Chief Resident Question???

[SCER2005]

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This has probably been asked before in a much more eloquent way, but cut me some slack. Are there any benefits to being chief, especially for someone with no aspiration to venture into academic medicine or administration? Sure, there is the completely meaningless title, perhaps a trip to a conference, and the near worthless addition to a CV. However, it seems vastly outweighed by the added work and hassle. At my program, it seems like the position should be renamed the schedule resident instead. We could all just take turn making a schedule for a month or two each and do away with the "white elephant" title.

Are there any added incentives to you guys out there across the country? Here we work the same number of shifts for the same pay as the other 3rd years. There is the opportunity to go to an added paid conference. Days off are not infrequently interrupted with scheduling or administrative crises.

Don't get me wrong, I'm all for doing my share of the work, but it seems silly to try to get to the front of the "more work, same compensation line". Are my views so skewed. Pardon the rant, but I'd really like to hear what you guys might have to add.

 

[GeneralVeers]

Chief responsibilities vary between residencies. At King/Drew our chiefs used to get an extra $100 per month as a "chief bonus". At Jacksonville, the chief would actually get their own office!

At almost all residencies the chiefs make the E.D. schedule. This has certain obvious advantages, unless you're the altruistic sort.

The chief also has responsibilities to attend joint practice meetings, QI, and M&M.

Finally the chief is often responsible for "disciplining" residents. If other residents are late/lazy on shift, they often have the power to assign extra shifts if necessary.

 

[EctopicFetus]

Also they tend to work fewer shifts for the time they put into other things.

 

[Haemr Head]

I suppose this is a skewed and aged perspective, but I think the reasons for being a chief resident are different than the perks of the job. Unless you are from the Scrubs school of thought “I became a doctor for the same four reasons everybody does: chicks, money, power, and chicks.” some of the reasons that made you decide to be a doctor are the same that apply to the chief residency. Those include the joy of helping others, making things better for your community, giving something back, and grabbing as much experience and variety as life will give you.


But there are perks. A chief resident should receive added compensation and protected time. The role should include some educational benefits as well. However, even when there is no protected time or increased income, it is still worth it.
1. The scheduler controls the schedule. This doesn’t mean you will make an unfair schedule but it is definitely a good thing.
2. Your ability to land a job is substantially enhanced. When I recruit for an open position in an academic or a community shop, a year as chief resident is a major plus in whom I invite and hire. The job market is getting tighter every year and it is already very tough to get jobs in good shops in good locations. The best spots go to the best residents.
3. You will develop enhanced mentorship from your faculty both during your training and after.
4. Unless you get a job in a department where you are viewed as a CRGU (clinical revenue generating unit), you will probably end up sharing some administrative work. You never can really predict what you will want 5 years from now, so it is always a better to give yourself the broadest possible skill set.

 

[Jimmy1]

How are Chiefs selected? And on that same note, how can a resident increase their chances of being chosen for the position?

 

[EctopicFetus]

How are Chiefs selected? And on that same note, how can a resident increase their chances of being chosen for the position?

Question #1 - Depends on the program. Usually by faculty. I have heard of a program where this is based solely on your inservice scores. I think that is a croc of you know what, but to each their own and thats the only objective measure I can think of.

Question #2 - Be a leader help out, make positive changes, be strong clinically.

 

[GeneralVeers]

MLK picked chiefs almost exclusively based on inservice scores. If the rumors are true, gender and race played a big part as well.

Most programs take a more balanced approach, combining inservice scores, academic performance, clinical performance, and votes from other residents.

 

[turtle md]

My program gives the residents a vote. Then they tally all the votes from us, the faculty, the clerical and nursing staff, toss them in a big pile, and in the end, I suspect, the PD just picks whomever he wants. But at least we get the illusion of choice... 😀

 

[roja]

there is absolutely no one awnser to this.

There is so much variation between program to program that when you interview you have to ask.

Even within our program, the role of chief has changed dramatically from one of little responsibilities (outside of the scedule) to one of huge responsibilities.
Now our chiefs not only do the scedule, they scedule all conferences/lecturers, they give chief rounds, the do tons of administrative stuff, they have to meet weekly with the residency director. They must attend certain meetings. Etc ETc. They get protected time, but like all things academic, protected time does not equal all the extra work you are getting.

So our chiefs do a ton. Every year we have a few residents who put out definate "I do NOT want to be chief" emails because they know its a huge amount of work.

 

[deleted109597]

I will say that the ability to be chief in EM is much nicer than being chief in Peds. For some asinine reason, being chief resident in peds requires a PGY-4 year, instead of just making it part of your last year like medicine, EM, surgery, etc. Can't say that this doesn't have an effect on who they get to be chief, but the salary difference is pretty big.

 

[NinerNiner999]

IMHO, if you are aspiring to an academic appointment, being a chief resident will help you. If you are lookinf for work in the community, it won't matter as much, but it may give you an edge in competitive markets. Our field is expected to remain open for many, many years into the future, which means being a chief is not a necessity.

Of course, if your goal is to become a director or administrator in the community, this will help you. Then again, anyone with an interest in administration or directorship will get the job if they want it...

