Yes there are residents that don't show up for one reason or another. Some are legitimate and some are BS.
http://forums.studentdoctor.net/showthread.php?t=180747
Interesting question that I haven't seen posted before. Guess I can reveal this information now that I am five months away from finishing.
Chief resident:
Job description: Leader, innovator, scheduler, full time pinch hitter, administrative assistant, human juggling act, counselor, mother/father, brother/sister, bastard/bitc*, and enforcer.
Benefits: Nice ribbon on your resume. Jobs come looking for you. Almost automatic interview when they know you are chief. Automatic fellowship placement if you go that route. Faculty appointment if you so desire.
Detractors: Time, TIME, T I M E. You spend at least 2-3 hours each day answering pages and e-mails, putting out small fires, hunting down wayward residents, sitting on important but numerous committee meetings, planning schedules two months in advance, planning out the yearly schedule at the beginning of the year which you will then change at least three dozen times due to maternity/paternity leave, poor resident performance, family tragedies, personality conflicts, etc. Someone doesn't show up for any reason then you are there to take their place. Educational planning meetings, residency review committees, multispecialty chief residents' conferences, residents' meetings, etc. are all part of your year. You spend more time being chief than reading for the most part and if you are married with kids, you aren't going to be a very good spouse/parent for that year.
Many of you have asked me how and why I respond so quickly to questions and the answer is easy: I am always on the computer checking e-mail and charting out schedules for multiple clinical sites at nine different hospitals.
The job hunt becomes a lot easier, however, and I had people contacting me as well as myself initiating contact. California, Arizona, Washington state, Oregon, and Texas were my acceptable destinations and I interviewed at more than a dozen sites including some who had previously published that they were not hiring this year. One friend of mine is still not talking to me after she found out I interviewed and was offered by a group that she had been trying to get into since before she started residency. Some groups even stated flatly to me that they only hire chief residents for their groups (a little pompous and shortsighted in my opinion, but whatever floats your boat).
So does it help? Definitely. Should you campaign to get the position? Hell no. Every resident should work with the diligence and enthusiasm that would make them candidates for the position, but what will separate you from the pack is your willingness to go the extra mile and help your fellow residents and program whenever there is a need and even when there isn't a need. Recognition comes through merit and service, not backstabbing, politicking, or machinations. I have seen a couple of people in other residencies do the latter and claim the position but all that does is create a chief resident without the ability or backing of the residents to lead.
I always wanted to help and do extra work because I loved the extra opportunities to gain experience and even just watch other people in action to learn their secrets. You can also separate yourself from the pack by being lazy, showing up late, not being prepared, and having a me first/the world is against me attitude. YOU CANNOT JUST TURN OFF LAZINESS AND SUDDENLY BECOME AN ACHIEVER. You slack off early in your residency and not only does it become hard to deviate from your wayward path, but it is also hard to shake off the label of lazy/stupid/dangerous resident.
For our institution, the residents and faculty each vote and the top two vote getters become chief, although the chairman holds veto power if he feels a candidate isn't academically well positioned to handle the spot or for any reason he feels a person should be disqualified from holding the position.
Would I do it again?
Yes I would. It's been the most taxing year of my life trying to be a full time spouse, father, chief, clinical resident, and job seeker, but if this experience coupled with an already deep educational residency hasn't prepared me for what lies ahead, I don't know what else could.
