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NP Fellowship vs. NP Residency: What’s the Difference?

NurseJournal Staff
Updated August 29, 2023
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Nurse practitioner residencies and fellowships are becoming more popular as hospitals attempt to attract top talent. Explore the differences and similarities between the two.
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When people think of residences in the healthcare field, physician residencies usually come to mind. In these programs, doctors fresh out of medical school practice care in a hospital or clinic under the supervision of an experienced physician.

But residencies and fellowships aren’t only for doctors. Postgraduate residency programs for nurse practitioners (NPs) have become increasingly popular since 2007. In fact, 38 of these programs were allowing newly qualified NPs to practice their profession in 2016.

NPs can pursue these programs after they earn their master of science in nursing (MSN) or doctor of nursing practice (DNP) degrees. Although residency and fellowships programs are not a requirement for NP qualification, they can help NPs gain experience and hone in on a specialization.

These programs are relatively new for NPs, so you may see many similarities in the way they’re described. But fellowships and residencies serve two different purposes. This guide breaks down those similarities and differences so you can choose the program best for you.

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Fellowship and Residency Program Key Similarities and Differences

Fellowship and residency programs offer postgraduate supervised training for new NPs. Residencies refer to programs where NPs can practice care within their specialization in a major field. Fellowships, on the other hand, let NPs gain even more focused knowledge and skills in a subspeciality.

Both programs include supervised work experience, and both are done in a professional setting like a hospital or private practice.

NPs can complete both of these programs after they complete their MSN or DNP degrees. Both programs allow NPs to build on the clinical experience they developed during their graduate programs.

Fellowships and residencies are often competitive, with a limited number of openings per year. They often last 12 months, although that can vary.

Despite these similarities, the two programs are also unique in many ways.

What Is a Fellowship Program?

A fellowship program provides an opportunity for NPs to specialize in something beyond their graduate school concentration. Over the course of the fellowship, NPs gain expertise working within this subspecialization. For example, an NP might enroll in a gastroenterology or nephrology fellowship program.

What Is a Residency Program?

Residencies are postgraduate programs for NPs who want to gain more clinical experience within their field. These are usually not as specialized as fellowships, but they do allow NPs to sharpen their skills.

The two have many similarities; they’re a way for NPs to carry out their initial clinical experience in a supervised postgraduate, professional setting. But they also differ. Fellowships tend to offer more niche practice settings than residencies.

Here are some common specialties for fellowships and residencies.

  • Primary care and family health
  • Geriatrics
  • Pediatrics
  • Neuroscience
  • Dermatology
  • Oncology
  • Cardiology
  • Emergency
  • Psychiatry
  • Acute care
  • Surgery
  • Palliative care
  • Gastroenterology and hepatology
  • Rural health

What to Expect During Nurse Practitioner Fellowship and Residency Programs

Since residencies and fellowships for NPs are still new in the healthcare field, you may be unsure about how these programs work. The curricula for the programs overlap but still offer distinctions.

What Happens During a Fellowship?

NPs in fellowships learn a specialized set of skills to carry out their jobs under the guidance of experienced professionals. These programs may include requirements in addition to clinical practice, including:

  • Didactic sessions
  • Specialty rotations
  • Simulation trainings
  • Direct patient care

What Happens During a Residency?

NPs who participate in residencies hone their skills by providing direct patient care. They experience on-the-job training with an intensity that they may not have received during their clinicals in graduate school. Residencies usually include other responsibilities too, such as:

  • Speciality rotations
  • Didactic sessions
  • Preceptor practice
  • Training with mentors

Nurse Practitioner Fellowship vs. Residency: Which Program Is Right for Me?

Before choosing between a fellowship or residency, first ask yourself whether a postgraduate program is the right step for you. It can help NPs gain more supervised experience, which can be a valuable option for new nurse practitioners. Both fellowships and residencies can boost newly qualified NPs’ job prospects as they begin their careers.

If you decide to pursue a postgraduate program, then ask yourself another key question: Do you want to gain general experience in your field, or would you rather develop an expertise in a specific area? If you prefer general experience, then consider a residency. If you’d rather pursue a subspeciality, then a fellowship might be the best option for you.

Frequently Asked Questions About Nurse Practitioner Fellowship and Residency Programs

Do nurses do fellowships?

Registered nurses do not necessarily do fellowships, but NPs can participate in fellowship programs. Fellowships are not required for licensure or employment. However, an NP may choose a fellowship if they wish to undergo more supervised experience before finding a full-time position.

Which comes first: residency or fellowship?

Many nurse practitioners choose to do either a fellowship or residency, not both. However, if an NP does both, they usually begin with a residency followed by a fellowship.

What specialties are common in residency and fellowship?

Some common specialities for residencies and fellowships include primary care, geriatrics, pediatrics, emergency care, acute care, and women’s health.

Is it worth doing a fellowship?

That depends on your career goals. If you wish to work in a niche field within a specialization, then a NP fellowship can help you achieve your goal. If you’d rather work in a more general field, like primary care or acute care, a fellowship may not be worth it.

Is it worth doing a residency?

Examine your career goals to determine whether an NP residency is right for you. If you feel like you’d prefer more supervised clinical experience before entering the field, then an NP residency could be worth it for you.


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Page last reviewed May 4, 2022

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