 

[Apollyon]

I will say that the ability to be chief in EM is much nicer than being chief in Peds. For some asinine reason, being chief resident in peds requires a PGY-4 year, instead of just making it part of your last year like medicine, EM, surgery, etc. Can't say that this doesn't have an effect on who they get to be chief, but the salary difference is pretty big.

In most places, IM chief residents are PGY-4 (or beyond, like at Duke, JHH, or Harvard places).

 

[roja]

IMHO, if you are aspiring to an academic appointment, being a chief resident will help you. If you are lookinf for work in the community, it won't matter as much, but it may give you an edge in competitive markets. Our field is expected to remain open for many, many years into the future, which means being a chief is not a necessity.

Of course, if your goal is to become a director or administrator in the community, this will help you. Then again, anyone with an interest in administration or directorship will get the job if they want it...

I think this is a grave misconception. Because the variability of chief responsibilities, I don't think it helps you as much. The only caveat being, that if as chief, you are doing things that you can put on your CV.

In the end, the title can be meaningless. Your CV is NOT. I know several non-chiefs who have incredibly impressive CV's.... one matched to a phenomenally competitive fellowship, the other was offered an assistant directorship position at a good hospital (and this was not a desperate offer on thier part... his cv is stacked with CQI projects, ed management stuff, billing stuff, etc etc.)

Just like the 'named school/program' issue, it doesn't have that much meaning. The proof is in the pudding.

Your CV is what is most important and LOR's. Not your titles.


And as an aside, if you really want an academic position, fellowship will trump chief most of the time... both probably even better... 🙂 but again, only if you produce something🙂

 

[Haemr Head]

I think this is a grave misconception. Because the variability of chief responsibilities, I don't think it helps you as much. The only caveat being, that if as chief, you are doing things that you can put on your CV.

In the end, the title can be meaningless. Your CV is NOT. I know several non-chiefs who have incredibly impressive CV's.... one matched to a phenomenally competitive fellowship, the other was offered an assistant directorship position at a good hospital (and this was not a desperate offer on thier part... his cv is stacked with CQI projects, ed management stuff, billing stuff, etc etc.)

Just like the 'named school/program' issue, it doesn't have that much meaning. The proof is in the pudding.

Your CV is what is most important and LOR's. Not your titles.


And as an aside, if you really want an academic position, fellowship will trump chief most of the time... both probably even better... 🙂 but again, only if you produce something🙂

IMHO:

Fellowship works for academics only when the department is looking for a specific skill set (ultrasound, sports medicine, toxicology). The only fellowship that would be attractive for a general academic spot would be a good research fellowship. I'm also worried that the number of ultrasound fellowships that are springing up like mushrooms will quickly overwhellm the recent spike in demand.

Chief resident tells the recruiter that the applicant for the faculty position was viewed as a leader in the class , more likely to be strong clinically, that they are willing to step up to the plate to go the extra mile, and that the person has some administrative background. It's hard to put these specific facts in the CV but they are implied by the title of chief resident. It is thus seen by some as a reliable predictors of performance as faculty, academic or community. Perhaps some other faculty members will chime about the practice in their departments, but "chief resident" on the CV plays a significant role when we recruit.

I hope the job market will be open for a long time to come. I do agree there will be jobs, I just have seen access to the better departments become very restrictive in the past years. Certain locations require locum or to sign up for night shifts only just to get a foot in the door. San Diego, LA, and Denver, come to mind. At some point, we will reach a steady state and the number of graduating residents will exceed the number of new positions. The threshold may be lower than you might think. Many of the positions in EDs that are listed are rural EDs, too low in volume to support an EM specialist.

 

[WilcoWorld]

I suspect that the answer to whether being Chief is "worth it" depends largely on what one is hoping to get out of it. If what you're looking for is a few less shifts per month, better pay, and a cush schedule, than it will likely disappoint you. If you are looking for an opportunity to contribute to your department through resident recruitment, making a fair schedule, sticking up for (and, unfortunately, disciplining) junior residents, and leading by example then being Chief is one of the best ways of accomplishing this. I have a hard time believing that having been being awarded (or should I say punished with?) a leadership position will not help in your future job search. Whether having 5 publications will be worth more likely depends on who is judging, so there is no single right answer to that part of the question.

In short, if you want to be Chief for the "right" reasons than you'll probably do a good job & have a good time doing it. If you want to be Chief for the "wrong" reasons than you'll probably do it poorly and will wish you hadn't.

 

[bulgethetwine]

IMHO:

Fellowship works for academics only when the department is looking for a specific skill set (ultrasound, sports medicine, toxicology). The only fellowship that would be attractive for a general academic spot would be a good research fellowship. I'm also worried that the number of ultrasound fellowships that are springing up like mushrooms will quickly overwhellm the recent spike in demand.

Chief resident tells the recruiter that the applicant for the faculty position was viewed as a leader in the class , more likely to be strong clinically, that they are willing to step up to the plate to go the extra mile, and that the person has some administrative background. It's hard to put these specific facts in the CV but they are implied by the title of chief resident. It is thus seen by some as a reliable predictors of performance as faculty, academic or community. Perhaps some other faculty members will chime about the practice in their departments, but "chief resident" on the CV plays a significant role when we recruit.

