Residency / The Application

Categorical vs Preliminary

After med school comes residency where young doctors learn how to actually be doctors. But not all residencies are the same. In general, there are two types of residencies that students can apply for, ‘categorical’ and ‘preliminary’ positions. Categorical spots offer full residency training for their specific field of choice in order to become board certified. Preliminary positions only offer one or two years of training.

Categorical positions are a guaranteed job and it’s what every applicant shoots for. Earning a categorical position means that your application process is over until you apply for jobs or fellowships in order to further specialize after you complete your residency. Each residency training program has different lengths. Internal medicine, family medicine, and pediatrics are three years a piece. General surgery, and otolaryngology are five years. Psychiatry, pathology, and obstetrics and gynecology are all four years.  Technically dermatology, anesthesia, neurology, opthalmology, diagnostic radiology, and radiation oncology are also four years. However, these residencies are actually three years long in their respective specialty after completing a one year preliminary year.

One might apply for a preliminary position for a few reasons. The biggest being that some advanced residencies require a preliminary year, such as those mentioned earlier. For instance, most anesthesia residencies require one preliminary year before a young doctor finishes their final three years of residency specifically training in anesthesia. The other big reason students apply for preliminary positions is as a backup. Prelim positions secure you one year’s worth of paid experience. For instance, a student might apply for both categorical and preliminary positions in their respective specialty depending on the strength of their application. Surgery is a notoriously competitive field so even a strong applicant might go unmatched. Thus, many students apply to both categorical and prelim positions in the hopes that if they don’t match into a categorical position that they will at least have one year to figure out their next move.

But a prelim spot at a program doesn’t secure you a categorical spot next year. Most residencies and programs don’t have second or third year prelim positions and you need a categorical position to finish residency. So if I apply to internal medicine only and receive a prelim spot I would be happy because I have a definite job for one more year but I would still be anxious because my future would not be certain. I would have to go through the match one more time to earn a categorical position somewhere.

If you’re looking for more information on this subject Wash U explains the basics pretty well. So do Doctors in Training (DIT). But my favorite post on this subject is from RK MD- a tech savvy anesthesia resident.


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