In keeping with the apparent time-honored tradition of making my SDN debut with a question, I present the following conundrum:

I am a second year IM resident at a second-tier TX program applying to a not-very-competitive fellowship (Pulm/CC) at some pretty competitive programs. I think I'm probably a pretty strong candidate, though I've been wrong once or twice before. :rolleyes:

I have been hearing increasingly frequent and loud rumors that I will be asked to be chief resident. I always thought I'd like to be a chief, but at this program, I'm not so sure. The chiefs don't run morning report, they don't attend in clinic, and they only attend on the wards as weekend or vacation coverage for the faculty (i.e. teaching opportunities low). Furthermore, several curriculum and schedule changes have come down in the last year or so that have been adverse for residents and that we have tried to alter through our advocates and faculty liaisons, the chiefs. This was quite unsuccessful, leading the residents to recognize that here, the chiefs have no real influence to advocate for the residents. Really, all they do is make the schedule.

Lastly, I'm kinda tired of living in Texas and am ready to move on.

I'd be more than happy to delay my career plan in order to be a chief if I could do good things for the residents and the program, but I don't get the impression that I can. So what do y'all (ha ha) think - is just the title of Chiefdom enough of a gold star that I'd be a fool to turn it down? Do I need it to be competitive for my dream fellowship?

...
I'd be more than happy to delay my career plan in order to be a chief if I could do good things for the residents and the program, but I don't get the impression that I can. ....

Wanting to do a CR for that reason is admirable, but probably not a good enough reason. It's too risky to invest a year with that goal in mind, as there is too high a risk of failure. In this case, the high risk isn't even justified by high rewards if you are successful. While there has to be some sense of wanting to do "good" for the greater benefit, the reasons for doing a CR need to be more narcissistic. Yes, you need to be a little selfish and think about yourself first (a hard thing to do if you don't have this natural tendency). What are YOU going to get out of the year? What do YOU want to personally accomplish in terms of professional growth--as examples, do you want to develop leadership skills, organizational skills, do you want to focus on your own medical skills and become a supremely confident and better doctor, or maybe do you want to complete a clinical research project? If you want to get those sorts of things out of your CR (N.B., these are only examples of more personal goals), then the year could be worth it and the best year of your professional life/education.