I hope the job market will be open for a long time to come. I do agree there will be jobs, I just have seen access to the better departments become very restrictive in the past years. Certain locations require locum or to sign up for night shifts only just to get a foot in the door. San Diego, LA, and Denver, come to mind. At some point, we will reach a steady state and the number of graduating residents will exceed the number of new positions. The threshold may be lower than you might think. Many of the positions in EDs that are listed are rural EDs, too low in volume to support an EM specialist.

I understand where you are coming from with this. I subscribe more to the point of view, however, that it is the c.v. that matters. I think the difference in our perspectives is likely traceable to what the chief role really is where we had the opportunity to observe.

At my program, the chief is little else than a figurehead who is employed for cheap labor purposes (i.e. scheduling). The chief (two per year, actually) has a limited role in education (doing one or two hours of lectures a month at conference) but little else in the way of tangible experience because the residency director is very controlling. In fact, I made the conscious decision to NOT puruse the chief position so that I could do exactly those things that a "chief" would do -- freed from the time to do a schedule every month and all the other trivial headaches related to that and the few administrative jobs that would be delegated by the controlling PD, frees up a lot of time to be involved in writing projects, QI projects, involvement in various academic committees, as well as helping out during conference and other ancillary resident issues as much as possible.

That is not to say, of course, that I would have been one of the chiefs even if I wanted it. We have currently, and have had in the past, very able chiefs who were constrained in their contribution not by their skillset but by their supervisor.

I guess what I'm saying is that although I respect your point of view that someone with a chief position as part of their resume deserves a gold star when it comes to getting a job, I get a little disheartened when I hear that someone might have an edge because of the title over someone who has the substance. Hell, some programs, EVERYONE takes a turn at being chief at some point during the year.

It is, of course, possible to be a leader without begin a chief. Sometimes it takes a lot of courage to forego pursuit of a title to be able to do exactly those things that the title usually signifies.

 

[roja]

IMHO:

Fellowship works for academics only when the department is looking for a specific skill set (ultrasound, sports medicine, toxicology). The only fellowship that would be attractive for a general academic spot would be a good research fellowship. I'm also worried that the number of ultrasound fellowships that are springing up like mushrooms will quickly overwhellm the recent spike in demand.

Chief resident tells the recruiter that the applicant for the faculty position was viewed as a leader in the class , more likely to be strong clinically, that they are willing to step up to the plate to go the extra mile, and that the person has some administrative background. It's hard to put these specific facts in the CV but they are implied by the title of chief resident. It is thus seen by some as a reliable predictors of performance as faculty, academic or community. Perhaps some other faculty members will chime about the practice in their departments, but "chief resident" on the CV plays a significant role when we recruit.

I hope the job market will be open for a long time to come. I do agree there will be jobs, I just have seen access to the better departments become very restrictive in the past years. Certain locations require locum or to sign up for night shifts only just to get a foot in the door. San Diego, LA, and Denver, come to mind. At some point, we will reach a steady state and the number of graduating residents will exceed the number of new positions. The threshold may be lower than you might think. Many of the positions in EDs that are listed are rural EDs, too low in volume to support an EM specialist.

First, ditto what bulge said. What you may not be aware of is that tox and ultrasound are not the only fellowships that are out there. One of the amazing things about EM is the incredible openess of training. There is plenty of room for carving out niches through fellowships.

While I am sure peski can adress the concerns for ultrasound, the fact of the matter is that ultrasound is still incredibly needed in the vast majority of ED's across the country. ( a great sampling view of this was at this years ACEP conference during the Hoffman/Bukata review where they informally polled the 200 something attendees about who used ultrasound on an even semi regular basis. Only about 20% of us raised our hands). There is still a huge need for ultrasound people thus, more ultrasound fellowships.

I think that your assumptions about chief are only applicable in SOME programs. In fact, I have heard many ED chairs and fellowship directors state exactly the same thing: they assume that chief roles are useless unless there is something in thier CV to prove it.

In fact, the things that you site are 'assumptions' are actually things that can go on your CV... if the chief is given the time. So, just because you are chief doesn't give you any edge over someone else if you haven't put anything on your CV other that CHIEF. in fact, I would imagine that would be rather suspicious. Nor does being chief mean that you have DONE any of the things you have assumed all chiefs do. And most people know that.

Fellowship, again, is also somewhat meaningless unless you have something to show you have done work. You'd be surprised what it can mean... Even if its not an overt need. Most fellowships require production, an incredible amount of administrative stuff, not to mention 1-2 years of proven faculty experience (as an attending)... all very attractive to many programs.

While you have your 'obvious' fellowships (tox, u/s, hyperbarics) there are many others that can make you phenomenally competitive.... Critical Care, Administrative, Patient Safety, etc. I built my fellowship around research and education (with the primary focus on Education).

I began building my CV as a resident and would definately have not been able to do many of the things I wanted to do had I been chief (also because our chiefs actually do tons of stuff).

So, again, 'chief' is such a variable role and means so many different things, it doesn't gaurantee that recruiters will assume ANYTHING.

However, your CV and strong LOR, speak mounds and there is NO variation about that.

 

[Haemr Head]

I understand where you are coming from with this. I subscribe more to the point of view, however, that it is the c.v. that matters. I think the difference in our perspectives is likely traceable to what the chief role really is where we had the opportunity to observe.

