They also perform hospital rotations and have some form of authority (although very little).

In some hospitals, these aspiring physicians take medical history from patients, review them and write various orders in patients’ charts. However, all of this must be reviewed and okayed with a licensed doctor’s signature.

10. Pre-Med Student

Every pre-med should understand there is no actual college major with this title. Pre-med is simply a term that describes a person taking strides to get into medical school.

A pre-med may be someone in high school who wants to become a doctor. This person makes sure to take biology and chemistry in high school. They also pursue extra-curricular activities related to medicine, such as teen summer camps and medical internships, etc…

Pre-meds may also be college students preparing for med school. They make sure to take several sciences each semester, such as ethics, psychology, public health, genetic, etc… They also take courses like foreign languages and writing classes to help with patient care in the future.

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