All hail the Chief!?!

[medlaw06]

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Hey all...I have been doing some research on scutwork about various programs that I am interested in and how well they place their people for fellowships....one of the themes that I have seen on quite a few reviews is that the Chief Resident has a better chance of getting the fellowship spot at that particular program...I have a very simple question: how's that/why?

I don't know much about Chief Residents....all I know is that they manage the academic stuff (grand rounds, etc.) and also aid in the in-coming intern selections and do interviews and stuff....some also do research....and the other thing I have heard is that they are usually 4th year residencts....true?...so what's the benefit by staying an additional year? If it is to get a better chance at the fellowship, then why not work as a hospitalist for that 1 year and make 2-3X as much and re-pay your loans instead and still "try your luck" at the fellowship?

If someone could give an unbiased (or even biased...hell any info is better than no info) info, that would be great!!

Take care!

 

[TommyGunn04]

It might be different at different places, but at Duke the chief residents are usually fellows already, who become chiefs after their first year of fellowship. We also have assistant chiefs though, and I'm not sure what year they generally are. I get the impression that they're not fellows, so maybe at Duke the ACR position is a "4th year" position like you described.

 

[AJM]

Chief selection is different depending on the program. Some programs want their Chiefs to start immediately after their residency, others will want the chiefs to have graduated from the program, take 2 years either to spend in fellowship or work as an attending and then come back as a chief. Still other programs take their chiefs who did their residency outside of their program, and are well into their fellowships.

At most places, being asked to be a chief resident is considered to be quite an honor. Usually the people who are selected tend to be some of the best residents in the program, and are considered to be the best teachers/educators. During their year of chief residency, they deal with alot of administrative stuff, but the big draw is that their primary role is the education of the residents and medical students. They lead morning report every day, organize noon conference, will hold special teaching sessions or physical findings rounds for the med students, and will also serve 3-4 months of the year as a ward attending where they can directly teach a team of housestaff. The compensation isn't nearly as good as working in private practice, but at most places they are paid more than the PGY-4 salary. I have heard of several kinds of payments for chiefs depending on the program -- for example, I have heard of chiefs making PGY-4 salary, but also getting a 20K bonus, at another program the chiefs get a 10K "discretionary fund", and at another program the chiefs make a PGY-7 salary (even if they only did 3 years of PGY training).

One of the main draws that people have to be a chief resident is that it is considered to be a very academic position, and is perfectly suited for someone interested in academic medicine who wants to make a lot of connections and get experience as an educator. Fellowship programs look very favorably on chief residents because 1. they were selected to be a chief for a reason (ie often top of their program), and 2. they tend to be more interested in academics, which is considered a plus for fellowships.

 

[medlaw06]

One of the main draws that people have to be a chief resident is that it is considered to be a very academic position, and is perfectly suited for someone interested in academic medicine who wants to make a lot of connections and get experience as an educator. Fellowship programs look very favorably on chief residents because 1. they were selected to be a chief for a reason (ie often top of their program), and 2. they tend to be more interested in academics, which is considered a plus for fellowships.

so when i start the interview trail, would it be ok to say to the person interviewing me (PD, chief, faculty, whoever) that i want to try to become chief...or does that sound a little wierd/odd/non-PC...i would like to become chief...just wondering

also....i have heard from some family members who are in medicine themselves and have done their residencies in some pretty nice places that becoiming a chief is more of a "popularity contest" than anything else...also, that "competition" for chief is less since other residents don't want to stick around for another year....true? not true?

just trying to understand....like i said, I would like to be chief but i keep hearing from friends/family that it's a waste of a year...the problem is that I can't seem to get an UNbiased opinion from anyone....thoughts?

 

[AJM]

so when i start the interview trail, would it be ok to say to the person interviewing me (PD, chief, faculty, whoever) that i want to try to become chief...or does that sound a little wierd/odd/non-PC...i would like to become chief...just wondering

also....i have heard from some family members who are in medicine themselves and have done their residencies in some pretty nice places that becoiming a chief is more of a "popularity contest" than anything else...also, that "competition" for chief is less since other residents don't want to stick around for another year....true? not true?

just trying to understand....like i said, I would like to be chief but i keep hearing from friends/family that it's a waste of a year...the problem is that I can't seem to get an UNbiased opinion from anyone....thoughts?

Well, I would definitely think it's kind of weird if you go into an interview with me saying that you want to become a chief. More because getting a chief resident position is not something people apply for or even compete for. Usually the PD will select certain individuals that they think would make good chiefs and ask them to do it. What would probably sound better would be to discuss how you are interested in academic medicine and education -- those two things are must-haves for chief residents.

As far as what the "competition" is for the chief job, it probably depends on the program and when the program decides to select their chiefs. At my program, for example, the PD asks certain residents toward the beginning of their second year to become chief residents after their 3rd year, and those chiefs are announced by October of their 2nd year. They select them so early because no one has definite plans by then or has been placed into fellowships yet. For example, one of my friends who was selected chief had just sent out applications to cards fellowships when he was asked -- he withdrew his apps soon after he accepted, and ended up applying the next year. In this program I was in, the vast majority of people (>80%) who are asked to be chiefs accept the position.

Of course, if the program waits until people are in their 3rd year to select chiefs that will start immediately after they're done with residency, then they will be stuck choosing among the few people who have no post-graduation plans. Most programs I'm familiar with are smarter than this, though, and they plan when to ask accordingly.

Personally, I don't think the chief year is a waste-- people I know who serve as chiefs get a lot out of it (from an academic/learning standpoint). No offense to your family members, but those people who think it would be a waste of time would typically not even be asked to do it in the first place, because the PD is usually aware of their resident's attitudes. They want chiefs who they know will be dedicated and enthusiastic about the job.

 

[Apollyon]

At Mt. Sinai, chiefs are PGY-4. At Johns Hopkins and Duke, the chiefs have done 1 year of fellowship. At Brigham and Women's, the chiefs come back after having done the entire fellowship (although my N for that is 1).

The ACR's at Duke are PGY-3's, or Med/Ped PGY-4's.

 

[medlaw06]

Hey AJM and Apollyon...thanks for all your input...I TRULY appreciate it...I would like to stay in academics and edumacation ...which is why I would be interested in something like that...I REALLY appreciate you (AJM) telling me that if I were to say during the interview that I wanna become Chief, it would raise some eyebrows (something which I DO NOT want to do...obviously)...On an aside, this is why I come to this site since you guys are REALLY helpful....Anyways, I will definitely tell them that I am interested in academics and education...

So, this begs the question....what should I do as an intern to show them that this is something that I want to do...how do I express that intention (in both words and actions) that could improve my chances without looking like a twit.

Also, AJM, you were mentioning in one of your previous posts that various places have various set-ups as to their chief year, and some of the other posts are evidence of that...this is something that I would be interested in knowing while I am interviewing, but it is not something that is SO critical that it would persuade/dissuade me from the program...for example, if a program has it set up that the chief comes back after 2-3 years of clinical experience, it is not as "nice/convenient" as a program in which you do it as a PGY4, but in any case. if I like the program enough, I wil still like to do my residency there...in any case, is asking a program about how their cheif residency is set up another rediculous question to ask...(I am assuming so, but could be wrong)

I know I am beating a dead horse by now, so my apologies.....but your advice is excellent and well appreciated...and I am still trying to learn the ropes...

 

[medlaw06]

Anyone?