At my program, the chief is little else than a figurehead who is employed for cheap labor purposes (i.e. scheduling). The chief (two per year, actually) has a limited role in education (doing one or two hours of lectures a month at conference) but little else in the way of tangible experience because the residency director is very controlling. In fact, I made the conscious decision to NOT puruse the chief position so that I could do exactly those things that a "chief" would do -- freed from the time to do a schedule every month and all the other trivial headaches related to that and the few administrative jobs that would be delegated by the controlling PD, frees up a lot of time to be involved in writing projects, QI projects, involvement in various academic committees, as well as helping out during conference and other ancillary resident issues as much as possible.

That is not to say, of course, that I would have been one of the chiefs even if I wanted it. We have currently, and have had in the past, very able chiefs who were constrained in their contribution not by their skillset but by their supervisor.

I guess what I'm saying is that although I respect your point of view that someone with a chief position as part of their resume deserves a gold star when it comes to getting a job, I get a little disheartened when I hear that someone might have an edge because of the title over someone who has the substance. Hell, some programs, EVERYONE takes a turn at being chief at some point during the year.

It is, of course, possible to be a leader without begin a chief. Sometimes it takes a lot of courage to forego pursuit of a title to be able to do exactly those things that the title usually signifies.

Got it and I agree. From now on, it sounds like what I need is a description of the chief resident year at individual programs when I screen job applicants. I know that at BWH, BIDMC, and Denver it is quite meaningful. However, it clearly can't be generalized. It's not a bad idea to query faculty and collect their impression of the value of the chief year where they trained. Somehow I feel there is a study in there somewhere.

At our program, it is a major admin/educational role running the weekly M&M conference, participating on the QI committee, advocating for the residents, and being responsible for the schedule. Although this is debated, I think that the disciplinary role should be kept to the PD and associates. I feel that the chief residents need to be the ones who every resident feels comfortable going to and can look to for protection. However, I know many people disgree with this.

The master schedule at our shop is done by the PD, not the chiefs. The selection of chief is based on clinical and academic excellence with input from attendings, residents, and nurses.. (Roja, perhaps you know Kaushal Shah at your shop who can speak to this and what a chief resident position would mean to him). For us, I would argue it is the best single criteria to judge one of our graduates.

Daily scheduling can be managed without much effort if you can get everyone to agree to have an annual schedule and correct it as needed with a back-up system for emergency swaps. It does not need to be painful if managed well up front.

 

[Haemr Head]

First, ditto what bulge said. What you may not be aware of is that tox and ultrasound are not the only fellowships that are out there. One of the amazing things about EM is the incredible openess of training. There is plenty of room for carving out niches through fellowships.

While I am sure peski can adress the concerns for ultrasound, the fact of the matter is that ultrasound is still incredibly needed in the vast majority of ED's across the country. ( a great sampling view of this was at this years ACEP conference during the Hoffman/Bukata review where they informally polled the 200 something attendees about who used ultrasound on an even semi regular basis. Only about 20% of us raised our hands). There is still a huge need for ultrasound people thus, more ultrasound fellowships.

I think that your assumptions about chief are only applicable in SOME programs. In fact, I have heard many ED chairs and fellowship directors state exactly the same thing: they assume that chief roles are useless unless there is something in thier CV to prove it.

In fact, the things that you site are 'assumptions' are actually things that can go on your CV... if the chief is given the time. So, just because you are chief doesn't give you any edge over someone else if you haven't put anything on your CV other that CHIEF. in fact, I would imagine that would be rather suspicious. Nor does being chief mean that you have DONE any of the things you have assumed all chiefs do. And most people know that.

Fellowship, again, is also somewhat meaningless unless you have something to show you have done work. You'd be surprised what it can mean... Even if its not an overt need. Most fellowships require production, an incredible amount of administrative stuff, not to mention 1-2 years of proven faculty experience (as an attending)... all very attractive to many programs.

While you have your 'obvious' fellowships (tox, u/s, hyperbarics) there are many others that can make you phenomenally competitive.... Critical Care, Administrative, Patient Safety, etc. I built my fellowship around research and education (with the primary focus on Education).

I began building my CV as a resident and would definately have not been able to do many of the things I wanted to do had I been chief (also because our chiefs actually do tons of stuff).

So, again, 'chief' is such a variable role and means so many different things, it doesn't gaurantee that recruiters will assume ANYTHING.

However, your CV and strong LOR, speak mounds and there is NO variation about that.

Allow me to retort 🙂

I agree Chief is just one criteria among many and of course the CV and other pieces of information influence the final decision. I now also agree that the value of the Chief Res year needs to be checked with specific programs, and we probably both agree that different departments prioritize differently. I think we will agree to disagree about the value of LORs. Personally a phone call with someone I know at the shop and the PD is much safer and serves the same purpose. I have lost count of the number of times I've been burned by LORs. However, chief resident from a program where I know it means something, is a very reassuring criteria and will make a difference in whom I decide to hire. This is true for many of the chiefs I know, who I have trained with, or who I have trained. Of course there needs to be more, making a decision of who to recruit just like selecting a program is a constellation of criteria.

I actually am not completely unaware about fellowships in EM. So let's have fun and address the fellowship question fully because it is quite complex.

