Between medical internship and residency: positions, external shifts, and what to do in the meantime

## Introduction

You have finished internship and have a license, but that does not mean residency begins tomorrow. Waiting several months is common: there are funded positions, admissions committees, external shifts, and many things nobody explains in an orderly way. This is a guide to the uncertainty between internship and residency, the options available, and using the time well.

## What is a position (and an HMO-funded position)?

A position is funded employment for a resident or physician in a department. A department may have candidates it wants, but it still needs an open funded position to employ them. Departments may know a position will become available when someone leaves, goes abroad, or retires; waiting months is therefore common, including in less sought-after departments.

Some departments offer an HMO-funded position, paid by the health fund rather than the hospital. That can allow residency to begin without waiting for a hospital-funded opening, if the department wants you. The trade-off is usually time that must be returned: after residency, you have to work for the HMO for several years.

## How do you get accepted to residency?

Each department works somewhat differently. The process almost always starts with an internship elective: it is your first date with the department. For a month, you can show how you work professionally and how you fit socially. At the end, set a meeting with the department head and clearly state your interest.

That conversation may itself be the admissions interview, and the department may tell you that it wants you but only has a position in several months—or may not know when one will open. More commonly, you will be directed to a future admissions committee, often held only when positions are expected to open. Many departments expect external shifts during this period, sometimes as a prerequisite. Residents’ opinions also often carry a great deal of weight, so social fit matters alongside the professional side.

## Admissions committees

Many departments require a formal admissions committee, usually an interview or several short interviews with the department head, a senior doctor, and the chief resident. It is rare to be asked medical questions about the specialty. The point is mainly to understand who you are, your ambitions, whether you plan research, and why you chose that department. Be ready to explain every item on your CV.

## External shifts

External shifts are shifts you do as a doctor after internship and before residency. Their character depends on the specialty: sometimes you are an extra pair of hands, and sometimes you fill the role of a junior on-call doctor. They help you get to know the department, let the department get to know you, demonstrate commitment, and build experience in the field.

They do not guarantee admission. You might do them for months, or even a year, and not be accepted. Before starting, define how long you are willing to invest in one department; find out how long other residents did external shifts before acceptance; ask whether there is a real prospect of a committee and positions; and, if your schedule allows, consider shifts at more than one department rather than putting all your eggs in one basket. Treat the experience as an opportunity with a clear expiry date: it gives you experience, connections, and a real test of whether you enjoy the field, even if you ultimately choose another department or specialty.

## What to do during the waiting period

The schedule can be relatively open, even if you do some external shifts. Clinical work can include general-physician roles in urgent-care centers, sometimes emergency-room shifts, and doctor-at-home services. These can provide income, experience, and confidence before residency.

Other options include teaching at places such as simulation centers or nursing schools. Professionally, update your CV and LinkedIn; begin research in a department that interests you; keep in touch through research, projects, or residents; attend specialty conferences; and develop useful skills, such as point-of-care ultrasound when relevant, statistics for research, or public speaking. The flexibility also makes room for family time and hobbies before the more demanding period of residency begins.