First there are ACGME accredited fellowships:
Tox, Peds, Sports Medicine, Hyperbarics
These have an exam and a board. They are usually the most valuable in terms of income and defined place in a department and a hospital. They also have the nice advantage of receiving Medicare funding if there is a spot available However, they do restrict the nature of the future practice.

Then there are admin related fellowships:
EMS, Administration, QI. All these are helpful if you are looking for an EMS director or a QI director. Again it targets a special need. A number of academicians argue about whether these should even be called fellowships. I agree it argues for specialized training but, just as with the chief residency, there is no defined core content, no board exam, no RRC criteria, so very little to judge the value. Finally these fellowships are usually paid for by clincal work and some shops sadly exploit the fellows taking a tidy profit off the revenue they generate.

Critical care is very interesting because it should be an ACGME fellowship for EM but this development has been blocked again and again by the other specialties. With research, it is actually a fellowship that I do recruit for because of the particular nature of our shop. Even though it is not accredited for EM, it's structure is defined by a board and there is an exam for the other specialties so the training is standardized.

About ultrasound fellowships, I believe if you can't say something nice, don't say anything at all. I have recently developed a huge negative bias about these which probably reflects my own psychopathology rather than reality. I will try not to address this unless sufficiently provoked.

Research fellowships from a productive department (under Judd Hollander at Penn, of Jeff Kline at Carolinas, or at Harbor) are, IMHO, worth their weight in gold. Finally some of the more epi orientated research fellowships at the CDC or with Robert Wood Johnson make me drool.

Have I forgotten any?😀

 

[SolidGold]

Allow me to retort 🙂

Sorry, off topic, but I love that line by Samuel L. Jackson in Pulp Fiction. I even heard his voice in my head when I read that. 🙂

 

[SolidGold]

To Haemr Head: This is also a bit off topic, but I have 6.5 months of elective time over 4 years to play with during residency to possibly develop my own niche in EM, which I know probably isn't as meaningful as a truly productive fellowship. Do you think that's better served trying to spend the majority of that focusing on one niche of EM that I am truly interested in, or using it to get a more broad experience with the different niches of EM? I'm basically asking what you'd think would be more important when you read a CV. I'm leaning toward either academics or clinical teaching right now, maybe the kind of person you'd hire in a few years. 😀

 

[Haemr Head]

In general, elective time should be used to compliment your training for personal needs and explore esoteric areas of the specialty to satisfy your intellectual curiosity. I don't think it plays a major role in job recruitment and this amount of time is one of the big perks of the 4 year programs.

In terms of a job here? I worship Cincinatti training having competed against it for years and years and will always interview their grads. We hire for pure academics, community-academic hybrids, and community only. The penalty is having to live in the North East, known for the high cost of living, the low reimbursement, and the delightful weather.

 

[Haemr Head]

I did forget one fellowship: International. Since we have one, talk about being glad this forum is semi-anonymous.😱

 

[roja]

Allow me to retort 🙂

I agree Chief is just one criteria among many and of course the CV and other pieces of information influence the final decision. I now also agree that the value of the Chief Res year needs to be checked with specific programs, and we probably both agree that different departments prioritize differently. I think we will agree to disagree about the value of LORs. Personally a phone call with someone I know at the shop and the PD is much safer and serves the same purpose. I have lost count of the number of times I've been burned by LORs. However, chief resident from a program where I know it means something, is a very reassuring criteria and will make a difference in whom I decide to hire. This is true for many of the chiefs I know, who I have trained with, or who I have trained. Of course there needs to be more, making a decision of who to recruit just like selecting a program is a constellation of criteria.

I actually am not completely unaware about fellowships in EM. So let's have fun and address the fellowship question fully because it is quite complex.

First there are ACGME accredited fellowships:
Tox, Peds, Sports Medicine, Hyperbarics
These have an exam and a board. They are usually the most valuable in terms of income and defined place in a department and a hospital. They also have the nice advantage of receiving Medicare funding if there is a spot available However, they do restrict the nature of the future practice.

Then there are admin related fellowships:
EMS, Administration, QI. All these are helpful if you are looking for an EMS director or a QI director. Again it targets a special need. A number of academicians argue about whether these should even be called fellowships. I agree it argues for specialized training but, just as with the chief residency, there is no defined core content, no board exam, no RRC criteria, so very little to judge the value. Finally these fellowships are usually paid for by clincal work and some shops sadly exploit the fellows taking a tidy profit off the revenue they generate.

Critical care is very interesting because it should be an ACGME fellowship for EM but this development has been blocked again and again by the other specialties. With research, it is actually a fellowship that I do recruit for because of the particular nature of our shop. Even though it is not accredited for EM, it's structure is defined by a board and there is an exam for the other specialties so the training is standardized.

About ultrasound fellowships, I believe if you can't say something nice, don't say anything at all. I have recently developed a huge negative bias about these which probably reflects my own psychopathology rather than reality. I will try not to address this unless sufficiently provoked.

Research fellowships from a productive department (under Judd Hollander at Penn, of Jeff Kline at Carolinas, or at Harbor) are, IMHO, worth their weight in gold. Finally some of the more epi orientated research fellowships at the CDC or with Robert Wood Johnson make me drool.

Have I forgotten any?😀

Retort away. 🙂 its the point of a discussion board. However, the question was not WHAT fellowships, or even a laundry list of fellowships. It was raised in the context of fellowship and chiefs in the role of the market.

Obviously, there are ACGME approved fellowships. These require that there be enough 'content' specific information that is unique enough that there can be a board exam for it. I imagine at some point, Critical Care will become Board eligable. However, for now, the European boards seem to be covering the Critical Care fellows that I know. Most of them don't seem to have trouble finding jobs, both as EM attendings or as ICU attendings.

For non-ACGME fellowships, there are many. I have seen many, including my own, that are unique and are well structured. I have seen 'patient safety' fellowships and other variations of 'business' type stuff.

For obvious reasons, many departments like research fellowships because they equal grant money and prestige.

But this digresses from the OP's question. 🙂

Again, as I said, names and titles in and of themselves are meaningless. I think its much more 'money' to have a full CV and strong LOR. But that's my $ .02 🙂

 

[Haemr Head]

However, the question was not WHAT fellowships, or even a laundry list of fellowships. It was raised in the context of fellowship and chiefs in the role of the market.

First I am ignorant, now I am off subject. I guess offensive is next. It's amazing how less cordial we are online then in RL.😉

There was a message in the “catalogue” that you missed.

ACGME accredited fellowships--> meaningful in the role of the market because there is a defined curriculum and a method of validating the education. Limited because they can only be used for a limited academic purpose.

Non accredited fellowships in shops without a track record à Possibly useful because of the experience for the fellow but of very limited value in the role of the market because it is impossible to determine what it truly brings for a recruiter. These fellowships only gain meaning if you publish and show true expertise in the area. In my experience, the publishing track record of most of these is poor.

Research fellowships do equal grants, prestige, but mainly suggest the recruit can help meet one of the basic missions of an academic center, namely to actually do research and publish. Something many young academicians in our specialty feel is an unfair requirement. It’s not only about ego and dollars, it’s about what EM needs to do to validate our justifiable claim to equal status to other specialties. From a young academic department, trying to meet RRC requirements for publications just to avoid probation to a dynamic academic village that wants to explore new territory, a research fellowship is one fellowship that I agree is highly competitive in the academic job market.

I’m glad your neck of the woods is more civilized about critical care boards. Mine will only accept US board eligibility before allowing former critical care fellows to practice. Before launching into the fellowship, I would check the market by calling the ICUs to see if I would be welcome with European boards. I agree ABEM may break down the barrier any day and hopefully will have a Grandfather clause for those that have done the fellowship.

Between you and I, I figure we have about 4 cents.🙂

 

[DrQuinn]

When I interviewed for my job where I'm at, my Dept Chair said, "We tend to hire chief residents only. Its self-selection. If your program, your residents, your hospital, and your nurses "picked" you for chief resident, that's one of the best recommendations we could have." It saves them a lot of time trying to sort through the riff-raff.

There are a lot of pros and cons to being a chief. I was the very first chief resident at my new program.... I will just make the statement, that if you have no interest in being truly involved in your resident, or atleast trying to make your program "just a little bit better" than you probably shouldn't be interested in being chief resident.

Q

 

[roja]

First I am ignorant, now I am off subject. I guess offensive is next. It's amazing how less cordial we are online then in RL.😉

There was a message in the “catalogue” that you missed.

ACGME accredited fellowships--> meaningful in the role of the market because there is a defined curriculum and a method of validating the education. Limited because they can only be used for a limited academic purpose.

Non accredited fellowships in shops without a track record à Possibly useful because of the experience for the fellow but of very limited value in the role of the market because it is impossible to determine what it truly brings for a recruiter. These fellowships only gain meaning if you publish and show true expertise in the area. In my experience, the publishing track record of most of these is poor.

Research fellowships do equal grants, prestige, but mainly suggest the recruit can help meet one of the basic missions of an academic center, namely to actually do research and publish. Something many young academicians in our specialty feel is an unfair requirement. It’s not only about ego and dollars, it’s about what EM needs to do to validate our justifiable claim to equal status to other specialties. From a young academic department, trying to meet RRC requirements for publications just to avoid probation to a dynamic academic village that wants to explore new territory, a research fellowship is one fellowship that I agree is highly competitive in the academic job market.

I’m glad your neck of the woods is more civilized about critical care boards. Mine will only accept US board eligibility before allowing former critical care fellows to practice. Before launching into the fellowship, I would check the market by calling the ICUs to see if I would be welcome with European boards. I agree ABEM may break down the barrier any day and hopefully will have a Grandfather clause for those that have done the fellowship.

Between you and I, I figure we have about 4 cents.🙂

🙂 I didn't think you weren't cordial at all. You raise some great points. Just having a lively discussion with two varying points. (I think leeway is important in posts because you can't assess tone of voice or facial expressions, but I'm an artsy person so maybe that's my projection.. I'm also from the south and think that most people are being polite unless they start verbally assaulting me.... fatal flaw, maybe?)

I missed your message in the ACGME list. But I think you raise a great point.. .and maybe the different sides of the same coin? Nothing gaurantees you a spot... not a fellowship, not a chief position. all way in, but your CV is where your money is. Its the proof that you are productive and doing things. It shows *what* you will be bringing to a department. I tend to agree that the publishing (not just from fellowships but EM in general) is often lacking. (but again, its probable that this is my own personal bias about quality research)


In my current neck of the woods, there are some areas that are friendly to the european boards. In my previous woods, they are just so desperate for the care that the CC boards are good. Again, supply and demand.
But who knows!

it’s about what EM needs to do to validate our justifiable claim to equal status to other specialties

I couldn't agree more!

Regarding the nonACGME fellowships, I think that its very important to look at what and how and making sure you end up with 'product' at the end.


but wow, this is serious digression.


I think ultimately the point I was trying to make is that there is "no magic bullet". If you want to be competitive in the Acadmeic EM world, you have to show that you are offering something substantial. Research publications, projects within the hospital, educational production.

whew. now I think I went way over my .02 and need to get to Regression analysis (I love feeling stupid... ) 😀

 

[southerndoc]

When I interviewed for my job where I'm at, my Dept Chair said, "We tend to hire chief residents only. Its self-selection. If your program, your residents, your hospital, and your nurses "picked" you for chief resident, that's one of the best recommendations we could have." It saves them a lot of time trying to sort through the riff-raff.

There are a lot of pros and cons to being a chief. I was the very first chief resident at my new program.... I will just make the statement, that if you have no interest in being truly involved in your resident, or atleast trying to make your program "just a little bit better" than you probably shouldn't be interested in being chief resident.

Q

Corey Slovis at Vandy seems to highlight the fact that almost 95% of his faculty were chief residents.

 

[Haemr Head]

Since we started the thread, I've been running the question of what chief resident means with members of my group. One former grad of the Vandy program confirmed that it is a very big deal out there, with a very competitive selection process. But Roja has spelled it out nicely, the sum of all activities is the final driver, and each institution will give different meaning to the position.

 

[GeneralVeers]

What if you are an "Executive Chief" like we had at MLK? Does that give you a fast track position to CEO of the hospital?

 

[bartleby]

Like all things in life, you get out of being a chief what you put into it. Aside from whether or not the additional feather in your cap will make any difference in the job search (it is MUCH more likely to matter if you're looking to do a competitive fellowship or academics) it will have secondary benefits in your PD's recommendations if you work hard and make yourself useful. It is no doubt a good leadership training exercise. And if you do the schedule, you will get a rather interesting glimpse into the machinery behind the curtain of every emergency department. You will have just a bit more sympathy for the scheduler (and understand precisely why you should try to dodge that role in the future).

On the other hand, if you decide that you're going to spend the chief year with your feet up on your desk resting on your laurels because you've already proved yourself, you will find yourself getting a rather cold reception from your colleagues and may actually worsen your recommendations.

 

[roja]

Since we started the thread, I've been running the question of what chief resident means with members of my group. One former grad of the Vandy program confirmed that it is a very big deal out there, with a very competitive selection process. But Roja has spelled it out nicely, the sum of all activities is the final driver, and each institution will give different meaning to the position.

I guess I'll be crossing Vandy off my list. 😉

Seriously, we modelled some of our chiefs activities after some of our faculty and what they had done in thier chief residency year. Chief's rounds, etc. Chief can be an incredibly powerful position, but its not a gaurantee.

We had an attending here who really went all out for that and ended up with some poorer canidates certain positions.

I think its a potential screen but if you only hire chiefs, you might miss some great canidates who have impressive CV's and do alot.

I can't think of anymore cliche's so I'm just going to leave it at:


I just wanna position at the In-n-Out. I just hope they'll be impressed with my LOR from Chuck Norris.

 

[aliraja]

I think that there are three camps of thought amongst EM attendings on this one, each stemming from personal experience. There are the folks who were chiefs (and so think it is important), those who weren't but wanted to be (and so don't place as much value on it), and those who just didn't care (and so skipped this entire thread). We went through our selection process a couple of months ago and since I now fall in the second group I can see myself agreeing with roja... but can also see that, were I picked as one of the chiefs, I'd be nodding right along with 'ol Haemr Head.

Roja's points are good ones but stem from the fact that academicians who weren't chiefs still feel like they're good docs (and we are, damnit! 🙂 ) and so do even more to support their CVs. Now that I anticipate having more time my last year I'm going to moonlight more, travel a bunch, do a couple of prospective trials, and spend more time with the 'ol lady who is ecstatic that I wasn't picked.

On the other hand, Haemr brings up the point that chiefs have already been vetted and were likely amongst the strongest in their classes. Given the amount of work the chief year takes here, I hope that those who are put through it get something for doing it... it's a sacrifice that should be somehow rewarded and their CVs are going to take a hit that mine won't simply because of the time they'll have to spend being chief.

In the end, I think that while being chief can be great for both your program and your CV if you do it right, you can still do a lot for both if you aren't one. But then again, I'm biased. 🙂

 

[roja]

I think that there are three camps of thought amongst EM attendings on this one, each stemming from personal experience. There are the folks who were chiefs (and so think it is important), those who weren't but wanted to be (and so don't place as much value on it), and those who just didn't care (and so skipped this entire thread). We went through our selection process a couple of months ago and since I now fall in the second group I can see myself agreeing with roja... but can also see that, were I picked as one of the chiefs, I'd be nodding right along with 'ol Haemr Head.

Roja's points are good ones but stem from the fact that academicians who weren't chiefs still feel like they're good docs (and we are, damnit! 🙂 ) and so do even more to support their CVs. Now that I anticipate having more time my last year I'm going to moonlight more, travel a bunch, do a couple of prospective trials, and spend more time with the 'ol lady who is ecstatic that I wasn't picked.

On the other hand, Haemr brings up the point that chiefs have already been vetted and were likely amongst the strongest in their classes. Given the amount of work the chief year takes here, I hope that those who are put through it get something for doing it... it's a sacrifice that should be somehow rewarded and their CVs are going to take a hit that mine won't simply because of the time they'll have to spend being chief.

In the end, I think that while being chief can be great for both your program and your CV if you do it right, you can still do a lot for both if you aren’t one. But then again, I'm biased. 🙂

Lol. We are going through the process now (attendings vote as well) for our chiefs. We always have a few poeple who adamantly point out that they do NOT want to be chief.

I was a fence-person. I knew it was 'prestigious', but I had a ton of things going on and wanted to build my fellowship. Plus, I was running our Research Associate program and was managing all clinical research projects in the department while the Clinical research director was in Iraq. No way I could do all that and be chief. I also did a number of large conferences and gave lectures almost every month. Plus, the thought of sceduling gave me hives... And put fear in my heart. Its hard enough for me to do my own scedule!

I have never equated Chief with being the strongest clinician or the 'smartest'. the past few years have consistently shown in our department that the highest inservice score has not been a chief. We also give out a peer-awarded 'best teaching resident' to the seniors which also has yet to be a Chief. An odd dichotomy in my department as the chiefs are elected by the residents and attendings.

🙂

And darn it, I am good enough and people like me.

 

[roja]

Its certainly not going to hurt. 🙂


Unlike the pile stuff I need to get through. 😉

 

[southerndoc]

Since we started the thread, I've been running the question of what chief resident means with members of my group. One former grad of the Vandy program confirmed that it is a very big deal out there, with a very competitive selection process. But Roja has spelled it out nicely, the sum of all activities is the final driver, and each institution will give different meaning to the position.

Yes, it's a very big deal at Vandy. However, you must realize that Vandy is a three-year programs and their chiefs are fourth-year residents. So their chiefs spend an extra year being junior faculty. This is a more formal chief role than what a normal chief during your last year of residency is.

 

[deleted109597]

Yes, it's a very big deal at Vandy. However, you must realize that Vandy is a three-year programs and their chiefs are fourth-year residents. So their chiefs spend an extra year being junior faculty. This is a more formal chief role than what a normal chief during your last year of residency is.

Plus, if there was ever a reason not to do something one way, that reason would be because they do it that way at Vahnduhr-BILT. You have to say that nasally to get the full effect. Vandy wishes they could find a way to dig up their campus and move out of Nashville.

 

[DeLaughterDO]

And darn it, I am good enough and people like me.

I thought it was I'm good enough. I'm smart enough. And Dog-gonnit, people like me.

 

[DeLaughterDO]

Plus, if there was ever a reason not to do something one way, that reason would be because they do it that way at Vahnduhr-BILT. You have to say that nasally to get the full effect. Vandy wishes they could find a way to dig up their campus and move out of Nashville.

hahahahahahahahahahahahaha!!!

 

[Reg]

MLK picked chiefs almost exclusively based on inservice scores. If the rumors are true, gender and race played a big part as well.

Most programs take a more balanced approach, combining inservice scores, academic performance, clinical performance, and votes from other residents.

Eventhough my 'visit' at MLK was short (i.e. just 2 rotations a couple of years ago), I still keep in contact with former residents there. I agree that the inservice seemed to be over-emphasized, and the chief(s) were those who scored well. The executive chief resident was the high scorer, and the other chief(s), although scored high, were typically better clinicians overall.

But the gender and race thing...not sure about that one. There were only a handful of women in the recent past, and up until this last year or two, the chiefs were always male, and typically ethnically mixed. Persian, Hispanic, Indian, Asian, biracial.... Just investigate deeper....over the last 5-7 years. This year just happens to be an AA male as exec chief.

 

[GeneralVeers]

Eventhough my 'visit' at MLK was short (i.e. just 2 rotations a couple of years ago), I still keep in contact with former residents there. I agree that the inservice seemed to be over-emphasized, and the chief(s) were those who scored well. The executive chief resident was the high scorer, and the other chief(s), although scored high, were typically better clinicians overall.

But the gender and race thing...not sure about that one. There were only a handful of women in the recent past, and up until this last year or two, the chiefs were always male, and typically ethnically mixed. Persian, Hispanic, Indian, Asian, biracial.... Just investigate deeper....over the last 5-7 years. This year just happens to be an AA male as exec chief.

The class you're talking about had 6 chiefs! That's 6/10 who were chief residents. Their whole chief-choosing policy was insane to say the least.

 

[The Pro]

My program gives the residents a vote. Then they tally all the votes from us, the faculty, the clerical and nursing staff, toss them in a big pile, and in the end, I suspect, the PD just picks whomever he wants. But at least we get the illusion of choice... 😀

So being chief is not exactly a good thing. Lol

 

[Transmogrifier]

So being chief is not exactly a good thing. Lol

Holy six year old necro bump batman!